Seminars in reproductive medicine
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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. · Jan 2017
ReviewMedical Management of Endometriosis in Patients with Chronic Pelvic Pain.
Endometriosis is a common cause of pelvic pain in women of reproductive age. Traditional medical therapies are hormonal in nature, including estrogen-progestin contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists. ⋯ Medical treatment of endometriosis can be complex, and requires consideration of side effects, the anatomic type of endometriosis, role of surgery, current infertility or future fertility desires, and other contributors to pain (e.g., central sensitization). These factors should be discussed for each patient, to ensure personalized treatment and optimal outcomes.
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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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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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Zika virus is a mosquito-borne Flavivirus that spread rapidly through South and Central America in 2015 to 2016. Microcephaly has been causally associated with Zika virus infection during pregnancy and the World Health Organization declared Zika virus as a Public Health Emergency of International Concern. To address this crisis, many groups have expressed their commitment to developing a Zika virus vaccine. ⋯ Important to Zika virus vaccine development will be the target group chosen for vaccination and which end point(s) is chosen for efficacy determination. The first clinical trials of Zika virus vaccine candidates will begin in Q3/4 2016 but the pathway to licensure for a Zika virus vaccine is expected to take several years. Efforts are ongoing to accelerate Zika virus vaccine development and evaluation with the ultimate goal of reducing time to licensure.