In benign prostatic hyperplasia (BPH) there will be a sudden impact on overall quality of life of patient. This disease occurs normally at the age of 40 or above and also is associated with sexual dysfunction. Thus, there is a need of update on current medications of this disease. The presented review provides information on medications available for BPH. Phytotherapies with some improvements in BPH are also included. Relevant articles were identified through a search of the English-language literature indexed on MEDLINE, PUBMED, Sciencedirect and the proceedings of scientific meetings. The search terms were BPH, medications for BPH, drugs for BPH, combination therapies for BPH, Phytotherapies for BPH, Ayurveda and BPH, BPH treatments in Ayurveda. Medications including watchful waitings, Alpha one adrenoreceptor blockers, 5-alpha reductase inhibitors, combination therapies including tamsulosin-dutasteride, doxazosin-finasteride, terazosin-finasteride, tolterodine-tamsulosin and rofecoxib-finasteride were found. Herbal remedies such as Cernilton, Saxifraga stolonifera, Zi-Shen Pill (ZSP), Orbignya speciosa, Phellodendron amurense, Ganoderma lucidum, Serenoa Repens, pumpkin extract and Lepidium meyenii (Red Maca) have some improvements on BPH are included. Other than these discussions on Ayurvedic medications, TURP and minimally invasive therapies (MITs) are also included. Recent advancements in terms of newly synthesized molecules are also discussed. Specific alpha one adrenoreceptor blockers such as tamsulosin and alfuzosin will remain preferred choice of urologists for symptom relief. Medications with combination therapies are still needs more investigation to establish as preference in initial stage for fast symptom relief reduced prostate growth and obviously reduce need for BPH-related surgery. Due to lack of proper evidence Phytotherapies are not gaining much advantage. MITs and TURP are expensive and are rarely supported by healthcare systems.

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Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, office vacuum aspiration (Pipelle) and the use of office hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of finding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-ΰ-vis each other. Histological assessment is the final word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Ca. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. A single-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the office hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.

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The term premature ovarian insufficiency (POI) describes a continuum of declining ovarian function in a young woman, resulting in an earlier than average menopause. It is a term that reflects the variable nature of the condition and is substantially less emotive than the formerly used "premature ovarian failure" which signaled a single event in time. Contrary to the decline in the age of menarche seen over the last 3-4 decades there has been no similar change in the age of menopause. In developed nations, the average age for cessation of menstrual cycles is 50-52 years. The age is younger among women from developing nations. Much has been written about POI despite a lack of good data on the incidence of this condition. It is believed that 1% of women under the age of 40 years and 0.1% under the age of 30 years will develop POI. Research is increasingly providing information about the pathogenesis and treatments are being developed to better preserve ovarian function during cancer treatment and to improve fertility options. This narrative review summarizes the current literature to provide an approach to best practice management of POI.

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Stress urinary incontinence (SUI) has a significant impact on the quality of life for many women. Most women do not seek medical attention for this condition. Treatment for this problem includes initial conservative therapies and then surgery is an option. More than 200 surgical procedures have been described in the literature for the treatment of stress incontinence. The gold-standard surgical treatment of SUI in patients with a mobile bladder neck and normally functioning urethra has been accomplished through a retropubic approach using either a Burch or Marshall-Marchetti-Krantz procedure. By the absolute success of Trans obturator tape (TOT) application in treatment of SUI and the niche it has created for itself in the maze of treatment modalities available for SUI, there seems to be little doubt that TOT is all set to become the new Gold Standard for treatment of SUI in times to come. It is difficult to imagine any further improvements in the midurethral sling procedures or surgeries for SUI. However 10 years ago, no one could have imagined the progress and development that has been seen over these few short years in the treatment of SUI. The future may hold promise in technologies such as stem cells that may be injected in or around the urethral support structures and provide regeneration of the lacking support structures. What so ever, it's definitely time to provide millions of women with knowledge that empowers them to make lifestyle changes to decrease their risk of SUI and to understand the reality that they are not alone if they have SUI.

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Background: The metabolic syndrome (MS) (syndrome X, insulin resistance syndrome) is a constellation of metabolic abnormalities and a complex predisease state that predicts future development of type 2 diabetes mellitus and cardiovascular disease. Menopausal transition and postmenopausal state are considered as a vulnerable period for developing MS, and this increased risk has been attributed to decreasing estrogen levels with an increasing risk of insulin resistance following menopause. Aims and Objectives: This study aimed to determine the prevalence of MS and its components in pre- and post-menopausal women from North India. Methodology: This is a cross-sectional study of 350 women in the age group of 45-55 years attending gynecology clinic in a tertiary center of North India. Details of sociodemographic data, menopausal history, reproductive, and medical profile were obtained. Then, waist circumference, body mass index (BMI), and blood pressure were recorded. A venous blood sample was collected for fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. MS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results: The mean age was 49.09 ± 2.2 years in premenopausal and 49.54 ± 2.8 years in postmenopausal women. The prevalence of MS in the study group was 62.6%. Occurrence of MS was higher in older and obese women. Abnormal waist circumference was the most prevalent component (87%) of MS and in terms of odd ratio, correlation was highest for BMI followed by total cholesterol and waist-hip ratio. Conclusion: We should target obesity and deranged lipid profile by bringing out changes in lifestyle and dietary habits to decrease the higher prevalence of MS and the risk of cardiovascular diseases.

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With a significant number of women belonging to the status of menopause and beyond, it is imperative to plan a comprehensive health program for them, including lifestyle modifications. Exercise is an integral part of the strategy. The benefits are many, most important being maintenance of muscle mass and thereby the bone mass and strength. The exercise program for postmenopausal women should include the endurance exercise (aerobic), strength exercise and balance exercise; it should aim for two hours and 30 minutes of moderate aerobic activity each week. Every woman should be aware of her target heart rate range and should track the intensity of exercise employing the talk test. Other deep breathing, yoga and stretching exercises can help to manage the stress of life and menopause-related symptoms. Exercises for women with osteoporosis should not include high impact aerobics or activities in which a fall is likely. The women and the treating medical practitioner should also be aware of the warning symptoms and contraindications regarding exercise prescription in women beyond menopause. The role of exercise in hot flashes, however, remains inconclusive. Overall, exercising beyond menopause is the only noncontroversial and beneficial aspect of lifestyle modification and must be opted by all.

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Bladder outlet obstruction in females remains a poorly understood condition and is much rarer as compared to males. More difficult is the objective diagnosis of this condition. There is no general agreement on the Urodynamic parameters to define the condition with certainty. A number of conditions are involved particularly in urinary retention in females are not completely understood. Besides, external sphincter dysfunction and post surgical retentions add another group of conditions which are distinct from retentions seen in the males. This article takes a review of various aetiological factors of Bladder outlet obstruction in women. An attempt is made to standardise the Urodynamic parameters for use in females, based on our data and experimentation on the models of the bladder and urethra. This article also takes a review of uncommon conditions such as Fowler's syndrome which often complicate evaluation of this condition.

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Background: Female sexual dysfunction (FSD) is described as difficulty experienced by a female during any stage of a normal sexual activity including physical pleasure, desire, arousal, or orgasm. There are various factors responsible for FSD including psychological status of a person, gynecological or medical problems, long use of certain drugs, and social beliefs. Objectives: To study the prevalence and various factors associated with FSD. Materials and Methods: Study Design - This study design was a cross-sectional observational study conducted at Tertiary Care Centre, in Ahmedabad from June 2015 to March 2016. Sample Size - One hundred and fifty-three fertile females in reproductive age group (20-47 years) were included in the study. Written and informed consent was obtained from all the females. Methods - FSD was assessed with a detailed 19-item female sexual function index questionnaire. All six domains of sexual dysfunction, i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain were studied. Various associated factors such as gynecological or psychological problems were also studied. Exclusion - Infertile patients were excluded from the study. Results: The prevalence of FSD was 55.55% among 153 fertile females. FSD was more prevalent in the age group of 26-30 years and with duration of marriage >16 years. FSD was also more common in females with middle education and those belonging to upper middle socioeconomic status. Psychological stress was significantly associated with FSD. Conclusion: It is right of every female to lead healthy sexual life as it is key to happiness in marriage. Females with FSD can be managed with proper counseling and treating the underlying etiology.

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Introduction: Paraovarian cyst arise from either mesothelium or from paramesonephric remnant. These present as either adneal mass or as an incidental finding. Diagnosis is usually established on ultrasound and it is important to differentiate these from ovarian cyst. Material and Methods: The present study is a retrospective analysis of 32 women with a confirmed diagnosis of paraovarian cyst after surgery. The clinical profile, symptoms and radiological findings of these patients were noted from the hospital records. A correlation was made with the surgical findings and the final histopathological diagnosis. Results: Only 2 patients were postmenopausal and one case was diagnosed during pregnancy. Ultrasound accurately diagnosed paraovarian cyst in 87.5% patients. 78% paraovarian cysts were found to be simple and none had any malignant change. We reported a higher incidence of cystic adenomatoid tumor in these paraovarian cysts. Conclusion: In our study, most paraovarian cysts occur in reproductive age group and present as an adnexal mass. Ultrasound is the diagnostic modality and a paraovarian cyst needs to be differentiated from ovarian cyst. Most of them were simple cysts on histopathology.

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This review will discuss the concept of reproductive aging, which includes the definition of menopause, its symptoms, and predisposing conditions. It will elaborate upon the contributory factors implicated in the pathogenesis of menopause, focusing most prominently on oxidative stress. Specifically, this paper will explain how oxidative stress, in the form of free radicals and antioxidant deficiencies, has been directly linked to the decline of estrogen during reproductive aging. Additionally, this paper will elaborate upon the treatment options aimed at mitigating the menopausal symptoms and hormonal deficiencies that can lead to various disease processes. Treatment options such as hormonal therapy, antioxidant supplementation, and lifestyle modification have been explored for their effectiveness in treating and preventing the symptoms and sequelae of menopause. The majority of information in this review was obtained through PubMed and the National Library of Medicine. While most references in this paper are original research articles, a limited number of references are comprehensive reviews on the topic.

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Aim: We undertook this study involving 200 peri- and postmenopausal women to determine the prevalence of osteoporosis, and in turn increase the awareness, education, prevention, and treatment of osteoporosis. Setting and Design: Postgraduate Institute of Medical Education and Research, UT Chandigarh, India, and a clinical study. Materials and Methods: A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designated for the study. Height and weight was measured, weight-bearing exercise was assessed, and sunlight exposure per day for each woman was recorded. Food intake was estimated by using the 24-hour dietary recall method, and calcium and vitamin D consumption pattern was assessed. Bone mineral density (BMD) at postero-anterior lumbar spine and dual femurs was assessed by densitometer. Women were classified according to the WHO criteria. Statistical Analysis Used: Student's t-test, multiple logistic regression analysis. Results: The prevalence of low BMD was found in more than half of this population (53%). The mean age in group I (normal BMD) was found to be 50.56 ± 5.74 years as compared to 52.50 ± 5.94 in group II with low BMD (P=0.02). The two groups were similar with respect to parity, education, socioeconomic status, family history of osteoporosis, hormone replacement therapy, and thyroid disorders. 46.8% of the women in group I and 33% of the women in group II had low physical activity and there was no statistically significant difference in sunlight exposure between the groups. Parity or the number of children and type of menopause was not seen to have much association with low BMD in our study. Lack of exercise and low calcium diet were significantly associated with low BMD. Multiple logistic regression analysis showed that age, exercise, menopause, and low calcium diet acted as significant predictors of low bone density. Conclusion: The findings from the study suggest the need for large community-based studies so that high-risk population can be picked up and early interventions and other life style changes can be instituted if there is delay in implementing national or international health strategies to tackle this increasing global health problem. Strategies to identify and manage low BMD in the primary care setting need to be established and implemented.

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Cyst of posterior vaginal wall is very rare. This case relates to a patient who presented with polypoidal mass protruding out from vagina which could have been easily mistaken as uterovaginal prolapse, but appropriate clinical evaluation supported with investigations clinched the diagnosis easily.

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Hippocratic Oath is a living document for ethical conduct of the physicians around the world. World Medical Association has been amending the oath as per the contemporary times. Although physicians maintain their ethical standards while treating a patient yet many a times social, administrative and ruling powers either use physicians as their tool of oppression or victimize them for conducting duties as per their oath. The Tuskegee Syphilis Study and Human Radiation Experiments in America, Nazi Experiments in Germany and compulsory sterilization program in India were the studies where States used physicians for the advancement of their rationality or belief. Conversely victimization of physicians in Kosovo, Sri Lanka and incarcerating physicians for treating human immunodeficiency virus/acquired immunodeficiency syndrome patients in some countries is concerning. The Nuremberg code, the Declaration of Geneva, Belmont Report and Declaration of Helsinki are ethical documents while active involvement of Food and Drug Administration through "common rule" resulted in guidelines like International Conference on Harmonization and Good Clinical Practices. Still unethical studies are found in developing countries. Studies such as experimental anticancer drugs in 24 cancer patients without adequate prior animal testing and informed consent in Kerala, studies at All India Institute of Medical Sciences in New Delhi resulted in 49 deaths of children and many more suspicious studies are rampant. Reverting back to the fundamentals of the medical profession; teaching medical ethics and enforcement of "medical neutrality" by embarking some grade of "medical immunity" on the basis of the oath is necessary for ethical conduct of physicians.

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Pressure ulcers (PUs) are an important aspect of geriatrics and palliative care that amplifies morbidity of the chronically bed-ridden patients posing a threat to health-care economy and resources. PUs can interfere with functional recovery, may be complicated by pain and infection and can prolong hospital length of stay. Their presence may be a marker of poor overall prognosis and premature mortality. The pathogenesis and progress in the management of PUs is discussed.

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Brenner tumor is a rare ovarian tumor that is a part of the surface epithelial group of ovarian neoplasm. It is usually asymptomatic and most of the times it is an incidental pathological finding. Here we present a case of benign Brenner tumor of ovary treated surgically.

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Urogenital infections are one of the most common causes for a woman to visit a gynecologist or a urologist. The well-known association between abnormal vaginal microbial flora and its formidable risk in the increased incidence of urinary tract infection underscores the importance of understanding the microbial flora and the efforts needed to maintain it, for ensuring urogenital health. Surprisingly in spite of the increased incidence urogenital infections receive very less attention from the medical fraternity. Growing awareness among people and newer advances in the medical field has brought them into the limelight. The importance of replenishing these depleting commensals with 'probiotics' has resurfaced in a big way. As the days go by science and medicines will touch new milestones, which will include probiotics. The value of a probiotics cannot be taken at face value. Probiotics must not be considered a panacea for treating urogenital infections. However, the available data promises that it will be a strong option in improving and maintaining urogenital health.

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Introduction: The World Health Organization has declared India as the "diabetic capital" of the world. In controlling of such chronic, mostly asymptomatic disease, patients' role can't be overemphasized. Aims : To assess the level of compliance to anti-diabetic therapies and to ascertain the determinants of non-compliance, if any. Materials and Methods : A cross-sectional observational study was conducted for 3 months in a diabetic clinic of R G Kar Medical College and Hospital, Kolkata. Data were collected by interviewing the patients, examining their prescriptions and laboratory reports and anthropometry after obtaining informed consent. Results : Blood report at the point of data collection revealed controlled glucose homeostasis in 38.93% patients but evaluation of past 3 months report showed only 24.3% had control over hyperglycemia. Glycemic control was seen to be positively related to short duration of disease, compliance to therapies, and high knowledge about diabetes. Compliance to therapies found in 32.22% of study subjects was in turn associated with short duration of disease. House-wives showed poor compliance; insulin treatment with or without oral-anti-diabetic agent showed better compliance. Knowledge of diabetes was significantly high among higher educated; poor among women, house-wives, and rural people. Conclusion : Patient-providers collaboration is to be developed through a patient-centered care model based on the mutual responsibility of both so that each patient is considered in the mesh of his/her other goals of life and helped to promote empowerment to take informed decision for behavioral change conducive to control the disease.

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Objectives: This study was designed to assess the effectiveness of self-administered osteoporosis risk score sheet, body mass index (BMI), and bone mineral density (BMD) (ultrasound) in screening females with low bone mass, and how the results of the tools correlate with each other. Materials and Methods: The study was conducted on 536 postmenopausal women, who attended public awareness camps on Midlife Women Health held at the Menopause Research Unit, MGMCH, Sitapura, Jaipur. At these camps, in addition to several informational sessions on issues related to menopause, ultrasonic measurement of BMD was conducted on each participant. A broad questionnaire to identify midlife health problems was developed, and osteoporosis specific score sheet was designed to be self-administered. Patients were required to complete the osteoporosis specific risk score sheet and women health questionnaire (WHQ). BMI was determined. Statistical analysis was carried out to find the correlation between various variables. Sensitivity and specificity of the each risk score ascertained and cutoff risk score for identifying osteopenia was derived by comparing area under curve of each risk score on drawing receiver operational curve (ROC). Results: Sensitivity of risk score system was calculated to be 78.33% with 95% confidence interval being 73.24-82.86% and specificity was 27.12% with 95% confidence interval being 21.56-33.27%, keeping the cutoff point at nine. There was statistically significant inverse relationship between risk score and BMD values with Pearson correlation coefficient of (-) 0.22 and positive relationship between BMD and BMI with correlation coefficient of 0.192. Conclusion: By noting down the risk factors and BMI, we can screen out the women who require further evaluation and management, thus, it is an effective tool, particularly in developing countries like India, where most of the patients cannot afford expensive DEXA scans, although considered as the gold standard for BMD assessment. With the help of such scoring systems, health resources can be judiciously utilized.

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Cervical cancer is the second most common malignancy among women in India, mainly affecting the females of Peri-Menopausal age group. Colposcopy has been very useful for diagnosing cervical cancer to guide the biopsy. Reids and Scalzi proposed the Reids Colposcopic Index (RCI) to make colposcopic diagnosis less subjective, which is currently the most accepted scoring system. Recognizing the correlation of size of the lesion with likelihood of harbouring high grade disease, a new scoring system, the Swede score, has been devised by Strander et al in 2005. In present study we compared the Reids colposcopic index with Swede score. From the present study it is evident that Swede score of 8 or more has 100% specificity and can be used for performing direct excisional procedure as a “see-and-treat” method at this cut-off. This may be the preferred method for the treatment of high-grade CIN because it reduces the number of visits to the clinic and failure to receive treatment.

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