Gynecology and pelvic medicine最新文献

{"title":"Uterine preservation in pelvic organ prolapse.","authors":"Mirelle Dawoud, Lisa C Hickman","doi":"10.21037/gpm-2026-0017","DOIUrl":"https://doi.org/10.21037/gpm-2026-0017","url":null,"abstract":"<p><strong>Background and objective: </strong>Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life and frequently requires surgical management. Historically, hysterectomy was considered the standard approach to prolapse repair; however, increasing recognition of patient preference and advances in surgical techniques have led to greater adoption of uterine-preserving procedures. Hysteropexy has emerged as a viable alternative to hysterectomy in appropriately selected patients. This review summarizes current evidence regarding uterine-preserving surgical approaches for POP, with a focus on patient selection, surgical techniques, and comparative outcomes.</p><p><strong>Methods: </strong>This narrative review was developed through a comprehensive review of the available literature on uterine-preserving surgery for POP. Studies were selected based on relevance to uterine-preserving prolapse repair, with emphasis placed on high-quality evidence, including randomized controlled trials, systematic reviews, meta-analyses, large observational studies, and contemporary publications. Historical studies were included when relevant to the development and evolution of specific surgical techniques.</p><p><strong>Key content and findings: </strong>This review summarizes current evidence regarding uterine-preserving surgical approaches for POP, with a focus on patient selection, surgical techniques, and comparative outcomes. Available data suggest that hysteropexy provides similar short- to intermediate-term anatomic and subjective outcomes compared with hysterectomy with apical suspension. Uterine preservation is associated with decreased operative time, reduced blood loss, and, in mesh-augmented repairs, a lower risk of mesh exposure.Multiple surgical approaches are described, including vaginal, abdominal, laparoscopic, and robotic techniques, each with distinct advantages and limitations. Patient preference remains a key driver in decision-making, with many individuals favoring uterine conservation for personal, cultural, and psychosocial reasons. However, factors such as advanced prolapse, cervical elongation, and risk of gynecologic malignancy must be carefully considered.</p><p><strong>Conclusions: </strong>Overall, hysteropexy represents a safe and effective option for the management of POP, although long-term durability data remain limited. Continued research is needed to better define optimal patient selection and long-term outcomes.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"31"},"PeriodicalIF":0.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of outcomes between fertility-sparing and radical surgery in patients with pathological stage I epithelial ovarian cancer: a single-center retrospective cohort study.","authors":"Si-Yu Cao, Cheng-Yu Zhao, Yu Fan, Yu-Fei Zhang, Yi Mu, Jin-Ke Li","doi":"10.21037/gpm-2026-0015","DOIUrl":"https://doi.org/10.21037/gpm-2026-0015","url":null,"abstract":"<p><strong>Background: </strong>Fertility-sparing surgery (FSS) is increasingly considered for young patients with early-stage epithelial ovarian cancer, but evidence regarding its oncologic safety remains limited. We compared oncologic outcomes between FSS and radical surgery (RS) in patients with pathological International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer and described reproductive outcomes after FSS.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with FIGO stage I epithelial ovarian cancer who underwent FSS or RS at West China Second University Hospital from 2013 to 2021. Clinicopathological, treatment, follow-up, oncologic, and reproductive data were extracted from medical records and follow-up data. Potential confounding was addressed using multivariable Cox regression and propensity score matching.</p><p><strong>Results: </strong>Among 472 patients, 425 underwent RS and 47 underwent FSS. Before matching, patients in the FSS group were younger and had more favorable tumor features; after matching, baseline characteristics were generally balanced. In the matched cohort, FSS and RS showed no significant differences in 5-year disease-free survival (DFS; 97.1% <i>vs.</i> 87.7%, P=0.15), 5-year overall survival (OS; 97.1% <i>vs.</i> 96.1%, P=0.75), or recurrence rate (4.2% <i>vs.</i> 8.8%, P=0.53). Similar findings were observed in the overall cohort and multivariable analyses. Among 15 patients desiring pregnancy after FSS, 10 achieved natural conception.</p><p><strong>Conclusions: </strong>In this single-center retrospective cohort, FSS was not associated with significantly worse oncologic outcomes than RS in selected patients with pathological FIGO stage I epithelial ovarian cancer and was associated with favorable reproductive outcomes. Larger prospective studies with longer follow-up are warranted.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"25"},"PeriodicalIF":0.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of any surgical detail: the surgical technique of suturing the uterus during cesarean section.","authors":"Michael Stark, Antonio Malvasi, Andrea Tinelli","doi":"10.21037/gpm-2026-1-0002","DOIUrl":"https://doi.org/10.21037/gpm-2026-1-0002","url":null,"abstract":"<p><p>Cesarean section (CS) rates have risen substantially and now represent the most frequently performed abdominal surgical procedure. This increase has been accompanied by a parallel rise in operative and postoperative complications. Despite its widespread use, CS technique remains highly heterogeneous across countries, hospitals, and even among obstetricians working in the same departments. Surgical standardization has the potential to reduce complications and improve both short- and long-term outcomes. Among the most controversial technical aspects of CS are the level of the uterine incision in the lower uterine segment (LUS), the use of single- versus double-layer closure of the uterine wall, and the caliber of the needle used for suturing. These elements therefore need critical evaluation, as they are important for uterine healing, scar integrity, and outcomes in subsequent pregnancies. The level of the uterine incision is particularly important, as lower incisions involve a higher proportion of fibrous tissue and less muscular tissue, which is important for the scar tensile strength and promote optimal healing. In this article, these three components are examined, and based on clinical experience and histology knowledge, a rational, standardized surgical approach is proposed. Lower LUS incisions incorporating predominantly fibrous tissue will result in a stronger uterine scar. Single-layer uterine closure minimizes retained suture material while providing adequate mechanical support, and the use of larger caliber needles reduces the amount of the remained suture material, thereby limiting foreign-body reactions. Standardization of these aspects of CS technique may improve surgical outcomes, enhance uterine scar quality, and will enable meaningful comparisons among clinical studies.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"29"},"PeriodicalIF":0.4,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pelvic floor: myth or hype?-a narrative review.","authors":"Febe Elsayghe, Hira B Khan, Mehwash Nadeem","doi":"10.21037/gpm-2026-1-0005","DOIUrl":"https://doi.org/10.21037/gpm-2026-1-0005","url":null,"abstract":"<p><strong>Background and objective: </strong>The pelvic floor represents a complex, dynamic neuromuscular structure integral to urinary, bowel, and sexual function. Despite its fundamental role, pelvic floor dysfunction remains under-recognised in both diagnosis and management within urology and gynaecology. Traditional perspectives have often confined its clinical relevance to stress urinary incontinence (SUI), overlooking its contribution to voiding dysfunction, chronic pelvic pain (CPP), sexual dysfunction (SD), and functional bladder outlet obstruction (FBOO). This narrative review aims to examine the pelvic floor as a central determinant of functional pelvic health rather than an adjunctive consideration.</p><p><strong>Methods: </strong>A narrative literature review was conducted using PubMed and Elsevier platforms, supplemented by targeted searches of national clinical guideline repositories, including the National Institute for Health and Care Excellence (NICE). Searches incorporated Medical Subject Headings (MeSH) and free text terms related to pelvic floor dysfunction, pelvic floor muscle training, chronic pelvic pain, voiding dysfunction, sexual dysfunction and neuromodulatory therapies. English language studies involving adult populations published between January 1^st 1998 and December 31^st 2025 were included to capture up-to-date trends. Eligible sources included systematic reviews, randomised controlled trials, observational studies and clinical guidelines. A formal risk of bias assessment was not undertaken due to the narrative design.</p><p><strong>Key content and findings: </strong>Evidence demonstrates both hypotonic and hypertonic pelvic floor states are clinically significant. Pelvic floor muscle hypertonicity is strongly associated with CPP, dysfunctional voiding and dyspareunia, while reduced pelvic strength contributes to incontinence and prolapse. High-quality evidence supports supervised pelvic floor muscle training (PFMT), with or without adjuncts such as biofeedback for managing postpartum SUI. Emerging data support relaxation-based pelvic floor rehabilitation and neuromodulatory interventions.</p><p><strong>Conclusions: </strong>The \"phantom floor\" is neither myth nor a clinical afterthought but a vital foundation of female pelvic health. Standardised functional assessment pathways, multidisciplinary approach and targeted therapy are the cornerstone for appropriate management of pelvic floor dysfunctions.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"32"},"PeriodicalIF":0.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral treatment of urinary incontinence: a guideline-driven narrative review.","authors":"José Tadeu Nunes Tamanini, Juan Matheus Santana Mendes, Gabriel Pelegrina Rosseto, Ana Carolina Cucato Christianini, Leonardo Furlan Ferro, Akihiro Eduardo Hirosse, Gabriel Henrique da Silva Santana, Bruno Florindo Crispim, Débora Stefany Fernandes Guedes, Fábio Cruxatti de Lima Oliveira, Marair Gracio Ferreira Sartori, Rodrigo Aquino Castro","doi":"10.21037/gpm-2026-1-0004","DOIUrl":"https://doi.org/10.21037/gpm-2026-1-0004","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Urinary incontinence (UI) is a highly prevalent condition affecting women and men across the lifespan, with substantial clinical, psychosocial, and economic impact on quality of life, functional status, and healthcare utilization. International clinical practice guidelines consistently recommend behavioral and conservative interventions as the primary of first-line strategy for most UI subtypes, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI)/overactive bladder (OAB), and mixed urinary incontinence (MUI). This narrative review aims to critically synthesize contemporary evidence on behavioral treatment of UI, integrating international guideline recommendations with key primary and secondary literature to support optimal translation into routine clinical care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A guideline-driven narrative review was conducted based on the most recent recommendations from the European Association of Urology (EAU), the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/SUFU), and the International Continence Society (ICS). Evidence cited within these guidelines was traced to randomized controlled trials, systematic reviews, and meta-analyses. Additional PubMed-indexed studies were included to address special populations, evolving models of care delivery, and implementation barriers. The literature reviewed was published predominantly between 2005 and 2025 and limited to English-language sources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key content and findings: &lt;/strong&gt;Behavioral interventions-including pelvic floor muscle training (PFMT), bladder training, timed or prompted voiding, urgency suppression strategies, lifestyle modification, and structured patient education-demonstrate robust and clinically meaningful improvements in symptom burden and health-related quality of life across UI phenotypes. PFMT remains the central evidence-based intervention for SUI in women and post-prostatectomy incontinence in men, whereas bladder training and urgency suppression strategies are core components of UUI/OAB management. In older adults, frail individuals, and cognitively impaired populations, multicomponent and caregiver-supported behavioral programs are particularly effective and feasible. Emerging telehealth and digital delivery platforms show promise in improving access, adherence, and scalability, although long-term effectiveness and comparative implementation data are still needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Behavioral therapy provides a safe, effective, and highly adaptable foundation for UI management across diverse populations and care settings. Despite heterogeneity in study design, intervention protocols, and outcome reporting, international guidelines consistently endorse conservative strategies as first-line treatment. Future research should prioritize intervention standardization, harmonized outcome framework","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"33"},"PeriodicalIF":0.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival trends and prognostic factors of metastatic cervical cancer: a population-based cohort study.","authors":"Cheng Wang, Cai Xu, Xingchen He, Wei Wang, Rutie Yin, Jing Zeng","doi":"10.21037/gpm-2026-0009","DOIUrl":"https://doi.org/10.21037/gpm-2026-0009","url":null,"abstract":"<p><strong>Background: </strong>Metastatic cervical cancer (mCC) remains a highly lethal disease. While clinical trials support the addition of targeted therapy and immunotherapy to chemotherapy, real-world survival trends are less well characterized. This study aimed to evaluate real-world overall survival trends and prognostic factors in mCC patients over the past two decades, in the context of evolving targeted and immunotherapeutic treatments.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to evaluate overall survival (OS) trends and prognostic factors among mCC patients diagnosed between 1998 and 2019. Based on major therapeutic milestones, patients were grouped into three calendar cohorts: 1998-2003 (pre-bevacizumab chemotherapy era), 2004-2013 (chemotherapy plus molecular-targeted therapy era), and 2014-2019 (chemotherapy plus immuno-molecular targeted therapy era, after pembrolizumab approval). Kaplan-Meier and Cox regression analyses were used to assess OS and identify independent prognostic variables.</p><p><strong>Results: </strong>Among 1,866 patients with distant mCC [corresponding to International Federation of Gynecology and Obstetrics (FIGO) stage IVB], 53.5% were aged ≥55 years and 67.1% had squamous cell carcinoma (SCC). Median OS increased from 11 months in 1998-2003 to 14 months in 2014-2019 (P=0.04), while the mortality rate declined from 91.6% in 1998-2003 to 75.9% in 2014-2019 (P<0.001). Among patients with SCC, median OS increased from 13 months in 1998-2003 to 16 months in 2014-2019 (P=0.006), whereas no significant survival improvement was observed among those with non-SCC histologies (P=0.48). Multivariable analysis identified SCC histology [hazard ratio (HR) =0.764, 95% confidence interval (CI): 0.670-0.871], lymphadenectomy (HR =0.730, 95% CI: 0.602-0.886), radiotherapy (HR =0.696, 95% CI: 0.619-0.783), and chemotherapy (HR =0.508, 95% CI: 0.452-0.571) were independently associated with improved survival. While age ≥55 years (HR =1.158, 95% CI: 1.045-1.284), Black race (HR =1.339, 95% CI: 1.108-1.620), absence of surgery (HR =2.160, 95% CI: 1.788-2.610), and local surgery alone (HR =1.501, 95% CI: 1.129-1.995) were associated with worse outcomes.</p><p><strong>Conclusions: </strong>Survival for mCC has improved in the past two decades, possibly because of the advances of local therapy and systemic therapy. However, outcomes remain poor for patients with non-SCC histologies, older patients, and Black patients, highlighting the need for individualized, multimodal treatment approaches and better access to emerging therapies.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"28"},"PeriodicalIF":0.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A TikTok take on polycystic ovarian syndrome: a cross-sectional study.","authors":"Madison Caja Labroo, Sydney Luu, Chelsea Kebodeaux, Y Frances Fei","doi":"10.21037/gpm-2025-1-56","DOIUrl":"https://doi.org/10.21037/gpm-2025-1-56","url":null,"abstract":"<p><strong>Background: </strong>TikTok has rapidly become a dominant social media platform, particularly popular among younger users, with 32% of its users under the age of 20, and up to 60% female. Its ease of content creation and engagement-focused algorithm often lead to the spread of misinformation, potentially harming patients. The main objective of this study was to assess the content, reliability, and overall reach of TikTok videos made by medical professional creators <i>vs.</i> other creators about polyendocrine metabolic ovarian syndrome (PMOS), previous known as polycystic ovarian syndrome (PCOS).</p><p><strong>Methods: </strong>A TikTok scraper was used to collect the top 250 TikTok videos using the hashtag #PCOS from 2020-2023 for this cross-sectional study. Each video was by two independent reviewers to evaluate variables regarding self-reported credentials of content creator, video statistics, and video content. The modified DISCERN scale was then used to rate educational quality of each video. This study was Institutional Review Board (IRB) exempt.</p><p><strong>Results: </strong>Of the top 243 videos, 73% were from the general public, 17% from dieticians, and 10% from medical professionals. The general public and dieticians were more likely to report having PMOS/PCOS (78% and 60%) compared to medical professionals (22%) (P<0.001). Weight gain, hirsutism, and acne were the most common symptoms mentioned by creators. Dieticians more frequently highlighted sugar cravings and fatigue compared to other creators (P=0.02 and P<0.001, respectively). Medical professionals were more likely than others to mention acne and polycystic ovaries (P=0.045 and 0.004, respectively). The average DISCERN score was 1.3/5, with medical professionals' videos scoring the highest (1.7) (P=0.002).</p><p><strong>Conclusions: </strong>PMOS/PCOS is a well-known medical condition which is frequently misunderstood outside of the gynecologic community. This study finds that the majority of creators lack a medical background and frequently focus on symptoms which are not necessarily attributable to PCOS. There was overall no difference in the reach of the different types of creators, though there was a significantly smaller proportion of medical professionals compared to others. Since social media is becoming increasingly used as a source of information, especially for younger generations, medical professionals should consider investing time in understanding these platforms which can prevent the spread of misinformation.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"27"},"PeriodicalIF":0.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoamputation of pelvic adnexa: two case reports.","authors":"Jinglin Wu, Chaoyan Yuan","doi":"10.21037/gpm-2026-0018","DOIUrl":"https://doi.org/10.21037/gpm-2026-0018","url":null,"abstract":"<p><strong>Background: </strong>Parasitic ovarian teratoma is a rare consequence of chronic torsion or auto-amputation of the adnexa. Delayed diagnosis may result in a free-floating pelvic mass without identifiable adnexal tissue.</p><p><strong>Case description: </strong>Respectively, two young women (23 and 29 years) presented with ignored pelvic pain a few months ago. Both had previously self-medicated with oral analgesics without further treatment. The ultrasound revealed an isolated solid-cystic pelvic mass with absent colour Doppler signals. No normal ipsilateral ovarian or tubal tissue was visualised. Both patients had no positive findings on laboratory tests; their cancer antigen 125 (CA-125) levels were 7.81 and 11.7 IU/mL, respectively. Diagnosticlaparoscopy was performed. In both cases, the ipsilateral adnexa was completely absent; a pelvic mass was identified, extensively and densely adherent to the anterior abdominal wall and both pelvic sidewalls; after dissecting the adhesion, the mass was freed, with its surface smooth and pedicle-free. The diameters of the masses were 7cm and 8cm, respectively. Histology showed a cyst lined by mature squamous and ciliated columnar epithelium, containing hair shafts, cartilage, adipose tissue, and dilated lymphatics; no immature neural elements were seen, consistent with mature cystic teratoma. Post-operative recovery was uneventful; both patients were discharged on day 5. At the 3-month follow-up, the ultrasound showed normal contralateral adnexa and no recurrence.</p><p><strong>Conclusions: </strong>Chronic adnexal torsion can lead to complete auto-amputation and an isolated pelvic mass. High index of suspicion and early diagnostic laparoscopy are essential in young women with acute or subacute abdominal pain.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"39"},"PeriodicalIF":0.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The power of words: the role of clinician communication and language in the management of women with chronic pelvic pain through a narrative review.","authors":"Sophie Fenton, Supuni Kapurubandara","doi":"10.21037/gpm-2025-1-72","DOIUrl":"https://doi.org/10.21037/gpm-2025-1-72","url":null,"abstract":"<p><strong>Background and objective: </strong>Chronic pelvic pain (CPP) is a common symptom amongst women and poses many challenges including physical, psychological, functional and economic. Clinician language is a key component of communication and has the ability to influence the patient experience and their engagement with healthcare. The importance of language has been reviewed in relation to chronic pain generally and in specific conditions like back pain and migraine, for its role in reducing stigmatisation and facilitating seeking care. This review discusses the current landscape of qualitative data pertaining to women with CPP and their perceptions of clinician interactions, communication and language. This research is pertinent given the prevalence of women with CPP holding negative perceptions of healthcare and an apparent need to prevent disengagement with practical recommendations.</p><p><strong>Methods: </strong>A narrative review was conducted using MEDLINE and Embase from 1990 to 2025 to identify qualitative research pertaining to this topic. Studies were selected based on relevance, inclusion and exclusion criteria. Existing qualitative studies that looked at the experiences of women with CPP and the role of clinician communication and language were analysed in the findings.</p><p><strong>Key content and findings: </strong>The literature search found 14 qualitative studies that explored the healthcare experience of women with CPP. There were no studies that adequately targeted perceptions of clinician language including analysis of specific words, terms and phrases. The review revealed studies which explored women with CPP's experiences of clinician communication more generally, including reports they feel their pain was normalised and dismissed. There was a clear desire for the validation of symptoms from clinicians, even in the absence of a definitive physical pathology.</p><p><strong>Conclusions: </strong>Women with CPP have lives associated with significant psychosocial and economic impact. Negative healthcare experiences are a commonly reported issue. Language used can be influential in the patient experience and engaging with healthcare. There is an unmet need in the literature for more targeted analysis of clinician language including the preferences and aversions of women with CPP. Such guidance will optimise an often negative and lengthy diagnostic journey by enhancing patient engagement and empowerment.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"36"},"PeriodicalIF":0.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gynecologic management of cervical cancer patients undergoing immunotherapy: an up-to-date narrative review.","authors":"Henrique Delgado, Caio Lopes, Gledison Queiroz, Pedro Henrique Lima, Carol Lemos, Henrique Cardôso, Mateus Mota, Renata Oliveira, Ingrid Oliveira, Renato Paulino, Fabrício de Melo","doi":"10.21037/gpm-2025-1-74","DOIUrl":"https://doi.org/10.21037/gpm-2025-1-74","url":null,"abstract":"<p><strong>Background and objective: </strong>Cervical cancer (CC) remains a significant global health challenge, especially in low and middle-income countries. The advent of immune checkpoint inhibitors (ICIs), such as anti-PD-1/PD-L1 agents, has introduced promising therapeutic options for advanced and recurrent cases. However, gynecologic management during immunotherapy is poorly characterized, particularly regarding structured pre-treatment evaluation, integrated oncology-gynecology surveillance, timed contraception and fertility preservation, management of immune-mediated genital-tract fistulas (GTFs), and evidence-based approaches to pregnancy planning and endocrine dysfunction. This narrative review synthesizes evidence on gynecologic management of CC patients receiving immunotherapy, clinical decision frameworks, and identifies knowledge gaps requiring further investigation.</p><p><strong>Methods: </strong>A structured search was performed in PubMed, Web of Science, and the Cochrane Library (January 2015-October 2025) using MeSH terms and keywords for cervical cancer, immunotherapy, ICIs, gynecologic management, and fertility or pregnancy. Only original articles, case reports, guidelines, and reviews in English or Spanish were included. References were supplemented by artificial intelligence (AI)-based retrieval using SciSpace, OpenEvidence, and Perplexity Pro; deduplication ensured AI-derived citations were only retained as \"AI-supplementary\" when not present in database searches. ChatGPT-5 Thinking was applied solely for English translation and technical editing, with no generative content added to scientific findings.</p><p><strong>Key content and findings: </strong>While ICIs (e.g., nivolumab, pilinumab, tisotumab, pembrolizumab, cemiplimab) have improved outcomes for advanced or metastatic CC, specific guidance for gynecologic management remains limited. Findings show that standard gynecologic screenings [human papillomavirus (HPV), cytology] proceed unchanged but should be aligned with oncology visits. Fertility preservation, via oocyte/embryo cryopreservation, and highly effective contraception are essential before, during, and after therapy. ICIs are discouraged during pregnancy; if pregnancy is detected, treatment should be interrupted. Proactive surveillance for immune-related adverse events (irAEs), including the emerging risk of GTF is crucial, especially within the first 6-8 weeks.</p><p><strong>Conclusions: </strong>Immunotherapy advances care for recurrent/metastatic CC but gynecologic management remains insufficiently addressed. Evidence for fertility counseling, reproductive monitoring, and managing gynecologic irAEs is fragmented. This review underscores the need for interdisciplinary oncology-gynecology coordination, clearer practice protocols, and future research focused on women of reproductive age undergoing ICIs.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"35"},"PeriodicalIF":0.4,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}