Metabolic syndrome is the constellation of risk factors that predisposes to increased risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus that is increasingly coming to light in menopausal females, thereby raising the morbidity and mortality. Declining estrogen levels along with genetic susceptibility and central obesity adversely affect the lipid metabolism, making postmenopausal females vulnerable to metabolic syndrome. Early identification of the various risk factors and appropriate preventive strategies (lifestyle modification and use of statins in selective cases) may decrease the emergence of metabolic syndrome in such females, thereby improving the longevity. Screening of risk factors for metabolic syndrome in postmenopausal females should be routinely done and therefore incorporated and inculcated in every postmenopausal clinic so that suitable candidates can be referred to cardiologists for expert advice and proper intervention if required.

Aim: To determine the effectiveness of Objectively Structured Clinical Examination (OSCE) in postgraduate training in obstetrics and gynecology (OBGY) to improve clinical examination skills. Materials and methods: Clinical examination skills of six presensitized postgraduate students were assessed though OSCE. Improvement in interpersonal and communication skills and skill of professionalism and procedural skills were assessed in successive sessions by guides using Dreyfus model. Results were analyzed by Student's t-test. Results: There was significant improvement in interpersonal and communication skills and skill of professionalism and procedural skills. Conclusion: Objectively Structured Clinical Examination is an effective method of evaluation for improvement in clinical examination skills of postgraduate students during their training in OBGY. Clinical significance: Objectively Structured Clinical Examination should be used as a formative assessment method to improve skills.

Objective: To study various gynecological problems in postmenopausal women; to study the awareness of gynecological problems in postmenopausal women. Materials and methods: It was a cross-sectional study carried out in the Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences & Research Center, Lata Mangeshkar Hospital, Nagpur, Maharashtra, India, from August 2015 to July 2016. The study population comprised all postmenopausal women attending the gynecological outpatient department and those admitted in the gynecological ward. The total number of postmenopausal women included in the study was 200. For the awareness of gynecological problems among postmenopausal women, a structured pretested questionnaire was used. Results: The mean age at menopause was 45 to 49 years. The most common gynecological problem was postmenopausal bleeding (45%), followed by pelvic organ prolapse (41.50%), frequent micturition (10%), white discharge (9%), burning micturition (8.50%), stress incontinence (4%), and lump in the abdomen (3.50%). Out of the total women of postmenopausal bleeding, 86% were benign and 14% were malignant. In our study, with the women with postmenopausal bleeding, cervical cancer was the most common malignancy (10%). Conclusion: The most common gynecological problem was postmenopausal bleeding (45%) followed by pelvic organ prolapse (41.50%). The commonest symptom of underlying malignancy was postmenopausal bleeding and the commonest malignancy in our study in the women with the symptom of postmenopausal bleeding was cervical cancer (10%).

Objective: Abnormal uterine bleeding (AUB) is a clinical entity with a significant impact on physical, social, economical, and material quality of life of women. The objective of this study is to evaluate the efficacy, change in menstrual pattern, and patient satisfaction after transcervical resection of endometrium (TCRE) in women with AUB. Study design: Fifty-five women who underwent TCRE at a tertiary care center over a period of 5 years from February 2012 to January 2017 were identified through computerized procedure coding. They were contacted either by telephone or by postcard communication. Nine women could not be contacted because of change in their address and telephone number and hence, excluded from the study. Forty-six women were included in the study. The main outcome measures were menstrual status, level of satisfaction with the procedure, and the need for repeat TCRE or hysterectomy. Results: The average age of the patients was 47.89 ± 4.68 years with the range of 38 to 57 years. Twenty-six women (56.5%) undergoing TCRE had comorbidities which made them high risk for hysterectomy. During hysteroscopy, structural abnormalities like fibroid were found in 5 (10.87%) women, cervical polyp in 1 (2.17%) woman, and endometrial polyp in 1 (2.17%) woman. In six women, intraoperative hemorrhage was controlled using uterine tamponade with the inflated balloon of a Foley's catheter, kept for 6 to 8 hours after surgery. Of the 36 patients who had pain as a significant symptom preoperatively, 35 (97.2%) experienced either minimal or no dysmenorrhea postoperatively. One woman developed hematometra after 2 months of TCRE, for which hysteroscopic-guided cervical dilatation and repeat TCRE was done. Eight (17.39%) women had undergone hysterectomy. Out of these 8 patients, 2 (75%) of the women underwent repeat TCRE before hysterectomy. A total of 38 (82.61%) women were rendered amenorrheic, 2 (4.35%) women had only slight staining every 2 to 3 months, while 6 (13.04%) women had no improvement in their bleeding status. All those 40 (86.9%) women, who had achieved amenorrhea or oligomenorrhea, had high rate of satisfaction. Conclusion: Transcervical resection of endometrium is a clinically effective and cost-effective alternative to medical management or hysterectomy in women with AUB in perimenopausal women. The cost-effectiveness, work performance, rapid convalescence, and improved quality of life provide TCRE a “distinct edge” over the definitive management-hysterectomy.

Introduction: Cervical cancer remains the most common gynecological cancer among women in developing countries. Objective: The objective was to analyze the clinical presentation and histopathological pattern of carcinoma cervix over a 3-year period. Design: This was a retrospective analysis. Results: The majority of the patients were between 40 and 50 years. Most of the patients presented at stage III. Squamous cell carcinoma was the most common histopathological pattern. Radiotherapy with concurrent chemotherapy was the modality of treatment. Conclusion: The outcome significantly shows the inadequate screening program to detect preinvasive stage of carcinoma cervix.

Objective: • To determine the incidence of urinary tract injuries during gynecological surgeries. • To explore the role of universal cystourethroscopy to detect lower urinary tract injuries during gynecological operations to reduce postoperative morbidity and its sequelae. Study design: A prospective observational study. Settings: A tertiary care center. Materials and methods: This was an observational study conducted in 163 women who underwent gynecological surgery at our department during August 2014 to May 2017. Results: Data are classified according to demography, type, and indication of surgery performed in 163 consecutive subjects. History of previous pelvic surgery, if any, was taken into account to correlate with incidence of lower urinary tract injury intraoperatively. The ureteric and bladder injuries detected by routine intraoperative cystourethroscopy were tabulated. Intraoperatively detected rates of silent ureteric and bladder injury by cystourethroscopy are higher than obvious visually inspected injuries. We obtained intraoperatively ureteric injury rate of 0.61% and a bladder injury rate of 4.29% detected by cystourethroscopy. In two patients (1.23%), in spite of blood-stained urine in urobag, we could not detect any lower urinary tract injury. On long-term follow-up, two subjects (1.23%) attended outpatient department with ureterovaginal fistula and one subject (0.61%) developed vesicovaginal fistula. Conclusion: Use of intraoperative universal cystourethroscopy during gynecological operations should be considered routinely to detect unsuspected lower urinary tract injuries and immediate management to prevent its long-term sequelae.

Objective: The study was done to determine the magnitude of gynecological morbidities in geriatric population and their management in a tertiary care center. Materials and methods: It is a retrospective observational study of female patients aged 60 years and above admitted in Department of Obstetrics and Gynecology, Sarojini Naidu Medical College, Agra, India, over a period of 3 years from January 2015 to December 2017. Results: In our study 484 patients were aged 60 years or above among total gynecological admission of 1,299 in 3 years duration. The most common gynecological disorder was genital tract malignancies (37.39%) followed by pelvic organ prolapse (28.93%). Of the total gynecological malignancies, cervical carcinoma was most common (83.98%). Urinary incontinence was seen in 8.06% patients; 124 patients presented with benign conditions like endometrial hyperplasia, endometrial polyp, fibroid, pyometra with endometritis, and benign adnexal masses. Total 136/140 patients with uterovaginal (UV) prolapse were managed surgically. Among 39 cases of stress urinary incontinence (SUI), 19 were managed conservatively and 20 were managed surgically [transobturator tape (TOT), tension-free vaginal-obturator tape (TVT-O)]. Conclusion: Genital malignancy and UV prolapse were the major gynecological problem in elderly women. As the size of geriatric population is increasing, approaches like geriatric friendly camps and geriatric clinics should be made so as to bring geriatric women in regular health care system for early detection and management of their hidden problems.

Aim: Repair of cystocele with good anatomic success rate remains the challenge for the gynecologists. Use of mesh in cystocele repair is still a controversy with regard to its efficacy and safety. The aim of our study is to evaluate the efficacy and safety of transvaginal anterior colporrhaphy reinforced (ACR) with partially absorbable mesh in the management of severe cystocele. Materials and methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology based on the surgeries performed between 2011 and 2013. The inclusion criteria were women with grades III and IV cystocele and had undergone vaginal hysterectomy with ACR with mesh. Results: Forty-two women were included in the study. The primary outcome measured was the efficacy of the mesh in terms of anatomical success rate. The secondary outcome was mesh safety. The anatomic success rate was 93% and the mesh erosion rate was 2.3%. Conclusion: Transvaginal ACR with partially absorbable mesh in the management of severe cystocele is safe and associated with encouraging anatomic success rate. However, the choice of surgery needs careful selection, considering patients at risk for recurrence. Clinical significance: The choice of mesh inlay cystocele repair may be individualized and recommended especially in grade IV cystocele, recurrent cystocele, scanty and weak perivesical fascia, to improve long-term outcome.

Aim: This study was undertaken to determine the frequency of ovarian lesions and their clinicohistological features. Materials and methods: A retrospective study was conducted for a period of 3 years on 1,844 cases of ovarian lesions in Jawaharlal Nehru Medical College, Ajmer, from July 2013 to June 2016. The specimens were analyzed macroscopically and studied microscopically. The non-neoplastic and neoplastic lesions were classified as per standard protocols. Results: In a total 1,844 cases of ovarian masses, 1,736 (94.14%) were non-neoplastic and 108 (5.86%) were neoplastic. Among neoplastic lesions, 71.29% (77/108) were benign, 2.78% (3/108) were borderline, and 25.93% (28/108) were malignant. The commonest non-neoplastic lesion was follicular cyst (66.59%) followed by corpus luteal cyst (26.73%). Surface epithelial tumor was the commonest histological type of ovarian neoplasm. The commonest benign tumor was serous cystadenoma (30/77) followed by dermoid cyst (28/77). The commonest malignant tumor was serous cystadenocarcinoma (8/28) followed by metastatic tumors to ovary (7/28). Mean age of the subjects was 41.54 years, ranging from 9 to 76 years. Conclusion: Non-neoplastic lesions outnumbered the neoplastic ones. Among the neoplastic lesions, epithelial histology was the dominant type. Only a provisional diagnosis can be made on clinical grounds, exact specification of the lesion requires its histopathological examination. Clinical significance: Histopathological findings of ovarian lesions are further helpful in treatment and prognosis of the patients.

Introduction: Urinary incontinence (UI) is the unintentional or uncontrollable leakage of urine or the inability to control the urge to urinate in certain circumstances. Some of the causes of UI are pregnancy, urinary tract infection, smoking and alcohol consumption, chronic cough, parity, constipation, obesity, pelvic surgeries, activity level, and weakness of pelvic floor muscle. Among them, obesity correlates with the most UI. Obesity has wide-ranging effects on the body as it can cause diabetes mellitus, coronary artery disease, low back pain, infertility, osteoarthritis, depression, as well as it can affect the pelvic floor. Urinary incontinence affects physical activities, self-perception, self-confidence, and social activities, thus presenting with low quality of life. Objective: To find correlation between body mass index (BMI) and UI in parous women. Materials and methods: Hundred parous women from a tertiary care hospital, Belagavi, were screened for the study after meeting the inclusion criteria. Results: The mean age of women with UI was 36.44 years. Among 100 parous women, 46 had high BMI, of which 29 women had complaints of UI. Conclusion: The present study found that there is a significant difference of BMI in subjects with and without UI.

Introduction: Sacrospinous ligament fixation is a simple procedure we use to treat cases with uterine prolapse. Aim: The aim of this work is to test the effectiveness of this procedure in the treatment of second-degree uterine prolapse. Materials and methods: The study included 50 women having second-degree uterine prolapse. Twenty-five of them (group I) were treated with bilateral sacrospinous ligament fixation, while the others (group II) were treated with unilateral sacrospinous ligament fixation. Assessment of the efficacy, intraoperative, and postoperative complications was recorded (follow-up of patients occurred 3 and 6 months postoperatively). Results: The mean operative time in unilateral sacrospinous fixation is 52 ± 10.6 minutes, while in bilateral procedure, it is 73 ± 12.6 minutes, but postoperative pain is more in bilateral than unilateral procedure. Conclusion: Sacrospinous ligament fixation is an effective treatment for patients having second-degree uterine prolapse. Unilateral is better than bilateral sacrospinous operation regarding postoperative pain.

Introduction: Gynocular^™ is a battery-operated, portable field colposcope with three-step magnification and green filter. The present study was conducted in a community setting to evaluate accuracy and also asess the advantages and limitations of Gynocular^™ as a field colposcope. Materials and methods: Women between 30 and 60 years were screened in the rural clinics in India using visual inspection on acetic acid (VIA) and human papillomavirus deoxyribonucleic acid (HPV DNA) test performed by trained health workers. Women positive on either test had evaluation by Gynocular^™ by cervical punch biopsy irrespective of their Gynocular^™ findings. A total of 12,727 women were screened using both VIA and hybrid capture 2 (HC2) test from April 2014 to February 2016. Result: A total of 1,021 women positive on either VIA or HC2 test were examined by Gynocular. A total number of 231 cases of cervical intraepithelial neoplasm 1 (CIN1), 23 cases of CIN2, 13 cases of CIN3, and 7 cases of invasive cancers were detected on histology. The sensitivity and specificity of Gynocular. at Swede Score (SS) ≥5 were 97.7% [95% confidence interval (CI): 87.7.99.9%] and 78.6% (95% CI: 75.9.81.2%) respectively. Raising the threshold to ≥6 resulted in drop in the sensitivity to 93.0% (95% CI: 80.9.98.5%), but a large improvement in specificity at 94.5% (95% CI: 92.8.95.8%). Conclusion: There is a great need for a technically less demanding and inexpensive colposcope to be used for programs in low- and middle-income countries (LMICs). The portability of the device, long battery back-up and ability to capture images using mobile phone are the advantages for using this device in field settings.

Introduction: Menopause is a natural process that all women go through. It is believed that a major physical and psychological change in a woman's life occurs during this period, though every woman may view these changes differently depending on the society and culture they belong to. And, it is also believed that quality of life (QOL) during this transitional period plays a major role in the remaining life of the woman. Evidences support the clinical importance of the transition for many women as a period of temporary changes in health and QOL and long-term changes in several health outcomes may influence women's QOL and the likelihood of healthy aging. Aim: The aims of the study were to assess the QOL among women using structured Menopause-specific quality of life (MENQOL) questionnaire and to find out the association between the QOL among women with selected demographic variables. Materials and methods: The researchers used quantitative research approach in the study. A descriptive survey design was used in the study. The sample consisted of 100 menopausal women, selected using convenient sampling technique. The investigator used the demographic pro forma and standardized MENQOL questionnaire for collecting the data. After the assessment of QOL among menopausal women, the researcher distributed the information booklet on menopausal health. The study findings have shown that the participants had average QOL in their menopausal period. An information booklet on menopausal health may improve the QOL among menopausal women and create an awareness regarding menopausal symptoms and its management. Conclusion: The following conclusions were drawn based on the findings of the study: • Most of the mothers had average QOL during menopausal period. • An information booklet regarding menopausal health was effective in creating awareness among menopausal women on QOL during menopausal period.

Objective: This study was planned to observe the prevalence of endometrial carcinoma in patients with complex endometrial hyperplasia. It has also assessed the risk factors for concomitant endometrial carcinoma. Materials and methods: Retrospective analysis of 71 patients with complex endometrial hyperplasia surgically treated between 1995 and 2015 in Aga Khan University Hospital, Karachi, Pakistan, was performed. Results: The prevalence rate of concurrent endometrial carcinoma in patients with endometrial hyperplasia was 34%. The rate for concurrent endometrial carcinoma in patients with complex hyperplasia with atypia was 49% as compared with 4.2% in patients without atypia. Cancer risk was significantly related to menopause (p = 0.043) and presence of atypia (p = 0.0005). Multivariate analysis to adjust for confounders revealed that cytological atypia [odds ratio (OR), 17.12; 95% confidence interval (CI), 2.07–141.42], menopause (OR, 2.07; 95% CI, 0.51–7.91), and hypertension (OR, 1.67; 95% CI, 0.51–5.44) were independent risk factors for endometrial hyperplasia coexisting with endometrial carcinoma Conclusion: The optimal management for menopausal women with complex hyperplasia along with atypia should be surgical intervention. We recommend that these women should be managed in centers where expertise and skills of adequate surgical staging are available.

Menopausal women suffer from various symptoms related to genital tract and urinary tract. These symptoms are due to low estrogen level at this stage of life. Although this is commonly termed as vulvovaginal atrophy or atrophic vaginitis, it does not reflect the presence of underlying urinary symptoms. So, to encompass full spectrum of symptoms, a broad term like genitourinary syndrome of menopause (GSM) is being used more recently in place of vulvovaginal atrophy or atrophic vaginitis. It describes various symptoms and signs of menopause which include genital symptoms, such as dryness, irritation and burning, urinary symptoms like urgency, dysuria, and recurrent urinary tract infection (UTI) and sexual symptoms like lack of lubrication and discomfort or pain. Wide range of treatments are available which include nonhormonal black cohosh, a phytoestrogen, lubricants or moisturizers for symptom relief, vaginal estrogen therapies, systemic hormonal therapies (HTs), tissuespecific estrogen complex [combination of selective estrogen receptor modulators (SERM) and estrogen] besides newer therapies. These newer therapy include laser, radiofrequency (RF), and magnetic therapy. As the GSM have negative impact, awareness, recognition and appropriate treatment of GSM will improve the quality of postmenopausal women.

Introduction: Fibrothecoma is a rare tumor of the ovary accounting for about 3 to 4% of all ovarian tumors. They are usually unilateral and have a good prognosis compared with other tumors of the ovary. Case report: Here we report a rare case of fibrothecoma with virilizing features in a postmenopausal woman who presented with complaints of abdominal mass with virilizing symptoms, such as excess terminal hair growth and clitoromegaly. Conclusion: Surgery is the treatment of choice for fibrothecoma, and it has a good prognosis. Virilizing features are usually not common in fibrothecoma. Here we present a rare case of fibrothecoma with virilizing features.

Giant condylomata are uncommon in developed countries; however, they are prevalent in developing nations. Condylomata acuminata are maximally transmitted by sexual contact. Giant condyloma acuminata, also called Buschke–Löwenstein tumor, is known to be a slow-growing cauliflower-like tumor, which is locally aggressive, with possible malignant transformation. Common management is conservative on medical lines. However, in extreme cases, surgical excision is required. A case of a 68-yearold nulliparous lady with giant condyloma acuminata is reviewed. She presented with a 3-year history of slowly progressive lesion on the vulva, with associated itching and another complaint of difficulty in walking. The growth measured 6 × 5 cm on left labia and was successfully excised with no evidence of malignancy. Concomitant reconstruction was also done.

Verrucous carcinoma of the vulva is a rare variant of squamous cell carcinoma, with about 50 cases reported in the literature. We report a 38-year-old patient with verrucous carcinoma of the vulva.

Purple discoloration of a urinary catheter and urobag is indeed a very rare phenomenon known as the purple urine bag syndrome (PUBS). It is usually associated with urinary tract infections occurring in catheterized patients who are generally elderly females with significant comorbidities and constipation. The urine is usually alkaline. We are presenting the case of a 78-year-old female who presented to us with urinary catheter in situ for the previous 2 months and she complained of purplish discoloration of urine bag and tubing for the previous 4 days.

Primary fallopian tube carcinoma (PFTC) is a rare tumor. It is seen in the age group between 40 and 60 years. It has resemblance to epithelial ovarian cancer, both clinically and histologically. Only 5% of patients show symptoms of profuse watery vaginal discharge (hydrops tubae profluens). Ultrasound, computerized tomography, and magnetic resonance imaging (MRI) can help in arriving at a diagnosis. Tumor marker cancer antigen (CA)-125 levels can be used as a diagnostic and prognostic marker to detect recurrence. The most common histopathology is serous papillary. Transcoelomic exfoliation of cells is the most common mode of spread of the tumor. Other modes of spread include contiguous invasion, hematogenous and transluminal dissemination. The PFTC is managed surgically like epithelial ovarian cancer. Adjuvant chemotherapy is also similar to epithelial ovarian cancer.