Introduction: Elderly or menopause is one of the uterine prolapses’ predisposition; however, not every patients with the menopause suffer from uterine prolapses. It is presumed that it is caused by differences of levator ani muscle strength between patients with and without uterine prolapses. Weak levator ani contraction strength is an initial predisposition of uterine prolapses’ occurrence; thus, researchers assumed that there is an overall skeletal muscle strength weakness among patients with uterine prolapses. The overall skeletal muscle strength was represented by the gastrocnemius soleus muscle. Materials and methods: This study aimed to compare gastrocnemius soleus contraction strength between women with and without an uterine prolapse. This study is a comparative, observational analytic study with a cross-sectional approach. Results: The subjects of this study were 48 women divided into two groups: (i) menopause women with a pelvic organ prolapse and (ii) those without a pelvic organ prolapse. Measurements were done on pelvic floor muscle contraction strength (Peritron™ perineometer) and gastrocnemius soleus muscle contraction strength (hand-held dynamometer). Discussion: This study was conducted at Dr Hasan Sadikin General Hospital Bandung during September–October 2016. Statistical analysis reported that the p value results on a perinometer and a hand-held dynamometer were below 0.05 (p value < 0.05) for both groups. A correlation coefficient (r) of 0.519 was classified as the moderate category, with significant correlation results due to a p value of 0.001, α < 0.05. It is concluded that there was a significant correlation between levator ani and gastrocnemius soleus muscle contraction strength among post-menopause uterine prolapse patiets. Conclusion: Gastrocnemius soleus skeletal muscle contraction strength among women with POP was lesser compared with women without POP, and there was a correlation between pelvic floor muscle contraction strength and gastrocnemius soleus skeletal muscle contraction strength.

Objective: To study the knowledge, attitude, and practices of nurses at a tertiary center regarding cervical cancer and preventive strategies. Materials and methods: A cross-sectional survey of cervical cancer screening awareness was conducted amongst 200 nurses at a tertiary care hospital in Delhi. A questionnaire was circulated after taking informed consent. The main factors studied included risk factors, sign and symptoms, screening, and prevention strategies. Results: In the present study, 70% of the staff nurses were aware of one or more symptoms of cervical cancer. Sixty percent were aware of HPV as a causative organism and 70% were aware of one or more risk factors. An estimated 76% of respondents were aware of a Pap smear as screening method, but only 11% had a Pap smear ever. Majority of them did not know about visual-inspection screening techniques. Only 58.9% were aware of the availability of a vaccine; of them only 27% knew about the age of administration of the vaccine and 10% were aware of the vaccination schedule. Conclusion: Knowledge of cancer cervix screening and vaccination was low among nursing staff. There is a need for periodic reorientation courses and integration of cervical cancer prevention issues in their existing curriculum.

Objective: To assess the knowledge of premenopausal women belonging to different socioeconomic backgrounds, about symptoms, treatment, myths, and causes of early or late onset of menopause. Materials and methods: The cross-sectional study was conducted at the Ziauddin University hospital over a period of 8 months. A sample size of 300 was taken. Socioeconomic status was determined by inquiring about income per capita. Knowledge and perception of the premenopausal women were assessed. Data were entered and analyzed using version 20 of SPSS. Results: The upper class seemed to be highly aware of the common menopausal symptoms. Young females from the lower class had least knowledge about menopause, followed by middle class. 55% of women considered menopause to be a natural aging process rest believed that it is a clinical condition. The majority, with a negative perspective, belonged to lower socioeconomic class. Conclusion: About a quarter of Pakistanis are living below the poverty line, and since the study suggests that women from this stratum have poor knowledge about menopause, there is a great need for spreading awareness to this class. This study would help improve the quality of life of women belonging to the lower class and would eventually decrease morbidity and mortality due to the consequences of menopause. There is limited research in Pakistan about the knowledge of women regarding menopause, and the focus is diverted more towards evaluating the experience of menopause rather than perception. Adverse socioeconomic conditions are likely to leave deep imprints on psychological well-being of an individual. Hence it can be a major risk factor for the difference in opinion and perception as well as knowledge.

Aim: This study aimed to investigate the effect of chewing gum after hysterectomy on recovery of bowel functions. Design: Randomized control trial. Materials and methods: Women who underwent hysterectomy and fulfilled the inclusion criteria were divided into two groups of 80 each by simple randomization. Study group women chewed sugar free chewing gum for 30 minutes every 4 hours, starting 4 hours after hysterectomy and control group did not chew chewing gum. Both the groups received standard treatment protocol. Bowel sounds were checked every 30 minutes and record of passage of first flatus and the first evacuation time were recorded by inquiring the women. Results: Compared with the control group, women in the chewing gum group experienced a significant reduction i.e., 5.5 hours at the time of first bowel sound (p < 0.05), 5.3 hours in the first passage of flatus (p < 0.05), 10.5 hours at the time of first feeling of hunger (p < 0.05), 5.6 hours at the time of first oral feed (p > 0.05), 13.8 hours at the time of first defecation (p < 0.05) and 12.9 hours at the time of first discharge (p < 0.05).

Objectives: The objectives of the study were to screen women who have an unhealthy cervix by cytology and correlate the findings with colposcopy, and colposcopic-directed biopsies. Materials and methods: This is a prospective study conducted in the Department of Obstetrics and Gynecology in Mamata Medical College, Khammam, from October 2011 to June 2013. A total of 100 cases who fulfilled the selection criteria were included in the study. All the women enrolled in the study underwent a pap smear, colposcopy, and a colposcopic-directed biopsy. The sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate, false-negative rate, and accuracy were calculated for the Pap smear and colposcopy, with the colpscopic-directed biopsy taken as the gold standard. Results: The sensitivity and specificity of the Pap smear were found to be 54.3% and 96.2%, respectively, and those of the colposcopy were 76.1% and 96.2%, respectively. The colposcopy showed a higher sensitivity than did the Pap smear. The specificity and positive predictive value of the Pap smear and colposcopy was comparable, whereas the accuracy of the colposcopy was higher than that of the Pap smear. Conclusion: Most of the women were in the age group of 31–40 years. The most common symptom was a recurrent white discharge per vagina. Colposcopy was useful in detecting cervical intraepithelial neoplasias. Colposcopy and cytology used together in patients with cervical lesions have a higher chance of detecting squamous intraepithelial lesions/malignancy than when either procedure used alone.

Background: Hysteroscopy has been proved to have diagnostic accuracy in abnormal uterine bleeding (AUB) and helps in localizing the lesions with minimal errors. However, histopathology has been considered as the gold standard in evaluating the pathological causes of AUB. The reliability of hysteroscopy as a single procedure to manage AUB has not been explored so far. This study was carried out to evaluate the validity of hysteroscopy in the diagnosis of AUB. Materials and methods: This cross-sectional study was carried out among 50 patients diagnosed with AUB. Hysteroscopy was performed along with curettage and the tissue obtained was sent for histopathological examination. All the participants underwent diagnostic hysteroscopy and hysteroscopic-guided curettage. The hyseroscopic findings were correlated with histopathological findings. Results: We observed that hysteroscopy was an effective diagnostic tool for detecting endometrial hyperplasia, with a specificity of 93% and negative predictive value of 90.1%. As far as polyps were concerned, we observed that hysteroscopy was an effective screening and diagnostic tool of detecting polyps, with a sensitivity of 93.3% and specificity of 82.8%. Conclusion: Because the histopathological findings significantly correlated with the hysteroscopy findings, we are of the opinion that hysteroscopy may as well replace the traditional dilatation and curettage and at the same time replace invasive procedures for endometrial sampling.

Background: More awareness regarding the postmenopausal syndrome (PMS) is needed for women to leading a quality life. Postmenopausal symptoms adversely affect the life expectancy and quality of life (QoL) of women. The aim of this study was to determine the knowledge and awareness regarding the postmenopausal syndrome among women above 30 years in Quetta, Pakistan. This study was to assess the amount of knowledge women have about postmenopause, its causes, symptoms, diagnosis, treatment, and complications. Materials and methods: A cross-sectional, interview-based survey was conducted from January to September 2016. An estimated 447 women (aged above 30 years) were selected. Their knowledge about the postmenopausal syndrome was assessed by a structured questionnaire. A convenient sampling technique was used to collect data. Results: A total of 550 questionnaires were distributed, of which 447 were returned (response rate: 81%). The mean age of the respondents was 38.06 ± 6.194 years. The mean of the total knowledge score was 12.77 ± 3.910. Totally, 53.0% had adequate knowledge regarding the postmenopausal syndrome and 47.0% had a poor knowledge regarding the postmenopausal syndrome. A total of 73.5% of the respondents were aware of the age of menopause. Majority of the respondents know the causes of the postmenopausal syndrome. An estimated 45.3% knew that it can be diagnosed by a blood test. A total of 43.8% did not know about the hormone replacement therapy used for the treatment of the postmenopausal syndrome. Conclusion: The purpose of this study was to assess the knowledge among Quetta women regarding the postmenopausal syndrome, its causes, symptoms, diagnosis, treatment, and complications. This study found that the knowledge among women regarding the postmenopausal syndrome is important for improving their QoL and for managing the symptoms of the postmenopausal syndrome. The study participants showed an adequate level of knowledge about the postmenopausal syndrome; however, there were areas of knowledge that need improvement by health education. Healthcare professionals should give all the necessary information to women about the postmenopausal syndrome. The ratio of poor knowledge can be improved by raising the awareness and increasing the education level of women.

Aim: The aim of the study was to evaluate the various causes of postmenopausal bleeding and incidence of various genital tract malignancies contributing to postmenopausal bleeding. Study design: Prospective interventional study. Place and duration of study: Kanyakumari Government Medical College Hospital, Asaripallam, from January 2017 to December 2017. Materials and methods: All women attending the gynecology outpatient department with complaints of postmenopausal bleeding during the study period were included in the study. History, clinical examination, and USG pelvis were done in all cases. CT, MRI abdomen, and pelvis were done for indicated cases. Hysteroscopically directed endometrial evaluation and sampling were done for all, except carcinoma cervix, carcinoma vulva, and carcinoma vagina. Results: Of the 62 cases, 30 cases were benign, 32 cases were malignant. The most common cause of postmenopausal bleeding was a carcinoma cervix followed by an atropic endometrium. Conclusion: Postmenopausal bleeding should be thoroughly evaluated and treated since there is a higher incidence of malignant etiology.

Serous cyst adenoma is a cystic ovarian tumor containing a serous fluid and a solid-tissue component. This tumor is a benign form, presenting as a cystic unilocular or a multilocular ovarian mass with a thin wall and minimal papillary projections. Giant ovarian tumors have become rare because of the early detection of adnexal pathology with the advent of routine imaging modalities in the recent era of medical practice. In previous studies, large or giant ovarian cysts were described as cysts measuring more than 10 cm in diameter in a radiological scan or those cysts reaching above the umbilicus. In this study, we report a case of 58-year-old woman who was diagnosed with a right ovarian benign serous cystadenoma measuring 30 × 26 × 24 cm in size with a weight of 5.5 kg.

A syndrome complex consisting of didelphys uteruses, obstructed hemivagina and ipsilateral renal agenesis is one of the most complex and rare congenital anomalies of the female urogenital system. In most of the cases patients remain asymptomatic till puberty only to present with dysmenorrhea, pelvic pains, and intermenstrual bleeding or abdominal lumps in the period following menarche. We present one of the atypical delayed presentations of this syndrome at 26 years of age with dysmenorrhea and irregular vaginal bleeding. Appropriate combination of imaging, clinical examination, and hysteroscopic evaluation confirmed the diagnosis followed by appropriate surgical correction to relieve the patient of her complaints.

Background: The broad ligament is the commonest extrauterine site for occurrence of leiomyoma. Because of its rarity, it poses both clinical and radiological difficulties in differentiating against an ovarian tumor. Case description: We are presenting a rare case of leiomyoma of broad ligament in a 45-year-old female with complaints of lower abdominal lump, pain, and menstrual abnormality. On clinical examination, there was a 18-week-old firm, nontender, and mobile mass extending to the umbilicus. Ultrasound pelvis showed a large hypoechoic lesion of 17 cm × 11 cm × 10.3 cm with internal vascularity in pelvis predominantly on the left side. MRI pelvis showed similar findings. IVP was normal. Result: Laparotomy showed a huge false left-sided broad ligament leiomyoma measuring 17 × 15 cm. Histopathology confirmed it to be a soft tissue tumor-leiomyoma. Conclusion: Broad ligament leiomyomas mimic ovarian tumors on clinical and radiological examination and may pose difficulties in differentiating both. Its diagnosis is difficult on clinical and radiological features owing to its unusual presentation. Thus histopathology plays an important role in confirming its diagnosis. Clinical significance: We present this case because of its rarity and the diagnostic difficulties it posed.

Spontaneous adrenal hemorrhage (SAH) in the absence of trauma or adrenal tumor is a rare incidence. Its incidence has been reported from 0.14% to 1.1% and it usually involves the right adrenal gland. During pregnancy, unilateral SAH has been reported very rarely. We describe a case who presented to us with pregnancy-induced hypertension (PIH) and pain in the right flank region for 1 day and diagnosed as a case of spontaneous right adrenal hemorrhage and managed conservatively.