A Review on Polycystic Ovary Syndrome-In USA

Abstract

Polycystic ovary syndrome (PCOS) is a set of symptoms caused due to elevated levels of androgens (male hormones) in women. PCOS symptoms and signs include irregular or no menstrual periods, heavy bleeding in periods, unwanted hair on face and body, pimples on face, pelvic pain, difficulty in getting pregnancy and skin rashes include patches, roughness, colour change etc. Polycystic ovary syndrome mainly caused by the hormonal imbalance in women. PCOS causes unwanted changes in your body look. If it isn't treated, it leads to serious health problems, such as diabetes, weight gain and heart disease. The common symptom of PCOS is it causes to grow many tiny cysts on women ovaries. This is the reason it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances. We can cure this due to early diagnosis and treatment and can assist to control the symptoms and can prevent long-term health problems and modifications in the body look. PCOS is can be caused due to combination of genetic and environmental factors on the body.

Keywords

Polycystic ovary syndrome, Hormonal imbalance, Cysts, Genetic factors.

Introduction

Menstrual disorders-PCOS produces oligomenorrhea or amenorrhea, but there are other types of menstrual disorders may also occur. The exact reason and cause of PCOS is unknown and doctors say that genetics and hormonal imbalances play a role in causing PCOS. Mostly it will develop in the women if their mother or any blood relations also have the condition [1-15]. Sometimes Overproduction of hormone androgen also causes PCOS. Women’s bodies also produce androgen even though it is a male sex hormone. Women who are affected with PCOS can produce androgen in higher-than-normal level. This will affect the development and productions of eggs during ovulation period. Usage of more insulin (a hormone that helps convert sugars and starches into energy) may increase the androgen levels. There is no cure for PCOS as one of the best treatments is a healthy lifestyle. A healthy diet which contains low in refined carbohydrates is important for to avoid such risks and also can help to regulate blood sugar levels [15-21]. As everyone knows exercise can also help the body to stay healthy and keep away from weight gain. Losing weight is challenging for women with PCOS, but trying to do so will help the body to reduce the androgen levels, and some women will begin to ovulate naturally. With early detection and diagnosis, healthy lifestyle and with PCOS treatment women can get relief or cure from this condition and they can overcome health problems that caused by the PCOS.

Major societies like IVF-World Wide mainly focused on doctors, embryologists, nurses and social workers. IVF-Worldwide.com has been constructed with a vision to provide its members with the ability to locate IVF units anywhere in the world and it helps to communicate directly with the unit. PCOS Awareness Association creates awareness in society through activities relating to the prevention and treatment of PCOS through awareness programs on women health issues [21-29]. The Lebanese Society of Obstetrics & Gynecology is providing information to women about their health care system for creating awareness for their good healthy life style.

Open Access literature plays a key role in proving the information and current researches across the globe. Reproductive System & Sexual Disorders: Current Research is an open access Journal which provides all the recent advancements and techniques in the treatment in sex hormonal changes and its consequences such as Sexually Transmitted Disease, Reproductive Behavior, Unisexual Reproduction and also provides knowledge on Fallopian Tube, Sex Hormones, Sexual Disorders and may other related topics [30-36]. Journal of Steroids & Hormonal Science is an international peer-reviewed scholarly journal, which published the papers across the world on Steroid Hormone Metabolism as a Special edition in its Volume 4 Issue S12 [36-45].style.

Journal of Women's Health Care is an international open access Journal which publishes articles related to women’s health issues. Recently it has published an article entitled “Comparison of Clinical and Biochemical Parameters in Adolescent Girls with Polycystic Ovary Syndrome in Different Clinical Settings” which discussed about the parameters in in Adolescent Girls with PCOS [45-48]. There are many open access Journals publishing articles related to women’s health care system to create awareness for their healthy life style [48-51]. Topic of Insulin Resistance in Women with Polycystic Ovary Syndrome article was published in Journal of Steroids & Hormonal Science. The above mentioned Open access journals on reproductive systems and genital disorders are the peer-reviewed journals that maintain the quality and standard of the journal content, reviewer’s agreement and with the help of respective reputed Editor’s acceptance in order to publish an quality article in the respective Journal which helps to create awareness and provides knowledge on the current research on the topic. These journals ensure the barrier-free distribution of its content through online open access [51-65].

New Hope for Women With Pcos

PCOS affects an estimated one in 10 women of their reproductive age in the United States. It can be treated with early detection and by maintaining healthy life style as this cause mostly due to food habits and also other factors include environmental and genetics [65-71]. PCOS was first discovered in 1935 and doctors have diagnosed and the symptoms of this syndrome are associated with it like unwanted hair on face, weight gain, irregular and heavy periods, acne etc., later that could be changed as the researchers begin to understand possible genetic factors also causes to PCOS [71-78]. Topics of Polycystic Ovarian Syndrome, Prevention and Management of PCOS, Ovarian Cyst and also other related topics were discussed in 2nd World Congress on Polycystic Ovarian Syndrome.

Doctors stated that pituitary gland was involved with PCOS previously but they did not see a normal relationship until new study stated that the pituitary gland was not thought to be the driver of PCOS [78-81], but it acts as a passenger in the syndrome. In Polycystic Ovarian Syndrome Conference Richard L Stouffer presented a keynote on chronic hyper androgenemia and western-style diet in adolescent female monkeys: A model for onset of PCOS in young women [81-91]. This abstract describes clinical symptoms of PCOS and western style diet. There are many related conferences are discussing on PCOS and many authors are presenting keynotes on the topic on current research advancements on PCOS treatment [93]. Janelle Luk has presented a keynote on In vitro maturation (IVM) for patients with polycystic ovary syndrome (PCOS): A retrospective case series in the United States in Polycystic Ovarian Syndrome Conference.

There are a few medicines effectively available for women with PCOS, however some work just for 50-60% of patients. There are no FDA-approved drugs for PCOS [94,95]. Another review demonstrates that rosiglitazone, an insulin sensitizer that is utilized to treat diabetics, builds ovulation and declines insulin resistance in women with PCOS. In the meantime, the medication did not bring on any liver issues in the women examined [96].

Dr. Aleksandr M Fuks has authored numerous publications on Obstetrics & Gynaecology and has been named as the named among America’s Top Obstetricians & Gynaecologists in 2010 [97]. Dr. Lawrence S. Amesse, MD an obstetrician-gynaecologist in Dayton, Ohio mainly focuses on hormonal replacement therapy, infertility, Adolescent & paediatric gynaecology etc [98]. Dr. Doris J. Baker has worked on infertility and is credited with the first birth by in vitro fertilization in Oklahoma [99]. She is certified as a high complexity laboratory director by the American Board of Bio analysts and is licensed as a medical laboratory director by the state of Nevada.

There are various open access peer reviewed journals that focuses mainly on the women’s health issues i.e. the reproductive system of women. Journal of Genital system and Disorders, Reproductive System & Sexual Disorders: Current Research are such journals. Andrology & Gynecology: Current Research is a journal which focuses on reproductive oncology, family planning, embryologists, women health, prostrate cancer etc. with an aim to motivate the masses about the facts [100-103].

Conclusion

PCOS happens all the more much of the time in women who take valproate to treat the psychiatric ailment of bipolar issue contrasted and other treatment alternatives. The new research, which was directed by Dr. Hadine Joffe and scientists at Massachusetts General Hospital in Boston, ought to guide treatment and assessment of conceptive age women when they are taking valproate. Bipolar disorder happens in one to two percent of the populace and valproate is utilized broadly to settle this issue. Sadly, we have found that reproductive aged women who are going out on a limb valproate might be at hazard for creating PCOS when taking this medication. Ladies with PCOS who experience the ill effects of rest apnea, a condition described by times of stopped breathing amid rest, might be at more serious hazard for creating diabetes, as indicated by new research. The new discoveries give specialists another approach to distinguish ladies who are at hazard for creating diabetes as a consequence of PCOS. Specialists definitely realize that women with PCOS are at a higher hazard for creating rest apnea and that rest apnea is connected to insulin resistance. Be that as it may, scientists tried to decide the relationship between hyperinsulinemia, a pre-diabetes condition when the glucose control system does not work appropriately body mass list (BMI) and hazard for rest apnea in women with PCOS. There are no FDA approved drugs for PCOS. PCOS affects an estimated one in 10 women of their reproductive age in the United States. There is no cure for this syndrome. Early diagnosis can be used to treat this. Health life style used for the prevention.

References

1. Erkekoglu P and Giray BK. The two faces of endocrine disrupting chemicals and genital development. J Genit Syst Disor. 2012;1:1.
2. Benti T and Teferi E. Sexual coercion and associated factors among college female students. J Women’s Health Care. 2015;4:245.
3. Ena L, et al. Knowledge, attitudes and practices towards risky sexual behaviors among adolescents of Jimma university community high school, south west Ethiopia, 2015. J Women’s Health Care 2016;5:292.
4. Leo VD and Benvenuti C. Pharmacological, microbiological and clinical activity of feminine intimate cleansers based on plant extracts active principles (saugella line). J Women’s Health Care 2015;4:244.
5. Bett G. Quantitative analysis of uterine action potentials. J Genit Syst Disor 2012;1:1.
6. Dhiman N, et al. Diagnostic evaluation of a multiplex quantitative real-time PCR assay for bacterial vaginosis. J Women’s Health Care. 2016;5:293.
7. Yamaguchi M, et al. Comparison of pelvic alignment among never-pregnant women, pregnant women and postpartum women (pelvic alignment and pregnancy). J Women’s Health Care. 2016;5:294.
8. Martínez-Beltrán M, et al. Uterus didelphys with septate cervix and unilateral endometrial carcinoma: A case report. J Genit Syst Disor. 2012;1:1.
9. Srinivasa R, et al. Transcatheter percutaneous embolotherapy of uterine arteriovenous malformations: A report of 2 cases. J Women’s Health Care. 2015;4:247.
10. Sims SM, et al. Uterine sarcoma presenting in the setting of non-puerperal uterine inversion with uterine prolapse. J Genit Syst Disor. 2012;1:1.
11. Smith SA. The use of intrauterine devices (IUDS) in adolescents and nulliparous women: a systematic review. J Women’s Health Care 2015;4:277.
12. Hassadia A, et al. Laparoscopic management of fallopian tube torsion associated with a paratubal cyst in a 13 year old adolescent girl. J Genit Syst Disor. 2013;2:1.
13. Saleh HS, et al. Stretching or core strengthening exercises for managing primary dysmenorrhea. J Women’s Health Care. 2016;5:295.
14. Yodono H, et al. First experience of uterine fibroid embolization using dc bead®in japan. J Women’s Health Care. 2015;4:278.
15. Brar S, et al. Cesarean scar ectopic pregnancy: Three cases illustrating divergent treatment options where no standard management exists. J Genit Syst Disor. 2013;2:1
16. Mariona FG and Plymel KL. Use of the “o” wound protector/retractor in extremely obese pregnant woman - an unexpected event. J Women’s Health Care. 2015;4:248.
17. Ventolini G. New insides on vaginal immunity and recurrent infections. J Genit Syst Disor. 2013;2:1.
18. Gund P, et al. Prevalence of periconception risk factors for adverse pregnancy outcomes in a cohort of urban Indian women: Implications for preconception health education. J Women’s Health Care. 2016;5:296.
19. Amesse LS. The fascinating world of androgen insensitivity syndromes. J Genit Syst Disor S1. 2013.
20. Gebru Z, et al. Utilization of cervical carcinoma screening service and associated factors among currently married women in Arba Minch town, southern Ethiopia. J Women’s Health Care. 2016;5:297.
21. Chhabra S, et al. Clinical, investigative, postoperative status in cervical precancer and cancer. J Genit Syst Disor. 2013;2:1.
22. Geetha P, et al. Effect of Socioeconomic conditions and lifestyles on menstrual characteristics among rural women. J Women’s Health Care. 2016;5:298.
23. van Bogaert LJ. Cervical neoplasia-associated schistosomiasis in HIV-infected and uninfected South African women. J Genit Syst Disor. 2013;2:1
24. Adams SK. The young and the restless: socializing trumps sleep, fear of missing out, and technological distractions in first year college students. J Women’s Health Care. 2015;5:299.
25. Ezeruigbo Chinwe R and UdeNebonta Abigail R. Impact of health education on knowledge, attitude and practice of cervical cancer screening among secondary school teachers in Enugu state. J Women’s Health Care. 2015;4:241.
26. Ventolini G. Vaginal septum in adolescents: clinical implications. J Genit Syst Disor S1. 2013.
27. Gultie T, et al. Home delivery and associated factors among reproductive age women in Shashemene town, Ethiopia. J Women’s Health Care. 2016;5:300.
28. Panayotidis C and Cilly L. cervical polypectomy during pregnancy: The gynaecological perspective. J Genit Syst Disor. 2013;2:2.
29. Zhang Y, et al. Effect of exercise intervention on the cardiovascular health of untrained women: A meta-analysis and meta-regression. J Women’s Health Care. 2016;5:301.
30. Sobowale O, et al. Spontaneous perforation of pyometra resulting in peritonitis in a postmenopausal woman. J Genit Syst Disor. 2013;2:2.
31. Sahilemichael A, et al. Determinants of long acting reversible contraceptives use among child bearing age women in Dendi district, western Ethiopia. J Women’s Health Care. 2015;4:242.
32. Tallon N, et al. Congenital ampullary atresia of the fallopian tube and the coexistence of fimbrial tissue. J Genit Syst Disor S1. 2013.
33. Dhillon HK, et al. Female urinary incontinence: a study protocol using the Malay quid in Selangor, Malaysia. J Women's Health Care. 2016;5:338.
34. Dobanovacki D, et al. Vaginal outlet obstruction - a review of cases. J Genit Syst Disor S1. 2013.
35. Dhillon HK, et al. Prevalence and risk factors of urinary incontinence and its impact on the quality of life and treatment seeking behavior among Malaysian women: A review. J Women's Health Care. 2016;5:337.
36. Khan S and Craig LB. A review of radiologic imaging in patients with androgen insensitivity. J Genit Syst Disor S1. 2013.
37. Nigussie AT, et al. Postpartum family planning utilization and associated factors among women who gave birth in the past 12 months, Kebribeyah town, Somali region, eastern Ethiopia. J Women's Health Care. 2016;5:340.
38. Igwebueze OI and Asimadu EE. Premenarcheal urethral mucosa prolapse in Enugu, southeast, Nigeria: Five case series. J Women’s Health Care. 2015;4:243.
39. Molina R, et al. Preputial abscess secondary to phimosis. J Genit Syst Disor. 2013;2:3.
40. Weyesa JB, et al. Prevalence and risk factors associated with maternal mortality in Mizan-Aman hospital, Bench Maji, southwest Ethiopia. J Women’s Health Care. 2015;4:274.
41. Jaiprakash T, et al. Obstructed hemivagina with ipsilateral renal anomaly (ohvira) syndrome-a rare congenital anomaly. J Genit Syst Disor. 2013;2:2.
42. Quilez A. Socio-demographic profile of a sample of women with premenstrual dysphoric disorder: exploratory study**. J Women's Health Care. 2016;5:341.
43. Babul Reddy H, et al. Klinefelter’s syndrome-unusual associations. J Genit Syst Disor S1. 2013.
44. Fernández-Cuadros ME, et al. Associated risk factors in female urinary incontinence and effectiveness of electromyography-biofeedback on quality of life. J Women’s Health Care. 2015;4:273.
45. Dibaba B and Mitike G. Factors influencing desired family size among residents of Assela town. J Women's Health Care. 2016;5:342.
46. Schettini M, et al. Urethral diverticula following explanation of artificial urinary sphincter. J Genit Syst Disor. 2013;2:3.
47. Kiemtorè S, et al. Sex during pregnancy: opinions, attitudes and practices among pregnant women. J Women's Health Care. 2016;5:343.
48. Guedes DR, et al. Anomalies of 46, XY sexual differentiation-the role of SRY and NR5A1. J Genit Syst Disor S1. 2013.
49. Medina-Porqueres I, et al. Influence of guided-stretching exercises and cool immersion on functional performance in young women. J Women’s Health Care. 2015;4:272.
50. Krishna Kumar G. Undescended testis: A plea for early diagnosis and optimal management. J Genit Syst Disor S1. 2013.
51. Nitin J, et al. Diagnostic and therapeutic endoscopy in pregnancy: when, why and how? J Women's Health Care. 2016;5:344.
52. Anila KR, et al. Benign metastasizing leiomyomas involving multiple pelvic and para-aortic lymph nodes: a case report. J Genit Syst Disor. 2013;2:3.
53. Khan A, et al. Serum CA 125 is a biomarker of tuberculous peritonitis and its inflammatory severity in female patients. J Women's Health Care. 2016;5:345.
54. Chhabra S, et al. Trends and profile of ovarian cancer at a medical institute. J Genit Syst Disor. 2013;2:3.
55. Hussen SH, et al. Timely initiation of first antenatal care visit of pregnant women attending antenatal care service. J Women's Health Care. 2016;5:346.
56. Figueiredo J, et al. Urogenital schistosomiasis presenting genital and urinary tract lesions and abdominal discomfort in a sterile Angolan woman. J Genit Syst Disor. 2013;2:3.
57. Trivedi MK, et al. Antimicrobial sensitivity, biochemical characteristics and biotyping ofstaphylococcus saprophyticus: An impact of biofield energy treatment. J Women’s Health Care. 2015;4:271.
58. Bila A and Gramatiuk S. To compare the mitochondrial complex between metastasis breast cancer and patients with breast cancer and hepatitis C virus. J Women's Health Care. 2016;5:315.
59. Shamrani H. A Cross-sectional survey of women’s provider gender preferences for gynecology and obstetrics care at King Abdulaziz University Hospital. J Women's Health Care. 2016;5:347.
60. Seth S, et al. Pedunculated angiomyxofibroma of vulva: A rare entity case report. J Genit Syst Disor. 2014;3:1.
61. Obayashi Y, et al. The validity and reliability of a scale on postnatal posttraumatic stress symptoms related to childbirth among Japanese women: Evaluation of the Japanese-language version of the impact of event scale-revised. J Women’s Health Care. 2016;5:316.
62. Lakshmidevi M, et al. Primary parasitic leiomyoma in a postmenopausal woman with neovascularisation from omentum. J Genit Syst Disor. 2014;3:1.
63. Camara MK, et al. Ebola in obstetric environment: by the way of 3 cases to the service of obstetric gynecology of the hospital national donka, fallen of Conakry. J Women's Health Care. 2016;5:317.
64. Geetha P. Outcome of multiple caesarean sections. J Genit Syst Disor. 2014;3:1.
65. Belachew T, et al. Postnatal care service utilization and associated factors among mothers in Lemo Woreda, Ethiopia. J Women’s Health Care. 2016;5:318.
66. Pedroso C, et al. Residual lesion after cervical intraepithelial neoplasia grade 2/3 treatment-the experience of our cervical pathology unit. J Genit Syst Disor. 2014;3:2.
67. Schuler A and Mary Guo A. Plasma cell vulvitis: A case report and review of literature. J Women’s Health Care. 2015;4:270.
68. Tilahun T, et al. Prevalence and perinatal outcome of singleton term breech delivery in Mizan Aman General Hospital, south west, Ethiopia; a three year retrospective hospital based study. J Women's Health Care. 2016;5:319.
69. Emery J, et al. Sarcoidosis of the cervix: An unusual case presentation. J Genit Syst Disor. 2014;3:2.
70. Olaleye Atinuke O, et al. Management of intimate partner violence: Physician’s readiness in southwestern Nigeria (management of intimate partner violence). J Women’s Health Care. 2015;4:269.
71. Samanta S, et al. An Intensive research study on rheumatoid arthritis through yoga shakti. J Women’s Health Care. 2015;4:263.
72. Linam LE, et al. Urororectal septum malformation sequence: A case report. J Genit Syst Disor. 2014;3:2.
73. Khullar R. Impact of obesity on fertility and pregnancy in women. J Women’s Health Care. 2015;4:264.
74. Finnegan T, et al. Right upper quadrant pain at 34 weeks pregnancy: An unusual presentation of acute cecal volvulus. J Genit Syst Disor. 2014;3:2.
75. Ranabhat C. Women’s health agenda after millennium development goal. J Women’s Health Care. 2015;4:265.
76. Seth S, et al. Successful twin pregnancy after pre-rupture diagnosis and resection of non-communicating rudimentory horn: Case report. J Genit Syst Disor. 2014;3:2.
77. Gwebueze OI. Mother’s experiences with cut380a postpartum intrauterine contraceptive device in Enugu, southeast, Nigeria. J Women’s Health Care. 2015;4:266.
78. ?sompos C, et al. The Effect of the antioxidant drug “u-74389g” on endosalpingeal edema during ischemia reperfusion injury in rats. J Genit Syst Disor. 2015;4:1.
79. Erashi MWM, et al. Dual-Contraceptive method utilization and associated factors among HIV positive women attending art clinic in Gebretsadik Shawo hospital, SNNPR, south west Ethiopia. J Women’s Health Care. 2015;4:267.
80. Kumar P and Chhabra S. Rare presentation of haematometra and haematocolpos presenting as bleeding per vagina. J Genit Syst Disor. 2015;4:1.
81. Fotopoulou V, et al. Greek medical student’s knowledge and attitudes towards infertility and assisted reproductive technologies (Greek medical students and art). J Women’s Health Care. 2015;4:268.
82. Mai HM. Gross anatomical study of the urogenital system of the indigenous Nigerian male donkey (Equus africanus africanus) in comparison with the stallion. Anat Physiol. 2014;4:145.
83. Asumatary S, et al. Female gonadal histology of Indian river shad, Gudusia chapra (hamilton, 1822) – a tactic of reproductive biology. Poult Fish Wildl Sci. 2016;4:173.
84. Gupta S and Banerjee S. Food, Feeding habit and reproductive biology of tire-track spiny eel (Mastacembelus armatus): A review. J Aquac Res Development. 2016;7:429.
85. Qambrani GR, et al. Reproductive biology of Glossogobius giuris (hamilton), in Manchar lake Sindh, Pakistan. J Aquac Res Development. 2016;7:392.
86. Pal A. Role of Copper and selenium in reproductive biology: A brief update. Biochem Pharmacol (Los Angel). 2015;4:181.
87. Hua NT and Ako H. Reproductive biology and effect of arachidonic acid level in brood stock diet on final maturation of the Hawaiian limpet cellana sandwicensis. J Aquac Res Development. 2014;5:256.
88. Olalekan EI and Lawal-Are AO. Comparative study of condition factor, stomach analysis and some aspects of reproductive biology of two land crabs:Cardiosoma armatum(herklots, 1851) andCardiosoma guanhumi(latreille, 1825) from a mangrove swamp ecosystem, Lagos – Nigeria. J Marine Sci Res Dev. 2013;4:143.
89. Ibtisham F, et al. Effect of antimicrobial triclosan on reproductive system of male rat. Pharm Anal Acta. 2016;7:516.
90. Sayed AEDH. Evaluation of apoptotic cell death and genotoxicty following exposure to silver nanoparticles in African catfish (Clarias gariepinus). Toxicol open access. 2016;2:109.
91. Cemile MS and Çigdem E. The effects of oxidative stress and some of the popular antioxidants on reproductive system: A mini review. J Nutr Food Sci. 2016;6:464.
92. Soundarapandian P, et al. Male reproductive system of blue swimming crab, Portunus pelagicus (Linnaeus, 1758). J Cytol Histol. 2013;5:206.
93. Zappa F, et al. NAD(P) H:quinone oxidoreductase 1 expression in human reproductive system and mitomycin-c cytotoxicity: a new chapter for old compounds? J Cytol Histol. 2013;5:209.
94. Burgess A, et al. Steps towards updating the curriculum and teaching methods in obstetrics, gynaecology and neonatology in Mongolia. J Nurs Care. 2016;5:347.
95. Jain D. Hypogonadotropic hypogonadism with Cushing’s disease-a case report. Clinics Mother Child Health. 2015;12:179.
96. Katherine CN, et al. Recurrent ipsilateral cornual pregnancy with high BHCG level successfully treated with single dose of methotrexate injection: A case report. Gynecol Obstet (Sunnyvale). 2014;4:227.
97. https://www.omicsonline.org/editor-profile/Aleksandr_M_Fuks/
98. http://www.scitechnol.com/editor-profile/Lawrence_Amesse/
99. http://www.scitechnol.com/editor-profile/Doris_Baker/
100. Ajayi OA. Medical simulation in obstetrics and gynaecology: The way forward to develop, maintain and assess operative skills? Reprod Syst Sex Disord. 2014;3:126.
101. Ciliacus E, et al. Multifocal acquired demyelinating sensory and motor neuropathy in pregnancy: A case report. J Clin Cell Immunol. 2013;4:175.
102. Pal A. Role of copper and selenium in reproductive biology: A brief update. Biochem Pharmacol (Los Angel). 2015;4:181.
103. Matthes ACS and Matthes GZ. Measurement of vaginal flexibility and its involvement in the sexual health of women. J Women’s Health Care. 2016;5:302.