Polycystic ovarian syndrome (PCOS) is a common endocrine condition in women. Studies have shown that PCOS is associated with poor quality of life, anxiety, sadness, dissatisfaction with one's appearance, and sexual dysfunction. This study was conducted to determine whether a strong psycho-pathological personality is related to PCOS and whether this personality is related to the hyperandrogenic state. Anthropometric, metabolic, hormonal, clinical, and psychological characteristics were examined in 90 Bahraini women with PCOS. After confirming the diagnosis of PCOS via Rotterdam criteria, including ovarian ultrasound, each patient was evaluated via the following questionnaires: 1) the GAD-7 (General Anxiety Disorder-7) to measure the severity of anxiety; 2) the Patient Health Questionnaire-9 (PHQ-9) to confirm and measure the severity of depression; 3) the Barratt Impulsiveness Scale (BIS‐11) to measure aggression; and 4) the McLean Screening Instrument to identify borderline personality disorders (MSI-BPDs). The study was approved by the Institutional Review Board. Compared to controls, PCOS patients exhibited significantly higher rates of severe depression (8

In recent years, excessive fluid intake by women has emerged as a well-being misconception without robust scientific support but may have an adverse impact on treatment outcome of overactive bladder (OAB) syndrome. Excessive fluid intake may have potential disadvantages as overhydration leads to exacerbation of symptoms of OAB particularly frequency, nocturia, and urgency. Fluid management by recommending daily intake levels is the integral, yet underutilized, component of the treatment plan and should be the initial therapeutic approach in all women suffering from OAB. This strategy will reduce the need for pharmacotherapy and other expensive interventions in women with OAB.

Obstetric anal sphincter injuries (OASIs) remain a major cause of postpartum morbidity and long-term anal incontinence. Despite advances in obstetric care, many injuries remain undiagnosed due to the limited sensitivity of digital rectal examination (DRE) and lack of imaging modalities in delivery settings. This special contribution explores the clinical, educational, and technological opportunities to improve early diagnosis, with a focus on integrating structured DRE scoring systems and emerging technologies such as impedance spectroscopy. We advocate for a shift from selective to routine postpartum screening and for urogynecology leadership in standardizing care pathways.

Introduction Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among reproductive-aged women. In Bahrain similar to other countries, the prevalence of PCOS in the general population is 5-10% Studies have shown that PCOS is associated with poor quality of life, anxiety, sadness, dissatisfaction with one's appearance, eating disorders and sexual dysfunction. However, the cause of these disorders remains unknown.This study aimed to investigate prevalence of psychological problems including generalized anxiety, depression impulsivity and borderline personality disorder, by using validated measures, in patients who have a confirmed diagnosis and treated for PCOS in a Gynecology clinic in Bahrain and compare these psychological conditions with an age-matched control group in the community. Materials This is a case-control study of women with PCOS attending the gynecology clinics at the King Hamad University Hospital in Bahrain. The sample size was estimated for the two-sided test with error probabilities of alpha of 0.05 and 90% power (b = 0.10). 90 cases were necessary (for each group/ patient and control) for powered analysis.Patients were selected from the hospital gynecology clinic using simple random sampling technique from the clinic list. The control group were age-matched woman in the community in Bahrain. The diagnosis of PCOS was confirmed using the Rotterdam criteria including ovarian ultrasound. The control group were excluded if they had psychiatric or physical health problems.Anthropometric, metabolic, hormonal, clinical, and psychological characteristics were examined in all subjects. Methods Each patient was evaluated by the following questionnaires: 1) GAD-7 (General Anxiety Disorder-7) to measure severity of anxiety 2) PHQ-9 (Patient Health Questionnaire-9) to confirm and measure severity of depression 3) Barratt Impulsiveness Scale (BIS‐11) to measure aggression 4) McLean Screening Instrument to identify Borderline Personality Disorders (MSI-BPD). Data were collected via a face-to-face interview in Arabic at the clinic by trained personnel. The study was approved by the Institutional Review Board. All scales used were validated in Arabic language. A written informed consent was taken from all participants. No specific information identifying specific participants was obtained. Results The rates of mild, moderate, and severe anxiety were 38%, 22%, and 14%, respectively in the study participants. The rates of mild, moderate, and severe depression were 41%, 22%, and 17%, respectively. The rate of borderline personality disorders was 5%. The rate of significant anger issues was 34%. All abnormalities were associated with high serum testosterone levels, but the correlation was not significant (p=0.7). The study findings are further depicted in tables 1,2. Conclusions 1. Bahraini women with PCOS have clinically higher rates of personality and psychiatric disorders than the general female population of the same age, owing to anxiety, depression, and anger issues.2. Our findings highlight the importance of a multidisciplinary approach to the care of women with PCOS. Screening for psychiatric disorders may be warranted in these women whether at the gynecology or endocrinology clinic to allow early detection and intervention.3. Gynecologists should include psychological assessment in their management plans because these psychiatric symptoms overlap with the physical symptoms of PCOS.

Background: Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It may be attributed to certain placental hormones during pregnancy which render insulin less effective. Our study aimed to focus on the levels of insulin in gestational diabetic women in the Kingdom of Bahrain as compared with non-diabetic pregnant women. Furthermore, we studied the correlation between insulin levels by ethnicity and age of the pregnant women. Methods: A cross-sectional study was conducted on 75 pregnant participants: 41 with GDM (test group) and 34 without GDM (control group). Insulin levels were determined in patients with GDM and compared to non-diabetic pregnant women. A comparison between Bahraini and non-Bahraini women was carried out in two different age groups: below and above 30 years of age. P values < 0.05 were considered significant. Results: The results showed higher mean values of fasting blood glucose (FBG), random blood glucose (RBG), and insulin levels in the test group when compared to the control group. There was no significant difference in FBG, RBG, and insulin levels among Bahraini women with GDM and non-Bahraini women (Indian, Pakistani. Bengali, and Filipino) with GDM. Age, less than 30 vs more than 30 years, had no significant effect on women with GDM. Conclusion: Insulin levels were higher in pregnant women with GDM irrespective of their ethnicity or age. The lack of blood glucose control in GDM even in the presence of high insulin secretion may suggest loss of insulin effectiveness due to other factors such as stress and lactogenic placental hormones.

[This corrects the article DOI: 10.7759/cureus.64886.].

Background Gestational diabetes mellitus (GDM) can be defined as hyperglycemia that develops during pregnancy. GDM poses both maternal and fetal potential risks. Elevated maternal cortisol levels have been linked to maternal hyperglycemia and insulin resistance. The present study aimed to investigate the relationship between GDM and serum cortisol levels in Bahraini and non-Bahraini pregnant women in the Kingdom of Bahrain. We also investigated the relationship between age and ethnicity in the development of GDM. Methods Data were collected from a total of 75 pregnant women; 41 of which were diagnosed with GDM and 34 had normal blood glucose levels. Serum cortisol, insulin, adrenocorticotropic hormone (ACTH), fasting (FBG), and random (RBG) blood glucose levels were measured. Results FBG, RBG, and insulin blood levels were significantly higher in the GDM group when compared to the control group. Serum cortisol and ACTH levels tended to be higher in the GDM group; however, they were statistically insignificant. Within the GDM group, there were no statistically significant differences in serum insulin, cortisol, and ACTH levels between Bahraini and non-Bahraini patients or between patients less than or more than 30 years old. Conclusion Our results suggest that cortisol may not have a major role in the development of GDM in our patients. Further research is needed to confirm these results. This study highlights the necessity to better understand the underlying mechanisms of the development of GDM in pregnant women.

Background:The COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU. Methods:This is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents' review, and calculation of online examination's psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes. Results:Quantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach's alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students' responses and review of documents. The examination was found to be feasible and of reasonable cost. Conclusion:Online OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students' physical examination skills.

Epidemiological research in the field of female sexual dysfunction (FSD) is mainly limited by the diagnostic dilemma because of the intricacy of the female sexual response. The problem might start since the beginning of the sexual life, or it might be acquired later after having a normal sexual life. Around 40% of women worldwide affected by FSD. The aim of this study is to determine the prevalence and sociomedical correlates of FSD in Bahrain and assess the consequences of the condition to investigate the public health burden of this condition and increase awareness amongst health care providers. Materials and methods: A hospital based two centers (Salmaniya medical complex and king Hamad university Hospital); cross sectional study was conducted in Bahrain on a consecutive sample of 255 women visiting 2 gynecology clinics. The main inclusion criteria were: married women and sexually active, aged 18-55 years who presented to the ambulatory clinic with general gynecologic complaints not related to sexual dysfunction. Pregnant, unmarried, and women aged less than 18 or more than 55 years were excluded from the study population. A validated female sexual function index questionnaire (English version) was self-completed by the women. Demographic, obstetric, medical, and socioeconomic data were collected. A cut off FSFI score <26.55 was used to define the presence of FSD. Results: The total number of patients encountered in the study was 255, 84% were Bahraini, 11.4% were Arabs and 4.5% were from other nationalities. The differences in population characteristics between the 3 subgroups was not significant. The majority of women had a university education (58.4%), worked as professionals (32.9%), had >2 deliveries (39.9%) and were non-smokers (97.6%). It was found that 60% of the participants were complaining of chronic pelvic pain, dysmenorrhea and / or sever premenstrual symptoms, while 11.3% and 2.9% of the study cohort answered having at least one episode of urinary and fecal incontinence over the last 12 months. The overall prevalence of FSD was 55.7%. Four general variables were studied among which age more than 50 years old was found significantly associated with FSD (P=0.01). There was a significant association between FSD and abnormal uterine bleeding (11.8%) and vaginitis (22%). The most significant effects on low FSFI score were pain, satisfaction, lubrication, orgasm, desire and arousal. Conclusion: FSD is a highly prevalent condition in married women attending a gynecology clinic in Bahrain with a significant adverse impact on their quality of life. FSD deserves more attention in the national agenda and should be a priority in women health care.

The Cochrane library first published a meta-analysis in 2000 on the role of the episiotomy in modern clinical practice, which concluded that only a policy of selective episiotomy is acceptable with evidence-based improvement in maternal health compared with routine episiotomy. Many years later, however, the new version of the Cochrane meta-analysis changed the previous recommendations in that the selective use of episiotomy could not be considered beneficial in all cases. A selective policy is associated with a statistically significant reduction in severe perineal and/or vaginal trauma, whereas routine episiotomy seems to protect against these complications only after instrumental deliveries. Both in the short and the long term, selective medio-lateral episiotomy has no additional beneficial effects without clear evidence of causing harm to the mother or baby.

Background: Infertility is found to be a major social and clinical problem, affecting 1 in 6 couples. Infertility should be diagnosed if a couple has tried natural, regular unprotected intercourse for twelve months without conceiving. Causes of infertility can be classified according to genders in which a male factor can be represented by sperm abnormalities while female factors may include anovulation, tubal pathology, in addition to combined female and male factors; furthermore, unexplained infertility would be the cause if all factors arc normal after investigations. Objective: To evaluate the most common causes of infertility from 2015-2016. Design: A Retrospective Study. Setting: Assisted Conception Clinic (ACC), Salmaniya Medical Complex, Bahrain. Method: Four hundred forty-one Bahraini patients diagnosed with infertility between years of 2015-2016 were included in the study. The data were documented from patients' records using predesigned data collection forms. Result: The mean duration of infertility was 5.02 years with a mean female age of 33.5 years. Secondary causes of infertility were found in 227 (51.5%) patients and primary causes in 214 (48.5%. Female causes were found in 252 (57%) and males causes in 77 (17.5%); causes in both male and female were found in 20 (4.5%). Unexplained causes found in 92 (20.8%). The major cause of females' infertility was anovulation, which includes Polycystic Ovarian Syndrome (PCOS), was found in 88 (20%), while Endometriosis was the least common cause, 8 (1.8%). Seventy-three (16.5%) had abnormal sperm analysis. One (0.2%) patient had abnormal Karyotyping. Conclusion: The mean duration of infertility was 5.02 years with a mean female age of 33.5 years. Female causes were 252 (57%); anovulation was the main cause. Male causes were found in 77 (17.5%). Secondary causes of infertility were found in 227 patients (51.5%) and primary causes in 214 (48.5%).

The purpose of the present study was to measure the plasma levels of matrix metalloproteinases (MMP)-2 and -9 and their tissue inhibitors (TIMP)-1 and -2, as surrogate biomarkers for pelvic floor tissue integrity in young, healthy multi-ethnic women. This was hoped to elucidate ethnic vulnerability to support-related pelvic floor dysfunctions. The plasma levels of MMP-2 and -9 and TIMP-1 and -2 were measured by sandwich ELISA in nulliparous, young (18-29 years) women volunteers (n=85) from five ethnic groups [n=17/group; Bahrainis, other Arabs, Filipinos, Indians/Pakistanis and Caucasians (Italians)] and compared with levels in Italians as the reference group. It was identified that the levels of plasma MMP-2 were significantly higher in Italians than in Bahrainis (P<0.001) and Filipinos (P<0.001), but significantly lower than in Indians/Pakistanis (P=0.013); whereas, the levels of plasma MMP-9 were significantly higher in Italians than in Bahrainis (P=0.009) and Indians/Pakistanis (P<0.015). The levels of plasma TIMP-2 were significantly lower in Italians than in Indians/Pakistanis (P=0.003), but the levels of plasma TIMP-1 were significantly higher in Italians than in all other groups (P<0.05) excluding Bahrainis. Although MMP-2 correlated negatively with TIMP-2 and MMP-9 correlated positively with TIMP-1, both correlations were not significant (r=0.071, P=0.533 and r=0.197, P=0.8, respectively). In all ethnic groups, MMP-9 level correlated positively with BMI (r=0.26, P=0.02), and TIMP-2 level with age (r=0.23, P=0.045). Overall, the trends for higher levels of MMP-2 and -9 and lower levels of TIMP-2 in the plasma of Caucasian women may indicate a greater tendency for collagenolysis and weaker connective tissue with increased risk of developing pelvic floor dysfunctions, and thus may potentially serve as biomarkers for pelvic floor tissue integrity.

OBJECTIVE:To study the prevalence of premenstrual dysphoric disorder (PMDD) symptom patterns among women in the United Arab Emirates and to measure the debilitating nature of PMDD symptoms and sociodemographic correlates.METHODS:This cross-sectional sample study used the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) and Premenstrual Symptoms Screening Tool (PSST) to screen for presence and severity of PMDD symptoms in Arab women attending ambulatory health services in Alain city, Emirate of Abu Dhabi, United Arab Emirates, for routine health care between May 2005 and September 2005.RESULTS:The study participants include 508 women (76% Emiratis, 15% Omanis, and 8% other Arabs) of childbearing age. In total, 94 women (18.6%) met MINI-Plus criteria for PMDD; of these, 21 (4.1%) met PSST criteria for severe symptoms, 29 (5.7%) for moderate symptoms, and 44 (8.7%) for mild or less symptoms. One woman (0.2%) with severe symptoms and 12 women (2.4%) with moderate symptoms had negative MINI-Plus scores. Presence of PMDD symptoms was significantly associated with higher education (P = .000), single marital status (P = .001), major life stressors (P = .001), and personal/family use of psychotropic medications (P = .000/P = .006), personal/family psychological problems (P = .000/P = .001), irregular/painful menses (P = .043/P = .001), and functional impairment on the Sheehan Disability Scale (P = .000). Multilogistic regression analysis showed higher education, major life stressor, personal use of psychotropic medications, personal/family psychological problem, and painful menses were independent predictors of PMDD symptoms.CONCLUSIONS:PMDD symptoms were common among the Arab women in our study. The cyclically triggered mood disturbances were clustered in women with personal/familial psychological problems, perhaps linking biologic constitution to genetic predisposition for the development of PMDD symptomatology.