Rev Bras Ginecol Obstet
· 2026 · PMID 42110676
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OBJECTIVE: To evaluate the clinical differences in the presentation of vulvar lichen sclerosus in pre- and postmenopausal women, aiming to provide insights to improve disease management and promote the health and well-be...OBJECTIVE: To evaluate the clinical differences in the presentation of vulvar lichen sclerosus in pre- and postmenopausal women, aiming to provide insights to improve disease management and promote the health and well-being of affected patients. METHODS: This was a retrospective analytical study involving 287 women diagnosed with vulvar lichen sclerosus, conducted between January 2009 and December 2023 at Erasto Gaertner Hospital, in Curitiba, Brazil. Clinical, epidemiological, and therapeutic management aspects were assessed and compared between pre- and postmenopausal patients. RESULTS: Most cases (87%) occurred in women over 50 years of age, showing a strong association with menopause. Systemic arterial hypertension and type II diabetes mellitus were the most frequent comorbidities. Complaints of vulvar atrophy and anatomical deformities predominated among women over 50 years. Pruritus was the most common symptom in both groups, while dyspareunia was more prevalent among younger women. High-potency topical corticosteroid therapy was effective in more than half of the patients in both groups. Additionally, contrary to previous literature, 2% testosterone cream showed significant clinical improvement in the younger group. Progression to in situ neoplasia was observed in 11 cases, and progression to invasive neoplasia occurred in 6 cases. CONCLUSION: Differences in clinical presentation according to hormonal status reinforce the importance of individualized management strategies. Further studies with larger samples are necessary to optimize treatment approaches and improve quality of life for women affected by this chronic, mutilating, and often neglected dermatosis.
Hazin M, Lemos A, Andrade R
… +3 more, Gantzel L, Barbosa L, Ferreira CWS
Rev Bras Ginecol Obstet
· 2026 · PMID 41988242
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OBJECTIVE: To describe genital hiatus area, pelvic floor muscle (PFM) function, pelvic floor dysfunction symptoms and sexual function characteristics of transgender women submitted to gender-affirming surgery. METHODS: S...OBJECTIVE: To describe genital hiatus area, pelvic floor muscle (PFM) function, pelvic floor dysfunction symptoms and sexual function characteristics of transgender women submitted to gender-affirming surgery. METHODS: Six participants were included in this case series conducted in a referral hospital which treats transgender individuals in Brazil. An individual assessment was performed with sociodemographic variables, clinical symptoms, PFM function, neovaginal depth and genital distances. Two and three-dimensional translabial ultrasound were used to measure hiatal dimensions. The results were shown with absolute and relative frequencies, mean and standard deviation. RESULTS: The genital hiatus area had an average of 11.09 (SD 3.49) cm² at rest and 14.36 (SD 3.00) cm² during the Valsalva maneuver. The mean distances of clitoris-vagina, genital hiatus and perineal body were 9.30 (SD 1.57) cm, 6.60 (SD 1.43) cm and 4.00 (SD 1.90) cm, respectively. The mean vaginal depth was 9.50 (SD 3.51) cm. Most volunteers had satisfactory PFM strength and tone. Transgender women reported an increase in daytime urinary frequency (100%), nocturia (83.3%), sensation of incomplete evacuation (66.7%), straining during defecation (50%), flatal incontinence (16.6%), dyspareunia (50%) and anodyspareunia (16.6%). There were no reports of urinary or fecal incontinence, vaginal bulging, perineal pain or dysuria. CONCLUSION: This is the first study reporting genital hiatus area by translabial ultrasound in transgender women. Adequate levator hiatal area and neovaginal depth were found, preserved PFM tone and strength, preserved urinary and fecal continence, increased daytime urinary frequency, nocturia, sensation of incomplete evacuation, dyspareunia during vaginal sex and moderate vaginal sexual satisfaction.
Bastos-Silva Y, Aguiar LB, Baccaro LF
… +2 more, Pedro AO, Costa-Paiva L
Rev Bras Ginecol Obstet
· 2026 · PMID 41988241
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OBJECTIVE: Vitamin D has a direct influence on musculoskeletal health, and vitamin D deficiency is related to lower bone density and greater bone resorption and to a higher incidence of fractures. To assess knowledge, at...OBJECTIVE: Vitamin D has a direct influence on musculoskeletal health, and vitamin D deficiency is related to lower bone density and greater bone resorption and to a higher incidence of fractures. To assess knowledge, attitudes and practices regarding vitamin D and osteoporosis in postmenopausal women. METHODS: This was a cross-sectional study carried out with 260 postmenopausal women who underwent routine consultations at the menopause outpatient clinic of Campinas State University-São Paulo. Women aged 50 years or older with amenorrhea for at least 12 months were included. From an interview, sociodemographic information and health data were collected, and knowledge about vitamin D, habits related to vitamin D, and knowledge about osteoporosis were evaluated using the Facts on Osteoporosis Quiz (FOOQ) questionnaire. RESULTS: A total of 67.31% of women answered less than half of the questions about knowledge of vitamin D, 58.85% performed their day-to-day activities mostly outdoors, and 53.85% said they did not expose themselves sufficiently to the sun in their daily lives. The average knowledge score on the FOOQ was 15.83 (± 3.75). The variables education level, number of correct FOOQ answers and total self-care score were associated with the highest score for knowledge of vitamin D. CONCLUSION: Knowledge about vitamin D and osteoporosis in this group of postmenopausal women was limited. High levels of education, knowledge about osteoporosis and self-care were factors associated with knowledge about vitamin D.
da Rocha KC, Castanha EB, Elias MEM
… +1 more, da Silva CML
Rev Bras Ginecol Obstet
· 2026 · PMID 41988240
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OBJECTIVE: To evaluate the performance of HPV-based testing compared to cytology in primary cervical cancer screening. STUDY SELECTION: This meta-analysis included randomized trials comparing HPV-based screening with cyt...OBJECTIVE: To evaluate the performance of HPV-based testing compared to cytology in primary cervical cancer screening. STUDY SELECTION: This meta-analysis included randomized trials comparing HPV-based screening with cytology in women aged 20-69 with at least one year of follow-up. Studies with overlapping populations, combining screening methods, lacking outcomes of interest, or study protocols were excluded. CENTRAL, PubMed/MEDLINE, and Embase were searched on April 12, 2025. The main outcome is the detection rate of cervical neoplasia grade 2 or worse (CIN2+). DATA COLLECTION: Analyses followed Cochrane and PRISMA guidelines. DATA SYNTHESIS: A total of 1,707 articles were identified. After removing duplicate records and excluding studies according to the pre-established criteria, 24 were selected for full-text review. Finally, eight were included in the statistical analysis, totaling 414,846 patients in a per-protocol assessment. The detection rate of CIN2+ by HPV-based tests was 61% higher compared to conventional or liquid-based cytology [RR 1.61; 95% CI 1.30, 1.98; p < 0.00001]. While our findings demonstrate the superior sensitivity of HPV testing, there are concerns about potential overdiagnosis and overtreatment. The absence of defined management protocols for HPV-positive patients contributes to this challenge. Therefore, risk-stratification strategies, such as HPV DNA genotyping, are essential to optimize clinical care and reduce these risks. CONCLUSION: HPV-based screening has a greater capacity to identify cervical neoplasia than cytology.PROSPERO registry: ID CRD420251027259.
Carneiro MS, Garmes HM, Pravatta-Rezende G
… +3 more, de Mira TAA, Yela DA, Benetti-Pinto CL
Rev Bras Ginecol Obstet
· 2026 · PMID 41988239
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OBJECTIVE: To evaluate the behavior of pituitary adenomas following cessation of cabergoline (CAB) treatment, postpartum, and postmenopause, in comparison to idiopathic hyperprolactinemia (HPRL). METHODS: This retrospect...OBJECTIVE: To evaluate the behavior of pituitary adenomas following cessation of cabergoline (CAB) treatment, postpartum, and postmenopause, in comparison to idiopathic hyperprolactinemia (HPRL). METHODS: This retrospective cohort study included women with HPRL treated with CAB under three conditions: treatment for at least two years and follow-up for a minimum of one year after treatment discontinuation, postpartum, and postmenopause. The evaluated parameters included tumor size, prolactin (PRL) levels, and clinical symptomatology. RESULTS: A total of 160 women with idiopathic HPRL, micro- or macroadenomas, with symptom onset at 29.3±9.0 years, were included. Menstrual alterations occurred in 70% and galactorrhea in 63% of cases. PRL normalization occurred more rapidly in idiopathic HPRL than in tumors. However, symptom resolution required a similar time across all groups. All macroadenomas regressed to <10 mm. After CAB withdrawal, reintroduction was necessary in all macroadenomas, 53% of microadenomas, and 23% of idiopathic HPRL. Following postpartum CAB withdrawal, mean serum PRL levels increased by 300% in macroadenomas, 218% in microadenomas, and 11% in idiopathic HPRL; approximately 75% of all patients experienced symptom recurrence. Postmenopausal PRL normalization occurred in over 40% of cases. One untreated idiopathic HPRL case developed a microadenoma 12 months after menopause. CONCLUSION: HPRL presented a high recurrence rate following CAB discontinuation, regardless of tumor presence or treatment duration, with no reduction in recurrence observed after the postpartum period.
Rev Bras Ginecol Obstet
· 2026 · PMID 41988238
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OBJECTIVE: To evaluate the accuracy of neural networks and Naïve Bayes models in diagnosing ectopic pregnancy, using clinical data, hCG levels, and transvaginal ultrasound findings from a real dataset. METHODS: This was...OBJECTIVE: To evaluate the accuracy of neural networks and Naïve Bayes models in diagnosing ectopic pregnancy, using clinical data, hCG levels, and transvaginal ultrasound findings from a real dataset. METHODS: This was a retrospective cohort study based on a public dataset of 2,495 first-trimester pregnant women with confirmed pregnancy under 13 weeks, documented transvaginal ultrasound reports, and follow-up on pregnancy outcome. The cohort presented a natural imbalance (8.5% ectopic, 91.5% intrauterine pregnancies), reflecting real-world clinical prevalence. Data on risk factors, clinical symptoms, ultrasound findings, and serial hCG levels were included. The dataset was preprocessed and split into training (80%) and testing (20%) sets using stratified sampling based on pregnancy outcome to preserve the proportion of ectopic cases in both sets. The main outcome measures were accuracy, sensitivity, specificity, and F1 score. RESULTS: The neural network model achieved an accuracy of 99.4%, sensitivity of 94.6%, specificity of 97.2%, and an F1 score of 95.9%. The Naïve Bayes model showed an accuracy of 96.5%, sensitivity of 98.1%, specificity of 71.2%, and an F1 score of 82.5%. Both models were validated without evidence of overfitting. CONCLUSION: The neural network model demonstrated statistically significant superior accuracy and reliability in diagnosing ectopic pregnancy compared to the Naïve Bayes model (McNemar's test, p < 0.001), suggesting the potential of machine learning models, particularly deep learning, to enhance early diagnosis and clinical decision-making.
Schuantes-Paim SM, Ejzenberg D, Mergulhão BSB
… +5 more, de Medeiros GM, Geraldo ACN, Ferrari VT, Roza BA, Schirmer J
Rev Bras Ginecol Obstet
· 2026 · PMID 41988236
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OBJECTIVE: To map risks related to uterus transplantation. METHODS: Scoping review based on the Joanna Briggs Institute method. Were included studies published in scientific journals that described complications, adverse...OBJECTIVE: To map risks related to uterus transplantation. METHODS: Scoping review based on the Joanna Briggs Institute method. Were included studies published in scientific journals that described complications, adverse events, and risks in women who were uterine transplant recipients, living uterine donors, and newborns, infants and children born from transplanted uteri. A modified version of Failure Modes and Effects Analysis was used for data collection, and the data were quantitatively analyzed through the development of risk categories and risks rates calculation. RESULTS: In total 44 studies from 13 countries were included. Mapped 115 patients, 62 recipients, 34 donors, and 19 newborns, infants, and children born from transplanted uteri, 324 complications and adverse events across 25 risk categories. An online system (UTx Observatory) was developed. Among recipients, 77.5% received uteri from living donors, and 22.5% from deceased donors with most prevalent immunological, vascular, infectious, and prematurity risks. Recipients of deceased donor uteri had a higher adjusted risk rate. Among living donors, most prevalent risks were neurological, infectious, and urological risks. Laparotomy (76.5%) was associated with a higher adjusted risk rate than robotic-assisted surgery (23.5%) for uterus donation. Mainly risks mapped from newborns, infants, and children were respiratory, development-related, and malformations. CONCLUSION: The study and the UTx Observatory provide a foundation for developing targeted risk-mitigation strategies, shaping future studies and interventions, and informing health teams, authorities, and patients involved in uterus transplantation.Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/524UT.
Amorim CVA, de Sá LSC, Damaso ÊL
… +5 more, da Costa RA, Zaccara TA, Rehder PM, Pereira BG, Guida JPS
Rev Bras Ginecol Obstet
· 2026 · PMID 41988235
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OBJECTIVE: To develop and test an instrument in Brazilian Portuguese to evaluate KAP regarding GDM. METHODS: We developed an instrument with 22 items (10 items for practice, 4 for knowledge and 8 for attitude), which was...OBJECTIVE: To develop and test an instrument in Brazilian Portuguese to evaluate KAP regarding GDM. METHODS: We developed an instrument with 22 items (10 items for practice, 4 for knowledge and 8 for attitude), which was tested in a population of pregnant women (24 - 28 weeks) with GDM. We performed an Exploratory Factor Analysis to evaluate the items included in the instrument, the covariance among the domains evaluated by the instrument, and the robustness of the instrument. RESULTS: One hundred seventy-five participants were included in this study (mean gestational age: 25.4±7.1 weeks). The majority of them did not present adequate KAP regarding diabetes. The average knowledge score was 0.84±1.02 points; the attitude score was 32.46±2.94; and the practice score was 4.65±1.65. The model with the best robustness to evaluate KAP was composed of 3 items for knowledge, 6 for attitude, and 5 for practice. CONCLUSION: The levels of KAP regarding diabetes among Brazilian pregnant women are low. The moderate association between knowledge and practice underscores the need for targeted educational interventions within prenatal care. Implementing a specific Brazilian Portuguese instrument to evaluate KAP among this population can bring evidence regarding the dimension of the problem in the country.
Afshar BM, Dargahi R, Tabrizian S
… +3 more, Jafarzadeh M, Sarkhani S, Sarkhani N
Rev Bras Ginecol Obstet
· 2026 · PMID 41988233
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OBJECTIVE: Maternal pro-inflammatory responses have been implicated in pregnancy complications. This study examined the association of maternal serum IL-2, IL-4, and IL-13 levels with intrauterine growth restriction (IUG...OBJECTIVE: Maternal pro-inflammatory responses have been implicated in pregnancy complications. This study examined the association of maternal serum IL-2, IL-4, and IL-13 levels with intrauterine growth restriction (IUGR) and umbilical artery Doppler indices. METHODS: This case-control study was conducted at Alavi Teaching and Referral Hospital, Ardabil, Iran, from August 2024 to June 2025. Sixty singleton pregnant women (30 with IUGR and 30 with normal pregnancies) between 28-36 weeks of gestation were included. Umbilical artery resistive (RI) and pulsatility (PI) indices were assessed by a single sonographer, and serum cytokine levels were measured using ELISA. Statistical analyses (t-test, chi-square, Pearson's correlation, logistic regression) were performed with SPSS v25. The study was approved by the Ethics Committee of Ardabil University of Medical Sciences (no. 1403.049). RESULTS: Compared with controls, the IUGR group had higher IL-2 and lower IL-4 and IL-13 levels, as well as increased PI and RI (all P<0.05). Elevated IL-2 (OR=1.027; 95%CI: 1.011-1.044; P=0.001) and reduced IL-4 (OR=0.963; 95%CI: 0.929-0.999; P=0.042) and IL-13 (OR=0.978; 95%CI: 0.962-0.995; P=0.009) were independently associated with IUGR. IL-2 correlated positively, while IL-4 and IL-13 correlated negatively, with both Doppler indices (all P<0.05). CONCLUSIONS: Pregnant women with IUGR exhibited a pro-inflammatory Th1-biased cytokine profile, characterized by increased IL-2 and decreased IL-4 and IL-13, which correlated with elevated umbilical vascular resistance. These findings suggest an immunologic contribution to placental dysfunction. However, given the observational design and small sample size, causal inferences cannot be made, and confirmation in larger multicenter studies is warranted.
Rev Bras Ginecol Obstet
· 2025 · PMID 41982307
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•Differences between laser, radiofrequency (RF) and microfocused ultrasound (MFU) energy-based devices (EBD). •Indication of energy-based devices in genitourinary syndrome of menopause (GSM). •Indication of energy-based...•Differences between laser, radiofrequency (RF) and microfocused ultrasound (MFU) energy-based devices (EBD). •Indication of energy-based devices in genitourinary syndrome of menopause (GSM). •Indication of energy-based devices in urinary incontinence (UI). •What is known about the use of energy-based devices in sexual dysfunction (SD)? •Indication of energy-based devices in vulvar lichen sclerosus (VLS).
Rev Bras Ginecol Obstet
· 2026 · PMID 41815932
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OBJECTIVE: To compare the effectiveness of pixel CO laser and vaginal promestriene in treating genitourinary syndrome of menopause (GSM). METHODS: A quasi-randomized controlled trial was conducted with 48 patients. CO La...OBJECTIVE: To compare the effectiveness of pixel CO laser and vaginal promestriene in treating genitourinary syndrome of menopause (GSM). METHODS: A quasi-randomized controlled trial was conducted with 48 patients. CO Laser Group (24 patients) received 3 sessions of vaginal pixel CO laser, and promestriene group (24 patients) used vaginal promestriene daily for 14 days, then twice weekly for 3 months and 3 weeks. Patients were evaluated before and after treatment using a visual analog scale (VAS), FSFI-6, ICIQ-SF, Vaginal Health Index (VHI), and vaginal wall biopsy. RESULTS: Of the 48 patients, 22 in CO Laser Group and 21 in promestriene group completed the study. Both groups showed significant symptom reduction by VAS, with improvements in desire, lubrication, and total FSFI-6 scores. CO Laser Group had greater improvements in lubrication, orgasm, and satisfaction (p<0.001). Urinary incontinence improved in both groups (p<0.01). VHI scores increased significantly in both groups (p<0.001). Biopsies revealed improvements in collagen, glycogen, vascularity, epithelial thickness, and reduced neutrophil count (p<0.01). CONCLUSION: CO laser appears to be a viable non-hormonal alternative for treating GSM, particularly for women unable or unwilling to use hormonal therapies.
Rev Bras Ginecol Obstet
· 2026 · PMID 41815931
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OBJECTIVE: This study aimed to evaluate the hemodynamic characteristics of fetuses with isolated Aberran Right Subclavian Artery (ARSA) and compare them with a control group of normal fetuses using Doppler ultrasonograph...OBJECTIVE: This study aimed to evaluate the hemodynamic characteristics of fetuses with isolated Aberran Right Subclavian Artery (ARSA) and compare them with a control group of normal fetuses using Doppler ultrasonography. METHODS: A total of 93 fetuses were included in this prospective case-control study. Forty fetuses with isolated ARSA and 53 control fetuses with normal right subclavian arteries were analyzed. Doppler ultrasonographic parameters (Peak Systolic Velocity (PS), Pulsatility Index (PI), Resistive Index (RI), Time-Averaged Maximum Velocity (TAMAX), Heart Rate (HR)) were assessed and compared between the two groups. RESULTS: No significant differences were found in the Doppler parameters (PS, PI, RI, TAMAX, HR) between the ARSA and control groups. Furthermore, there was no correlation between gestational age, fetal weight, and Doppler parameters in either group. CONCLUSION: The study supports the hypothesis that isolated ARSA is a benign anatomical variant without significant hemodynamic impact on fetal development. ARSA cases without associated cardiac or chromosomal anomalies do not appear to affect fetal growth.
Chagas LAD, Silva LGR, de Sousa RML
… +6 more, da Silva AVADC, Barros RAJPA, Barroso FA, Pititto BA, Araujo Júnior E, Mattar R
Rev Bras Ginecol Obstet
· 2026 · PMID 41815930
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OBJECTIVE: This study investigated the association between gestational weight gain based on the new weight gain curve adopted by the Brazilian Ministry of Health for pregnant women and the risk of developing Gestational...OBJECTIVE: This study investigated the association between gestational weight gain based on the new weight gain curve adopted by the Brazilian Ministry of Health for pregnant women and the risk of developing Gestational Diabetes Mellitus (GDM). METHODS: Cross-sectional study was conducted with 104 pregnant women-52 with GDM and 52 without-matched for age, self-reported skin color, pre-existing hypertension, and family history of type 2 diabetes. Statistical analyses were performed using SPSS version 19.0. Categorical variables were analyzed using the Chi-square or Fisher's exact test, and continuous variables with the Student's t-test or Mann-Whitney U test. Two multivariate logistic regression models were applied: one using BMI and GWG as continuous variables and another using their categorical classifications. Odds ratios (OR) were calculated as exp(b), and models were adjusted for age, skin color, income, education, and family history of diabetes. A p-value < 0.05 was considered significant. RESULTS: Women with GDM reported less physical activity before (26.9% vs. 46.2% p = 0.042) and during pregnancy (17.3% vs. 40.4% p = 0.009). Regarding pre-gestational nutritional status, women with GDM showed a higher prevalence of overweight (53.9% vs. 30.8%), while obesity was more frequent among women without GDM (40.4% vs. 26.9%), although these differences were not statistically significant (p = 0.059). Women with GDM had lower median gestational weight gain (4.5 kg vs. 8.0 kg, p < 0.001) and a higher proportion exceeded the recommended values (84.6% vs. 40.4%). Excessive GWG was significantly associated with GDM: each additional kilogram gained increased the odds of developing GDM by 28% (aOR 1.28; 95% CI: 1.12-1.47, p < 0.001). CONCLUSIONS: Excessive gestational weight gain was significantly associated with GDM, underscoring the importance of monitoring maternal weight gain to prevent complications.
de Moraes MC, Argenta LDCB, Fagherazzi SL
… +5 more, Belfort GP, Dos Santos BMB, Camelo LL, da Silva LBG, Saunders C
Rev Bras Ginecol Obstet
· 2026 · PMID 41815929
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OBJECTIVE: To analyze the adequacy of gestational weight gain (GWG) and associated factors, according to the Brazilian GWG charts, and compare with the Institute of Medicine (IOM) recommendations. METHODS: This was a cro...OBJECTIVE: To analyze the adequacy of gestational weight gain (GWG) and associated factors, according to the Brazilian GWG charts, and compare with the Institute of Medicine (IOM) recommendations. METHODS: This was a cross-sectional study. Sociodemographic, clinical, and obstetric data were collected from interviews and medical records. The sample was divided into three groups according to the Brazilian charts: insufficient GWG, adequate GWG, and excessive GWG. The chi-square and Kruskal-Wallis tests were used to compare frequencies and medians, respectively, and Dunn's test was used to verify differences between groups, assuming statistical significance of p<0.05. RESULTS: Seven hundred and twenty-five women with low-and high-risk pregnancies were evaluated. Using the Brazilian charts, the prevalence of insufficient, adequate, and excessive GWG was 25.8%, 21.1%, and 53.1%, respectively. Compared with the classifications given using the IOM method, there was a lower prevalence of insufficient and adequate GWG and a higher prevalence of excessive GWG. The sensitivity and specificity of the Brazilian charts versus the IOM recommendations were 100% and 76.6%, respectively, for excessive GWG and 72.3% and 20%, respectively, for insufficient GWG. The modifiable factors related to GWG were pregestational BMI (p=0.001) and number of consultations with a nutritionist (p=0.008). CONCLUSION: Studies evaluating the Brazilian GWG charts are scarce. The Brazilian charts indicated a higher prevalence of excessive GWG than the IOM recommendations. The sensitivity and specificity of the Brazilian charts were better for excessive GWG than for insufficient GWG, using the IOM recommendations as the standard.
Tcherniakovsky M, Carneiro MM, da Cunha JSL
… +13 more, Petta CA, Lino CAPC, de Castro CLA, Schor E, Nogueira J, de Oliveira MAP, Abrão MS, Poli OB, Quintairos RA, Pearce S, Abdalla HS, Podgaec S, Silva JCRE
Rev Bras Ginecol Obstet
· 2026 · PMID 41815928
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