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Spasm of pelvic floor muscles as a cause of its dysfunction
Hurt, Karel ; Zahálka, František (advisor) ; Martan, Alois (referee) ; Otčenášek, Michal (referee)
Background: Currently, there are no effective therapy strategies for idiopathic, non-organic vulvodynia and dyspareunia in women. ESWT (extracorporeal shock wave therapy) is a nonsurgical/noninvasive technique widely used to treat musculoskeletal diseases, muscle spasticity, hypertonia, renal, biliary calculi and urological disorders. Aim: The goal of our work is to investigate the possibility to eliminate chronic and acute forms of pelvic pain by a non-invasive physical method. We wanted to know if the extracorporeal shock wave technique could fulfill these requirements. Study design: The prospective, randomized, double-blind, placebo-controlled studies were conducted following feasibility studies. Methods: The study 1. included 62 women with vulvodynia for at least 3 months. The women were randomly assigned to either a treatment group (n=31) or a placebo group (n=31). The patients in the treatment group received perineally applied ESWT weekly (3000 pulses each for four consecutive weeks). The position of the shock wave transducer was changed six times after every 500 pulses. Patients in the placebo group underwent the same treatment procedure, but the handpiece was provided with a placebo stand-off that disabled energy transmission. Subjective pain was evaluated by a visual analogue scale (VAS,...
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Sexuality of patients after simple and radical hysterectomy for bening or malignant gynaecologic disease
Vrzáčková, Petra ; Sláma, Jiří (advisor) ; Tošner, Jindřich (referee) ; Kubíček, Vladimír (referee)
Background: Cervical carcinoma is frequently diagnosis of young, sexually active women. Radical hysterectomy, as a basic therapeutic modality of early stages of cervical cancer, has very positive oncogynaecologic results. On the opposite site it has it's significant morbidity including bladder and rectal dysfunctions, lymphedemas, and deterioration in patient's sexual life. Methods: Data of forty one patients undergoing radical hysterectomy for cervical cancer were used for analysis, as well as data of forty nine patients undergoing simple hysterectomy for benign gynacologic disease and fifty three healthy controls Participants filled out sexual function and quality of life questionnaires before surgery and three and six months postoperatively. Results: The most important finding was statistically significant worsening in objective arousal in cervical cancer patients (p = 0,041). Also decrease in libido and higher frequency of dyspareunia was registered. Patients undergoing simple hysterectomy showed decreasing trend in sexual dysfunctions, mainly in severe dyspareunia. Conclusions: Radical hysterectomy for cervical carcinoma has a risk of arousal disorder, libido decrease and worsening of dyspareunia. Psychosexual counselling decreases frequency of early postoperative sexual dysfunctions.
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Obstetric interventions and pelvic floor disorders
Rušavý, Zdeněk ; Kališ, Vladimír (advisor) ; Roztočil, Aleš (referee) ; Mašata, Jaromír (referee)
Obstetric interventions and pelvic floor disorders - Abstract One of the principal objectives of obstetric interventions in the second stage of labor is prevention of pelvic floor trauma and associated pelvic floor disorders. The most commonly used and also most frequently discussed interventions are manual perineal protection and episiotomy. The majority of pelvic floor disorders are of subjective nature. Therefore, tools for objectification and severity quantification of these disorders are the key to reliable comparison and identification of the most effective interventions. The aim of the dissertation was to find the most effective modification of manual perineal protection, to compare two frequently used types of episiotomy regarding all pelvic floor disorders and finally to find a consensus on the most suitable instrument for anal incontinence severity assessment. Our studies concerning manual perineal protection experimentally described the direction and extent of perineal deformation during vaginal delivery. The subsequent studies on biomechanical model demonstrated that the most effective method of manual perineal protection in peak perineal strain reduction is when the fingers are placed on the perineum 6 cm laterally and 2 cm ventrally from the posterior commissure at both sides and are...
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Problems with pelvic floor during painful intercourse
Fikarová, Lucie ; Ježková, Martina (advisor) ; Čech, Zdeněk (referee)
This research bachelor's thesis deals with the issue of the pelvic floor in painful sexual intercourse. At the beginning of the theoretical part, the anatomy and kinesiology of the pelvic floor are described. The physiology and pathophysiology of pain are also outlined together with the evaluation. The thesis deals with the description of female sexual dysfunctions, summarizes the cause generating changes in the pelvic floor, which can subsequently lead to painful intercourse or impossibility of intercourse due to pain. The main part of the thesis then deals with the possibility of using physiotherapeutic methods and concepts to influence dyspareunia in musculoskeletal causes. The practical part of the thesis contains a case history of patient with dyspareunia caused by a change in the pelvic floor, its kinesiological analysis, including palpation examination of soft tissues in the pelvic area and a therapeutic plan using several methods of physiotherapy.
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Technical Aspects of the Second Stage of Labor
Karbanová, Jaroslava ; Kališ, Vladimír (advisor) ; Procházka, Martin (referee) ; Záhumenský, Jozef (referee)
Obstetrical intervantion`s goal is to normalize an abnormal or pathological course of labour. In a certain case (e.g. fetal distress) this is not fully achievable. Then the goal is to accelerate the delivery without inadequate increase of risk of maternal or neonatal trauma. The aim of this dizertation thesis was to offer an up-to-date definition and to outline a proper performance of these interventions. Therefore, it was necessary to properly and timely describe the labour layout in which the accoucheur and/or the parturient happen to occurr when an intervention is to take place. It was essential to describe the quantity of perineal loading as well as to define the main vector of perineal strain and deformation. Based on the range of this deformation it was subsequently possible to adequately describe and execute some obstetrical interventions (e.g. a variety of types of episiotomy) or to evaluate a variety of modifications by means of computational modelling (e.g. manual perineal protection) that might have so tiny nuances between each other or differences that are difficult to measure because the clinical evaluation is impossible due to interindividual imprecision or very short duration of the intervention. We described the maximum strain on the perineal surface during vaginal delivery that...
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Dyspareunia and the Treatment by Physiotherapy
Čechová, Zuzana ; Hurtíková, Ida (advisor) ; Šebek, Milan (referee)
Name, surname: Zuzana Čechová Supervisor: Bc. Ida Hurtíková Opponent: Title of bachelor thesis: Dyspareunia and the Treatment by Physiotherapy ABSTRACT: The aim of this bachelor thesis is to determine the effect of Physiotherapy through treatment of Dyspareunia in selected patients, and to provide a comprehensive overview of this diagnose. In the theoretical part described the Pelvic floor muscles from anatomical and functional view and their activity in Deep stabilizing muscles and during the coitus. Next an overview of Female sexual dysfunctions included Dyspareunia, her manifests, classification, etiology and possibilities in the treatment. The practical part contains two case reports of patients diagnosed with Dyspareunia. Both patients went through gynecological, sexuological, psychological and other checkups with negative results. Assumption in these patiens is dysfunctional Pelvic floor muscles in contraction. I aimed the therapy on notification, relaxation and correct activity of the Pelvic floor muscles, concatenations and results of the general comprehensive Physiotherapy examination. I attempted to touch the psychological aspect of the patients as well. Patients had eight intense therapies during more than two months and assigned to exercise at home. Both patients improved condition, mentally,...
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Obstetric interventions and pelvic floor disorders
Rušavý, Zdeněk ; Kališ, Vladimír (advisor) ; Roztočil, Aleš (referee) ; Mašata, Jaromír (referee)
Obstetric interventions and pelvic floor disorders - Abstract One of the principal objectives of obstetric interventions in the second stage of labor is prevention of pelvic floor trauma and associated pelvic floor disorders. The most commonly used and also most frequently discussed interventions are manual perineal protection and episiotomy. The majority of pelvic floor disorders are of subjective nature. Therefore, tools for objectification and severity quantification of these disorders are the key to reliable comparison and identification of the most effective interventions. The aim of the dissertation was to find the most effective modification of manual perineal protection, to compare two frequently used types of episiotomy regarding all pelvic floor disorders and finally to find a consensus on the most suitable instrument for anal incontinence severity assessment. Our studies concerning manual perineal protection experimentally described the direction and extent of perineal deformation during vaginal delivery. The subsequent studies on biomechanical model demonstrated that the most effective method of manual perineal protection in peak perineal strain reduction is when the fingers are placed on the perineum 6 cm laterally and 2 cm ventrally from the posterior commissure at both sides and are...
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Sexuality of patients after simple and radical hysterectomy for bening or malignant gynaecologic disease
Vrzáčková, Petra ; Sláma, Jiří (advisor) ; Tošner, Jindřich (referee) ; Kubíček, Vladimír (referee)
Background: Cervical carcinoma is frequently diagnosis of young, sexually active women. Radical hysterectomy, as a basic therapeutic modality of early stages of cervical cancer, has very positive oncogynaecologic results. On the opposite site it has it's significant morbidity including bladder and rectal dysfunctions, lymphedemas, and deterioration in patient's sexual life. Methods: Data of forty one patients undergoing radical hysterectomy for cervical cancer were used for analysis, as well as data of forty nine patients undergoing simple hysterectomy for benign gynacologic disease and fifty three healthy controls Participants filled out sexual function and quality of life questionnaires before surgery and three and six months postoperatively. Results: The most important finding was statistically significant worsening in objective arousal in cervical cancer patients (p = 0,041). Also decrease in libido and higher frequency of dyspareunia was registered. Patients undergoing simple hysterectomy showed decreasing trend in sexual dysfunctions, mainly in severe dyspareunia. Conclusions: Radical hysterectomy for cervical carcinoma has a risk of arousal disorder, libido decrease and worsening of dyspareunia. Psychosexual counselling decreases frequency of early postoperative sexual dysfunctions.
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