Seminars in reproductive medicine
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Uterine adenomyosis can be diagnosed on ultrasonography (US) and magnetic resonance imaging (MRI) with a high degree of accuracy. Adenomyosis is a myometrial process that can appear as diffuse or focal on imaging. Diffuse adenomyosis typically causes uterine enlargement, while focal adenomyosis can mimic other myometrial lesions, such as leiomyomas. ⋯ Despite these characteristic imaging appearances, there are several gynecologic pathologies which can mimic adenomyosis and it is important to be vigilant of these when interpreting cross-sectional imaging exams. The decision to evaluate patients with US or MRI is contingent on multiple factors, including availability of the necessary technology and expertise for the latter. However, MRI appears to offer greater specificity and positive predictive value for the diagnosis of adenomyosis.
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Semin. Reprod. Med. · Jan 2017
ReviewRelating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction.
Chronic pelvic pain is a frustrating symptom for patients with endometriosis and is frequently refractory to hormonal and surgical management. While these therapies target ectopic endometrial lesions, they do not directly address pain due to central sensitization of the nervous system and myofascial dysfunction, which can continue to generate pain from myofascial trigger points even after traditional treatments are optimized. ⋯ A framework for evaluating such sensitization and myofascial trigger points in a clinical setting is presented. Treatments that specifically address myofascial pain secondary to spontaneously painful myofascial trigger points and their putative mechanisms of action are also reviewed, including physical therapy, dry needling, anesthetic injections, and botulinum toxin injections.
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Semin. Reprod. Med. · Sep 2016
ReviewKeeping the Zika Virus Out of the Assisted Reproductive Technology Laboratory.
The Zika virus (ZIKV) epidemic spreading through South and Central America, as well as several U. S. territories has created worldwide concern as the linkage between ZIKV infection and microcephaly has been established. ⋯ There are still many unanswered questions regarding the mechanism of ZIKV sexual transmission. Just as strict guidelines have been set regarding the screening and handling of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus-positive patient tissues, similar recommendations are needed to prevent contamination and inadvertent transmission within the ART laboratory.
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The emergence of the Zika virus (ZIKV) epidemic in South and Central America has ascended to the forefront of international attention. While research regarding the effects and details surrounding ZIKV in pregnancy is well underway, especially related to blood-borne transmission, less attention has been devoted to ZIKV infection in semen and questions concerning implications of ZIKV infection in men. ⋯ Furthermore, we discuss the potential for active ZIKV transmission in the United States as world travel continues to rise and the evolution and case history of ZIKV sexual transmission. We also review the current government-sponsored and reproductive society recommendations for managing sexual transmission of ZIKV and elucidate future research needs.
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Chronic pelvic pain is a condition defined by pelvic pain for more than six months which is severe enough to cause functional disability or require treatment. When pain becomes a chronic condition, it is more challenging to evaluate and treat. Chronic pelvic pain patients often have multiple factors contributing to their pain. ⋯ It is important to establish a trusting patient-physician relationship. When evaluating a female patient with chronic pelvic pain, an in-depth history and targeted physical exam can localize contributors to pain. While limited, corresponding imaging and laboratory work should also be considered.