will be subjected to skin repair after episiotomy with skin adhesive tape.

will be subjected to skin repair after episiotomy with the currently traditional method for episiotomy repair by continuous absorbable subcuticular suture.

Episiotomy Wound

Adhesive tape

Continuous subcuticular skin suturing

Steri-strip Adhesive Tape Versus Subcuticular Suture for Episiotomy Repair in Primiparous Obese Women

pain experience will be evaluated during the procedure by the visual analog scale(VAS). VAS of 0 indicates no pain and VAS of 10 indicates the worst possible experienced pain.

the patient will report her pain by placing a line perpendicular to the VAS line at the point that represents their pain intensity.VAS of 0 indicates no pain and VAS of 10 indicates the worst possible experienced pain.

During the second visit 7-10 days after delivery; wound healing will be evaluated and recorded by Redness, Edema, Ecchymosis, Drainage, Approximation (REEDA), data may be collected by home visits for those may not be able to come back for the second visit.

pain experience will be evaluated by visual analog scale

timing of both procedures will be recorded and documented

the patient will report her pain by placing a line perpendicular to the VAS line at the point that represents their pain intensity. VAS of 0 indicates no pain and VAS of 10 indicates the worst possible experienced pain.

Ahmed Samy aly ashour

lecturer in obstetrics and gynecology

Cairo University

Anterior and apical repair with laparoscopic sacropexy

Anterior and apical repair with laparoscopic lateral suspension

Pelvic Organ Prolapse

Surgical correction of anterior and apical pelvic organ prolapse by laparoscopy

Laparoscopic repair of anterior and apical pelvic organ prolapse

Lateral Suspension Versus Sacral Colpopexy POP

Laparoscopic Lateral Suspension Versus Laparoscopic Sacral Colpopexy for Anterior and Apical Prolapse: an International Multicentric Randomized Trial

Provided by the patient's feeling of the "Absence of a bulge in the vagina"

Defined as anatomic absence of advanced prolapse at POP-Q sites Ba, C and Bp defined as less than 1 cm individually and as a total

This will be assessed using a Visual Analogue Scale for Global Satisfaction (10=very satisfies, 0=entirely dissatisfied)

This will be assessed using a validated questionnaire (Prolapse Quality of Life questionnaire P-QoL) The questionnaire contains 9 domains. Each answer of the patient will have values that range between 1 to 4 or 1 to 5 for the 1st question only). (1 very good 4/5 very poor). There is no overall score. A symptomatic woman might have only one domain impaired and another one might have all domains impaired. We consider both of them symptomatic but in different or same aspects of quality of life. To differentiate different domains, it is important for the decision of our surgery (we will be careful in shortening and narrowing a vagina of a woman who had only a preoperative high (impaired) Personal relationships domain score and other domains in the normal range).
This will also help us in the follow up visits.

This will be assessed using the Clavien-Dindo Scale. It consists of 7 grades (I, II, IIIa, IIIb, IVa, IVb and V). The introduction of the subclasses a and b allows a contraction of the classification into 5 grades (I, II, III, IV and V) depending on the size of the population observed or the of the focus of a study.
Complications that have the potential for long-lasting disability after patient's discharge (e.g.: paralysis of a voice cord after thyroid surgery) are highlighted in the present classification by a suffix ("d" for disability). This suffix indicates that a follow-up is required to comprehensively evaluate the outcome and related long-term quality of life.

This will be assessed using a validated questionnaire (Prolapse/Incontinence Sexual Questionnaire-IUGA revised PISQ-IR) The PISQ-IR is a validated evaluation tool which can be used clinically as well as in research for assessment of female sexual function (FSF), in women with female pelvic floor disorders. The resultant scale is composed of six sub-scales in sexually active (SA) women and four in women who are not sexually active (NSA).
For women who are SA, it contains 21 items covering six domains: arousal/orgasm, partner related, condition specific, global quality rating, condition impact, and desire. For women who are not SA, it contains 12 items covering four domains: condition specific, partner related, global quality, and condition impact. Each domain receives a separate score

This will be assessed using the Patient Global Impression Scale of Improvement (PGI-I) (6=very much improved condition, 1=condition worsened)

Nikolaus Veit-Rubin

Senior resident Urogynecology

Medical University of Vienna

This group will be treated with medication alone (amitriptyline hydrochloride, 25 mg) for chronic vulvar pain (vulvodynia).

This group will be treated with medication (amitriptyline hydrochloride, 25 mg) plus pelvic floor exercises such as Kegel contractions and stretching of pelvic floor muscles with patients own hands.

This group will be treated with medication (amitriptyline hydrochloride, 25 mg) plus electrical stimulation with Interferential Current (manufacturer: Quark Medical; Model: Dualpex 961 - program number 42): two electrodes put into the perineal surface area emitting interferential current, once a week for twenty minutes each, for eight weeks long.

Vulvodynia

Volunteers will take 25 milligrams of this medication every day from their enrollment until completing eight weeks long.

Amitriptyline

Volunteers will be taught to contract their pelvic floor muscles right before stretching it, following a home protocol, every day for eight weeks long.

Kinesiotherapy

Volunteers will visit physical therapy clinic once a week to receive twenty minutes of electrical stimulation with Interferential Current (Duapex 961 of Quark Medical manufacturer) in their perineal area, for eight weeks long.

IC (Quark)

Unicamp

Physical Therapy as Adjuvant Treatment of Vulvodynia: a Randomized Controled Trial

Effectiveness of the treatment for vulvodynia will be accessed through pain score scale from zero to ten, compared from day zero of treatment to day eight

Will be accessed through FSIF (Female Sexual Index Function questionnaire) score that goes from 2 to 36, compared from day zero of treatment to day eight, which indicates sexual disfunction pointed by scores below 26,55.

A 3D Ultrassound will be used to access these outcomes and compare changes from day zero to day eight of treatment

Vaginal fluid collected will be analysed in laboratory to access possible inflammatory response of vulva and vagina of women with vulvodynia obtained by comparing quantitatively interleukin 1-B presente before and after treatment

dyspareunia/obesity

Steri-strip Adhesive Tape Versus Subcuticular Suture for Episiotomy Repair in Primiparous Obese Women

Lateral Suspension Versus Sacral Colpopexy POP

Physical Therapy as Adjuvant Treatment of Vulvodynia: a Randomized Controled Trial

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