Purpose: Polycystic Ovary Syndrome (PCOS) is a multifaceted endocrine-metabolic condition affecting around 5–15% of women globally. Despite its prevalence and diverse impact, the psychological aspect of PCOS is often underestimated in clinical settings, leading to significant distress among affected individuals. This study aimed to explore the extent of body image perception disorders, psychological comorbidities, and their influence on the health-related quality of life (HRQOL) in women with PCOS. Additionally, we focused on measuring the impact of factors associated with PCOS, particularly obesity, to gain a more comprehensive understanding of their effects. Methods: An online survey was distributed anonymously to gynecologists, hospitals, and women’s clinics across Austria, Germany, and Switzerland, as well as through social media platforms to connect with women with PCOS. The survey was conducted from November 14, 2023, to February 05, 2024. HRQOL, anxiety/depression levels, body image and self-esteem were assessed employing the Modified-PCOS-Questionnaire (MPCOSQ), Hospital Anxiety and Depression Scale (HADS), Multidimensional Body-Self Relations Questionnaire Appearance Scales (MBSRQ-AS) and Rosenberg Self-Esteem Scale (RSE) respectively. Identification of potential confounding variables relied on their plausibility and association with the estimate. Adjusted odds ratios and their respective 95% confidence intervals were computed through regression analysis. Results: 587 participants fully completed the questionnaire. The study participants were on average 32.5 ± 5.9 years old and had a BMI of 31.3 ± 7.8 kg/m². In this study, 84.5% of all PCOS patients exhibited pathological scores in the MBSRQ-AS Appearance Evaluation, 83.8% in Body Areas Satisfaction, and 67.5% in Overweight Preoccupation. Half of the participants (46.7%) showed significantly poor results in the RSE, indicating low self-esteem. A notable portion of the study participants displayed elevated HADS scores, which supports a higher rate of distress in PCOS patients. (HADS-Anxiety > 8: 75.0% (440); HADS-Depression > 8: 57.6% (338). Examining the HRQOL of PCOS patients revealed that all average scores of the subscales, except for the Acne subscale and MPCOSQ-Total (3.6 ± 1:0), were situated in the lower half, indicating diminished HRQOL. The linear regression revealed that pathological values in the MBSRQ-AS, indicating impaired body image, were associated with low scores in the MPCOSQ subscales and HADS scales, suggesting impaired HRQOL and a higher rate of distress in PCOS patients. Furthermore, the multivariate analysis showed a statistically significant link between adverse body perception and HRQOL, as well as distress among PCOS patients in this study group. [multivariate HADS-Anxiety: MBSRQ-AS Body Areas Satisfaction (B: − 2.10; CI: − 3.88; − 0.33; p = 0.02) HADS-Depression MBSRQ-AS Body Areas Satisfaction (B: − 1.92; CI: − 3.59; − 0.26; p = 0.02)]. Conclusion: Our findings reveal that obesity and a negative body image are interconnected factors that adversely affect both HRQOL and mental health in women with PCOS. Healthcare professionals should recognize the negative effects of obesity and poor body image in patients with PCOS and proactively provide effective treatment options.

Background: Pelvic organ prolapse constitutes a prevalent condition associated with a considerable impact on the quality of life. The utilization of transvaginal mesh surgery for managing POP has been a subject of extensive debate. Globally, trends in TVM surgery experienced significant shifts subsequent to warnings issued by the FDA. Methods: This study aims to explore temporal patterns in transvaginal mesh surgery in the German healthcare system. A comprehensive analysis was conducted on in-patient data from the German Federal Statistical Office spanning 2006 to 2021. A total of 1,150,811 operations, each associated with specific codes, were incorporated into the study. Linear regression analysis was employed to delineate discernible trends. Results: The trends in transvaginal mesh surgery within the anterior compartment exhibited relative stability (p = 0.147); however, a significant decline was noted in all other compartments (posterior: p < 0.001, enterocele surgery: p < 0.001). A subtle increasing trend was observed for uterine-preserving transvaginal mesh surgery (p = 0.045). Conclusion: Surgical trends over the specified timeframe demonstrate how POP management has evolved globally. Notably, despite observed fluctuations, transvaginal mesh surgery remains a viable option, particularly for specific cases with a high risk of relapse and contraindications to alternative surgical approaches.

PCOS is one of the most prevalent endocrine disorders among women of reproductive age, often involving obesity, insulin resistance, and mental health challenges that reduce health-related quality of life (HRQOL). Although metformin has been shown to improve HRQOL in PCOS patients, it is unclear whether this effect is due to the drug itself or its metabolic benefits. This study included 66 PCOS patients from the University Medical Center Mainz, in two groups: 31 received metformin (M-group) and 35 received alternative or no treatment (C-group). HRQOL and distress were assessed at baseline and after 6 months using the Modified PCOS-Questionnaire (MPCOSQ) and the Hospital Anxiety and Depression Scale (HADS). At baseline, the M-group had significantly worse metabolic markers, including HOMA-IR, waist circumference, Visceral Adiposity Index, and Fatty Liver Index. By follow-up, this group showed greater improvements in these markers. However, both groups improved similarly in HRQOL and distress. Regression analysis revealed that improvements in HOMA-IR and BMI were associated with better HRQOL scores. Group assignment was not a significant predictor. These findings may indicate that improvements in HRQOL and reduced distress are linked to metabolic changes associated with metformin use, underscoring the potential relevance of addressing metabolic health in treatment approaches.

Klippel–Trénaunay syndrome (KTS) is a rare congenital disorder defined by a triad of capillary malformation, venous malformation, and soft tissue or bone hypertrophy most commonly affecting unilateral lower limbs. Due to the rarity of KTS, evidence‐based guidelines for the management of pregnancy in people with KTS are still lacking. A 34‐year‐old woman (gravidity 1; parity 0) presented at 25 weeks of gestation with malformations of the right side of her body. The extent of the KTS affecting the vulva, pelvis, and right leg was remarkable. As the prenatal MRI showed massive vascular malformations of the pelvis and vulva, we performed an elective cesarean section to avoid severe perinatal hemorrhage during a vaginal delivery. Intraoperatively, we observed varices on the parietal peritoneum within the vesico‐uterine pouch and the isthmocervical transition of the uterus, which were not identifiable in the preoperative MRI. Although KTS patients have been discouraged from pregnancy in the past because of a high risk for complications, successful and uncomplicated pregnancies are possible. For this purpose, we believe a multidisciplinary strategy that is crucial.

Background: Enhanced Recovery After Surgery (ERAS) protocols improve postoperative outcomes and promote multidisciplinary, evidence-based perioperative care. However, ERAS adoption in gynecological departments remains inconsistent, and the underlying implementation challenges are poorly understood. Objective: To identify key barriers, facilitators, and preferred implementation strategies influencing ERAS adoption in German gynecological departments, and to assess whether clinicians’ ERAS knowledge or institutional certification shapes these perceptions. Methods: We conducted a nationwide, web-based cross-sectional survey of gynecologic clinicians in Germany. The questionnaire assessed ERAS-related knowledge, current implementation status, and perceived barriers, facilitators, and strategies. Statistical analyses included equality of proportions tests, logistic regression, and internal consistency measurement. Results: A total of 116 clinicians participated; 66 provided data on barriers and 64 on facilitators and strategies. Only 37.9% reported routine ERAS use. The most frequently identified barriers were limited ERAS knowledge (40.9% “very important”) and insufficient personnel resources (40.9%). The strongest facilitators were improved patient well-being, reduced morbidity, and higher patient satisfaction (each >60% “very important”). High-impact implementation strategies included informational materials, workshops, and online training. Well-informed clinicians had significantly higher odds of reporting a positive professional impact of ERAS (OR = 9.0, p = 0.001). Conclusions: ERAS implementation in gynecological settings remains restricted by staff knowledge gaps and personnel limitations. Patient-centered benefits and interactive educational strategies serve as powerful facilitators. Enhanced staff education and multidisciplinary support structures may substantially improve ERAS uptake and contribute to greater professional satisfaction among clinicians.

Polycystic Ovary Syndrome (PCOS) is a multifactorial condition that can include a myriad of symptom complexes. A study in North America demonstrated that a significant percentage of physicians were unaware of crucial aspects of PCOS. This study aimed to examine the level of knowledge about PCOS among physicians in Germany. An anonymous cross-sectional online questionnaire was distributed to all gynecological clinics and fertility centers in Germany. The responsible gynecologists in service were contacted and they were asked to distribute the questionnaire among the employed physicians in their clinic. The questionnaire was completed 206 times. 92 (65.7 %) of all respondents were board-certified gynecologists without specialty training in reproductive medicine and gynecologic endocrinology (Non-RMGE), 48 (34.3 %) had completed this training (RMGE). RMGE were more likely to know the correct criteria for the diagnosis of PCOS (97.9 % vs. 51.3 %; p < 0.001) and were able to name a higher number of correct symptoms that may be associated with PCOS (20.8 vs. 14.0; p < 0.001) than Non-RMGE (B = 4.530, CI 1.379–7.680; p = 0.006). The preferred general treatments and fertility treatments for PCOS patients also differed significantly between the two groups (p = 0.002, p < 0.001). The participants were asked how doctors and healthcare professionals could be best supported to improve the care of PCOS patients. Over 58.3 % of participants considered the creation of a PCOS website dedicated to healthcare professionals to be valuable. This study is the first to identify knowledge gaps about PCOS among physicians in Germany. The findings also highlight the potential disparities in PCOS knowledge between hospital and fertility center settings, emphasizing the need for improved training to ensure consistent and high-quality care for PCOS patients. The participants preferred a dedicated website for health professionals, indicating a demand for easily accessible information and training resources.