Disorders of sexual development (DSD) defined as congenital conditions associated with atypical development of anatomical, gonadal or chromosomal sex, is a rare condition that may present with ambiguous genitalia. Included in the varied classes of DSD is mixed gonadal dysgenesis which is known to be due to mosaicism, a chromosomal aberration. Mosaic individuals may have concerns on growth, hormone balance, gonadal development, sex of rearing and fertility. This case report presents an 18-year old student who presented with primary amenorrhea, delayed secondary sexual characteristics and phenotypic features of Turner syndrome who, on chromosomal analysis revealed 45X0/46XY mosaicism. The patient underwent operative laparoscopy with bilateral gonadectomy on the basis of the increased risk of development of gonadal malignancy in phenotypic females with Y-chromosome material. Histopathological analysis revealed bilateral streak gonads. Hormone replacement therapy was then initiated for the induction of secondary female sex characteristics, as treatment for estrogen deficiency, for the induction of pubertal growth spurt and for optimization of bone mineral accumulation. Management of disorders of sexual development is challenging, thus the need for a multidisciplinary approach involving experts in endocrinology, gynecology, psychology and genetics.
GONADAL DYSGENESIS, MIXED ; MOSAICISM ; TURNER SYNDROME ; CASTRATION

Objective: This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. Materials and Methods: MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. Results: A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE. Conclusion The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
COVID-19 ; Personal Protective Equipment ; Telemedicine

Herlyn Werner Wunderlich Syndrome is a rare congenital Mullerian anomaly that commonly presents with uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. Presented here is a rare variant with contralateral dysplastic kidney with ectopic ureteral insertion instead of renal agenesis. The patient initially presented as a case of recurrent pelvic inflammatory disease who eventually underwent excision of vaginal septum with drainage of pyocolpos. Postoperatively, the patient had urinary incontinence and was eventually referred to Urology for further surgical intervention. The wide range of symptomatology and the uncommon anatomic presentation of this case led to the delay in the diagnosis and the consequent gynecologic complications.
Uterine Anomalies

OBJECTIVE: This study aimed to determine the efficacy of evening primrose oil versus dinoprostone gel as a cervical priming agent prior to operative hysteroscopy.

METHODOLOGY: Nine patients were randomized to receive either oral Evening Primrose Oil 1000mg/capsule one capsule three times a day for 7 days (n=4) versus 500 mcg intracervical dinoprostone gel 12 hours (n=5) prior to the procedure. The primary outcome measures were baseline cervical width prior to operative hysteroscopy. The secondary outcomes were surgeons' subjective assessments of insertion difficulty, number of patients requiring cervical dilatation, duration of cervical dilatation, pre-operative pain, adverse effects and complications.

RESULTS: Both agents, Evening primrose oil and dinoprostone gel, were effective for cervical dilatation with a mean cervical diameter of 8.0 ± 1.4mm and 8.2 ± 1.3mm, respectively (P=0.832). There were no significant difference in the mean cervical diameter, ease of insertion of operative hysteroscope, time required for and number of patients requiring cervical dilatation. More patients in the dinoprostone complained of hypogastric pain prior to the procedure. No perioperative complications were observed in both groups.

CONCLUSION: Both oral Evening primrose oil and intracervical dinoprostone gel were equally effective in inducing proper cervical priming prior to operative hysteroscopy. Nevertheless, Evening primrose oil may be superior due to its oral route, reduced cost, patient convenience and acceptability.

OBJECTIVE

This study aimed to determine the efficacy of evening primrose oil versus dinoprostone gel as a cervical priming agent prior to operative hysteroscopy.

Nine patients were randomixed to receive either oral Evening Primrose Oil 1000mg/capsule one capsule three times a day for 7 days (n=4) versus 500 mcg intracervical dinoprostone gel 12 hours (n=5)prior to the procedure. The primary outcome measures were baseline cervical width prior to operative hysteroscopy. The secondary outcomes were surgeons' subjective assessments for insertion difficulty, number of patients requiring cervical dilatation, duration of cervical dilatation, pre-operative pain, adverse effects and complications.

Both agents, Evening primrose oil and dinoprostone gel, were effective for cervical dilatation with a mean cervical diameter of 8.0+1.4 mm and 8.2+1.3 mm, respectively (P=0.832). There are no significant difference in the mean cervical diameter, ease of insertion of operative hysteroscope, time required for and number of patients requiring cervical dilatation. More patients in the dinoprostone complained of hypogastric pain prior to the procedure. No perioperative complications were observed in both groups.

Both oral Evening primrose oil and intracervical dinoprostone gel were equally effective in inducing proper cervical priming prior to operative hysteroscopy. Nevertheless, Evening primrose oil may be superior due to its oral route, reduced cost, patient convenience and acceptability.

Premature pubarche is the development of pubic hair without the development of other secondary sexual chacteristics before the age of 8 in girls. Traditionally, considered to be benign, premature pubarche has been associated with polycystic ovarian syndrome and the metabolic syndrome. This is the case of a 7-year-old female with warty lesions on the right thumb and labia majora, and an incidental finding tanner stage 2 pubic hair. 17-OHP and testosterone levels were normal, DHEAS level at the pubertal range. Her clinical profile places her at risk, and as such, monitoring is warranted for early detection of polycystic ovarian syndrome and metabolic syndrome in the future.
Human ; Female ; Child ; POLYCYSTIC OVARY SYNDROME ; WARTS

Objective: The purpose of this study was to determine the efficacy of Evening Primrose Oil as a cervical ripening agent when used prior to operative hysteroscopy. Study Design: A randomized, double-blind, placebo-controlled trial included a total of 42 patients randomly assigned to the Evening Primrose Oil group (24) and to the placebo group (18). The primary outcome was initial cervical dilatation prior to hysteroscopy. The number of patients requiring cervical dilatation and duration of cervical dilatation to Hegar dilator size 10 were included as secondary outcomes. Results: There was a statistical and clinically significant difference between the initial cervical dilatation in the treatment and placebo groups (7.81 mm vs. 4.33mm). All patients in the placebo group required cervical dilatation prior to hysteroscopy while only 47.62 percent of patients in the treatment group required any dilatation. It took an average of 53.56 seconds to dilate the cervix to Hegar size 10 in the placebo group compared to 17.43 seconds in the treatment group. Conclusion: Similar to trials in pregnant patients, this study proved that Evening Primrose Oil can be used as a cervical priming agent prior to gynecologic procedures.
EVENING PRIMROSE OIL ; CERVICAL PRIMING ; HYSTEROSCOPY

The Sex or sexuality is very complex subject. From a biological standpoint, the appearance of the external genitalia is only one parameter. Complete androgen insensitivity syndrome (CAIS), the most common form of male pseudohermaphroditism, embodies the multifaceted nature of this concept. Patients usually present with 46, XY karyotype with bilateral testes, female external genitalia, a shortened vagina, absent or rudimentary mullerian derivatives, normal breast development, and absent or scant pubic and axillary hair, as was the case in the patient presented herein. Prevalence ranges from 1 :20,400 to 1 :62,400 births. Its management often requires a multidisciplinary approach. Aside from addressing health risks, the psychosexual, social and ethical aspects of this condition should also be dealt with.
ANDROGEN INSENSITIVITY SYNDROME

A case of Partial Androgen Insensitivity Syndrome in a 21 year old woman who underwent bilateral gonadectomy and postoperative estrogen therapy is presented.
Human ; Female ; Young Adult ; ANDROGEN-INSENSITIVITY SYNDROME ; DISORDERS OF SEX DEVELOPMENT