Both intensive supervised PFMT and unsupervised PFMT are effective to treat female SUI if training session is provided.

Angiotensin (Ang)-(1-7) is one of the major active components of the renin-angiotensin system, produced from cleavage of Ang II by angiotensin-converting-enzyme type 2 (ACE2), which acts through a specific G protein-coupled receptor, Mas. We have investigated whether the human endometrium expresses these components during menstrual cycle. By radioimmunoassay, Ang-(1-7) was detected in endometrial wash fluid at picomolar concentrations. Using immunofluorescence, both the peptide and its receptor were identified in cultured endometrial epithelial and stromal cells. By immunohistochemistry, Ang(1-7) was localized in the endometrium throughout menstrual cycle, being more concentrated in the glandular epithelium of mid- and late secretory phase. This pattern corresponded to the ACE2 mRNA, which was more abundant in epithelial cells than in stromal cells (2-fold increase, p < 0.05) and in the secretory vs. proliferative phase (6.6-fold increase, p < 0.01). The receptor Mas was equally distributed between epithelial and stromal cells and did not change during menstrual cycle. The physiological role of this peptide system in normal and pathological endometrium warrants further investigation.

The pelvic floor (PF) provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high-impact and in strong-effort activities are at risk for the occurrence of urinary incontinence (UI). This study aimed to investigate the occurrence of UI and other PF dysfunctions (PFD) [anal incontinence (AI), symptoms of constipation, dyspareunia, vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes (AT) compared with a group 96 of nonathletes (NAT). An ad hoc survey based on questions from reliable and valid instruments was developed to investigate the occurrence of PFD symptoms. The risk of UI was higher in AT group (odds ratio: 2.90; 95% CI: 1.50-5.61), mostly among artistic gymnastics and trampoline, followed by swimming and judo athletes. Whereas, AT group reported less straining to evacuate (OR: 0.46; 95% CI: 0.22-0.96), manual assistance to defecate (OR: 0.24; 95% CI: 0.05-1.12), and a higher stool frequency (OR: 0.29; 95% CI: 0.13-0.64) than NAT group. The occurrence of loss of gas and sexual symptoms was high for both groups when compared with literature, although with no statistical difference between them. Pelvic organ prolapse was only reported by nonathletes. Athletes are at higher risk to develop UI, loss of gas, and sexual dysfunctions, either practicing high-impact or strong-effort activities. Thus, pelvic floor must be considered as an entity and addressed as well. Also, women involved in long-term high-impact and strengthening sports should be advised of the impact of such activities on pelvic floor function and offered preventive PFD strategies as well.

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Background/Aims: To compare biomechanical properties of vaginal tissues between women with and without pelvic organ prolapse (POP) and investigate factors that may influence these properties. Methods: Forty patients submitted to POP surgery and 15 non-POP cadavers were evaluated. The tissue was excised from anterior and posterior middle third vagina. The biomechanical properties considered were stiffness (E) and maximum stress (S_max), and they were evaluated by means of uniaxial tension tests. Results: POP patients were associated with higher values of E (13.1 ± 0.8 vs. 9.5 ± 0.7 MPa; p < 0.001) and S_max (5.3 ± 0.5 vs. 3.2 ± 0.9 MPa; p < 0.001) in the anterior vaginal wall compared to the posterior wall. In contrast, non-POP women presented lower values of E (6.9 ± 1.1 vs. 10.5 ± 1.0 MPa; p = 0.01) and S_max (2.6 ± 0.4 vs. 3.5 ± 0.4 MPa; p = 0.043) in the anterior wall. The occurrence of POP was the only independent predictor of higher values of E and S_max in anterior vaginal samples (p = 0.003 and p = 0.008, respectively). Women with severe anterior vaginal prolapse presented higher levels of E and S_max in the anterior sample compared to those with lower POP stages (p = 0.001 and p = 0.01; respectively). Conclusion: Women with POP present significant changes of biomechanical properties in the vagina.

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III.