Giuseppe Benagiano

Verified

Giuseppe verified their affiliation via an institutional email.

Learn more

Verified

Giuseppe verified their affiliation via an institutional email.

Learn more

• MD, PhD, FACOG(hon), FICOG(hon), FRCOG(ad eundem), HonSen(Szeged), DHC (Arad)
• Professor FR at Sapienza University of Rome

Gender‐based violence (GBV) comes in many different forms, including emotional, physical, economic, and cultural. Regardless of its form, it represents an evil that the international community must work hard to eliminate. A crucial step in eradicating men's violent behavior is implementing initiatives aimed at prevention. However, effective prevent...

Objectives: The aim of the study was to evaluate current practices among gynecologists in managing large endometriomas before in vitro fertilization (IVF). Design: A cross-sectional online survey was conducted. Participants/Materials: The survey was distributed to an estimated 410 gynecologists, with 111 specialists completing the survey (respon...

The optimal contraception dosing strategy proposed by Gavina et al. recently is a commendable attempt to model a complex physiological process with potenial to apply to real-life data. However, there is a need to take into account the real challenges that arise when moving from the theory to its practical application, and it is important that lesso...

On 19 July, 2024, at the age of almost 105 years, Joseph W. Goldzieher, the last survivor of the group of pioneers who created oral contraception, peacefully passed away. Here we briefly reconstruct the salient points in his long, productive life, and highlight his achievements in the development of hormonal contraception. His work is indissolubly...

Gender‐based violence (GBV) and, more specifically, violence against women (VAW) are commonly considered a consequence of a patriarchal structure—a social system granting the senior male absolute authority over the family and the community as a whole. Anthropologists have documented that human male dominance is rooted in evolution, with male violen...

Background: Thomas Cullen described bleeding abnormalities and dysmenorrhea as the “expected” presentations of adenomyomas. Adenomyosis is included within the FIGO classification of structural causes of abnormal uterine bleeding (AUB). Nevertheless, this long-standing association has been questioned by some authors who reported a high incidence of...

Background: There has been considerable progress in our understanding of endometriosis, but its pathophysiology remains uncertain. Uncovering the underlying mechanism of the rare instances of endometriosis reported in early postmenarcheal years and in girls before menarche can have wide implications. Methods: We conducted a literature review of all...

Purpose of Review The observation that retrograde menstruation is almost universal while only a small proportion of women suffer with endometriosis is among the most quoted challenges to Sampson’s hypothesis. Addressing this challenge has focused on identifying unique features in the endometrium of affected women. The assumption that endometriosis...

Open access: https://www.jmig.org/article/S1553-4650(24)00073-6/fulltext or click the DOI above. // Endometriosis research has not progressed at a pace in proportion to disease severity and the negative impact on women’s quality of life. Furthermore, advancement in our understanding of this condition requires a quantum shift based on new theories o...

In recent literature reviews, we concluded that the possibility that endometrial molecular aberrations are the sole or a necessary determinant of endometriosis and the Tissue Injury and Repair (TIAR) theory are yet to be convincingly proven. Here, we critically examine the theory that adenomyosis and endometriosis represent different phenotypes of...

Today, there is strong and diversified evidence that in humans at least 50% of early embryos do not proceed beyond the pre-implantation period. This evidence comes from clinical investigations, demography, epidemiology, embryology, immunology, and molecular biology. The purpose of this article is to highlight the steps leading to the establishment...

Most published research focuses on the amount of menstrual blood loss and, to a lesser extent, on cyclicity. Little attention has been paid to the duration of bleeding, the factors that enable its cessation within a ‘normal’ timeframe, or to patterns that entail interruption and resumption of blood loss. The definition of what constitutes normal re...

Unlabelled: The occurrence of vaginal bleeding in early neonatal life has been observed for centuries and was considered a consequence of the sudden drop in circulating hormones following birth. As such, neonatal uterine bleeding was dismissed as having no clinical significance. Interest in the phenomenon was renewed when a new theory suggested a...

As understanding their pathogenesis remains elusive, both endometriosis and adenomyosis are often referred to as “enigmatic diseases”. The uncertainty and heightened interest are reflected in the range of expressed views and opinions. There is a sense of urgency because of the entailed patient suffering. The plethora of opinions calls for a critica...

The terms clon/clone initially referred to the asexual propagation of any plant, mostly by replanting cuttings. It was subsequently extended to natural/asexual, molecular, cellular, and artificial reproduction.Reproductive processes in the animal kingdom are so diversified as to include cloning as a natural existing option. However, for mammals and...

Human males inherited an inherent violent behavior from their ape ancestors probably founded in the patriarchal structure that humans shared with the great apes. Inheriting, however, does not imply its inevitability, because such a violent behavior does not seem to be the product of the action of genes into behavior, and among great apes violent be...

Practically unknown outside of China, the “endometrial determinism” theory was proposed to account for the apparent gap between the relatively low prevalence of endometriosis and nearly universal retrograde menstruation. Attracting uncritical advocacy, the theory culminates in a recent consensus by elite Chinese gynecologists in favor of “root trea...

Adenomyosis is a complex and poorly understood gynecological disease. It used to be diagnosed exclusively by histology after hysterectomy; today its diagnosis is carried out increasingly by imaging techniques, including transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). However, the lack of a consensus on a classification system h...

Today, a diverse range of contraceptive techniques is available to women; this, coupled with continued positive trends in female children and adults’ educational attainment, will hasten declines in fertility and continue to slow population growth. [...]

Objective: Many women experience negative feelings during menstrual bleeding. Aim of the study was to evaluate the attitudes of Italian women towards menstrual bleeding, their desire to reduce its frequency and knowledge of the existence of methods capable of achieving such an objective. Methods: An internet-based anonymous questionnaire has bee...

Pregnant women and their partners often ask healthcare professionals whether sex is safe during pregnancy, and what consequences may result from sexual activity. Many clinicians can also be unsure of the answers to these type of questions, leading to both patient and clinician resorting to the internet for advice, which can be inaccurate and anxiet...

Religions continue to be a strong moral, even political, force in the world. They are often seen to be in conflict with women's health; we argue that this should not continue to be the case. The conflict can be traced back to when religions had their birth and early development in patriarchal communities in which women were marginalized to the edge...

Religions continue to be a strong moral, even political, force in the world. They are often seen to be in conflict with women's health; we argue that this should not continue to be the case. The conflict can be traced back to when religions had their birth and early development in patriarchal communities in which women were marginalized to the edge...

We undertook a literature review of the use of levonorgestrel-releasing intrauterine devices when utilized for heavy menstrual bleeding and/or dysmenorrhea

Some 150 years ago, pathologists identified “mucosal invasions” in peritoneal organs. The term “adenomyoma” was coined to refer to these epithelial lesions and the surrounding smooth muscle and stroma. Early descriptions featured rare and unusual presentations, but it became increasingly apparent that the presence of ectopic mucosa is relatively fr...

There is not a single true history of endometriosis because historians differ in how they process and synthesize past events. However, a history of endometriosis is distinct from that of symptoms such as pain or infertility which have multiple causes. Crucially, a history should focus on endometriosis as defined by its characteristic histological f...

Adenomyosis is defined by the presence of heterotopic endometrial glands and stroma embedded within the myometrium. The study of adenomyosis across different age groups confirms it as a disease of the adult woman. Whereas endometriosis can manifest in young adolescents and even before menarche, the rare juvenile cases of adenomyosis feature localiz...

Information on the development of ectopic endometrial foci during fetal life be deduced from the embryogenesis of the reproductive tract. It is possible that fragments of the Müllerian duct epithelium become displaced to adjacent sites, giving rise to ectopic foci. Congenital endometriosis also remains a possibility. The reported incidence of endom...

Transvaginal sonography is the first-line imaging technique to diagnose endometriosis, but magnetic resonance imaging is more accurate in staging the extent of lesions, especially for deep pelvic endometriosis. The revised American Society for Reproductive Medicine and Enzian classifications are commonly used to stage the extent of endometriosis. H...

Background: Adenomyosis is a common gynecological disorder traditionally viewed as "elusive". Several excellent review papers have been published fairly recently on its pathogenesis, and several theories have been proposed. However, the falsifiability, explanatory power, and predictivity of these theories are often overlooked. Since adenomyosis ca...

Purpose: To analyze the characteristics of the ovarian endometrioma (OE) across the life span of a woman. In the past, the OE has traditionally been viewed as a single, monolithic disease. Today, there are emerging data indicating that OE phenotypes differ according to the age of the woman. Method: A narrative review of original articles on OE i...

Bleeding in newborns and young girls fascinated writers for more than a millennium. Initially, there was confusion between neonatal bleeding, early menstruation due to precocious puberty, and hemorrhage due to disease. During the 19th century descriptions appeared of what is referred to today as ‘neonatal menstruation’ or ‘neonatal uterine bleeding...

This authoritative textbook provides a much-needed guide for postgraduate trainees preparing for the European Board and College of Obstetrics and Gynaecology (EBCOG) Fellowship examination. Published in association with EBCOG, it fully addresses the competencies defined by the EBCOG curriculum and builds the clinical practice related to these compe...

This authoritative textbook provides a much-needed guide for postgraduate trainees preparing for the European Board and College of Obstetrics and Gynaecology (EBCOG) Fellowship examination. Published in association with EBCOG, it fully addresses the competencies defined by the EBCOG curriculum and builds the clinical practice related to these compe...

Classically, the diagnosis of adenomyosis relied on histological examination of uteri following hysterectomy and classifications focused on the depth of endometrial invasion within the myometrium. There remain uncertainties around the cut-off point for the histological diagnosis. Imaging-based diagnosis enables recognition of the condition in women...

Over the last thirty years, evidence has been accumulating that Hypertensive Disorders of Pregnancy (HDP) and, specifically, Preeclampsia (PE) produce not only long-term effects on the pregnant woman, but have also lasting consequences for the fetus. At the core of these consequences is the phenomenon known as defective deep placentation, being pre...

Endometriosis in adolescence represents a specific variant of the disease with its own characteristics and, in some cases, even a possibly different pathogenesis. It has its own clinical presentation, diagnostic and therapeutic modalities. The condition is not rare as once thought and certainly deserves attention in view of increasing evidence of i...

Introduction: Following a historical overview, the effect of different contraceptive methods on vaginal microbiome has been reviewed and summarized. Areas covered: Effects of: combined hormonal contraceptives (oral or vaginal) and of progestin only (injectable and implantable), intrauterine devices/systems (copper- or levonorgestrel-releasing), on...

Through microscopy, early researchers identified the epithelium on the inner surfaces of the uterus, cervix and Fallopian tubes. The identification of ectopic epithelium was gradual, starting from the gross pathology study of unusual cystic lesions. Towards the end of the nineteenth century, attention focused on the epithelium as a critical compone...

Objective: Based on the hypothesis that neonatal uterine bleedings (NUB), occurring mostly in the first week after birth, could represent a pathogenetic mechanism for early-onset endometriosis, this systematic review (SR) was undertaken to evaluate the prevalence and screening strategies used to assess and quantify NUB. Design: Both a SR and a s...

There is emerging evidence that early uterine development in humans is an important determinant of conditions such as ontogenetic progesterone resistance, menstrual preconditioning, defective deep placentation and pre-eclampsia in young adolescents. A key observation is the relative infrequency of neonatal uterine bleeding and hormone withdrawal at...

Introduction: The contraceptive activity of synthetic progestins is mediated through three basic mechanisms: (a) An anti-gonadotrophic action leading to the inhibition of ovulation; (b) Changes in cervical mucus characteristics that inhibit sperm penetration and (c) desynchronization of the endometrial picture necessary for implantation. Areas co...

Based on a variety of tissue samples, including Caesarean hysterectomy specimens with the placenta in situ, a detailed map of uteroplacental vascular lesions was established in over a century of research. One such lesion is acute atherosis of unremodelled basal and uteroplacental arteries, defined by the presence of fibrinoid necrosis, subendotheli...

Context Whether endometriosis is a progressive disease is a highly contentious issue. While progression is reported to be unlikely in asymptomatic deep endometriosis, progression in symptomatic deep endometriosis has recently been reported, especially in menstruating women. However, pathophysiological reasons for these differences are unclear. Obj...

The availability of non-invasive diagnostic tests is an important factor in the renewed interest in adenomyosis, as the disease can now be more accurately mapped in the uterus without a need for hysterectomy. An agreed system for classifying and reporting the condition will enhance our understanding of the disease and is envisaged to enable compari...

Introduction: Steroid hormones are responsible for specific changes in the endometrium during the menstrual cycle, when they are sequentially secreted and, because of this, in the early days sequential combined oral contraceptive regimens were utilized. The same basic concept has been utilized with multi-phasic regimens, in order to produce endomet...

Research on the placenta as the interface between the mother and the fetus has been undertaken for some 150 years and in two subsequent reviews, we attempted to summarize the situation. In the first part, we described the discovery of unique physiological modifications of uteroplacental spiral arteries enabling them to cope with a major increase in...

The term placental bed was coined to describe the maternal-fetal interface (ie, the area in which the placenta attaches itself to the uterus). Appropriate vascularization of this area is of vital importance for the development of the fetus; this is why systematic investigations of this area have now been carried out. Initially, the challenge was th...

Autoimmune diseases (AIDs) affect women and men with a 2:1 ratio, which suggests that hormonal contraceptives play a role in their clinical course. Combined oral contraceptives have complex, sometimes contradictory, effects on AIDs; they can worsen the situation in women with systemic lupus erythematosus and with anti-phospholipid syndrome, conditi...

Background: We reviewed published cases of uterus-like mass (U-LM), endomyometriosis, polypoid adenomyoma (PA), adenomyomatous polyp, atypical PA (APA), and adenomyoma. Search methods: PubMed, Medline, and Scopus searches of all cases published in the databases till November 26, 2018. Results: We identified 45 case reports of U-LM in the pelvi...

Autoimmune diseases (AIDs)are a heterogeneous group of disorders in terms of clinical manifestations, pathogenesis, and prevalence, and there is no agreement to date on a common classification. Adaptive immune responses are responsible for the existence of AIDs, although innate immunity is also involved in misguiding the immune response against sel...

We explore the potential role of the endothelial lining of uteroplacental arteries in the pathogenesis of preeclampsia, a severe pregnancy disorder characterized by incomplete invasion of the uterine vasculature by extravillous trophoblast and angiogenic imbalance. In normal pregnancy, the endothelium disappears progressively from the uteroplacenta...

Uterine fibroids are the most common gynecological disorder, classically requiring surgery when symptomatic. Although attempts at finding a nonsurgical cure date back to centuries, it is only around the middle of the last century that serious attempts at a medical treatment were carried out. Initially, both progestins and estrogen–progestin combina...

Introduction: Following a historical overview, the ovulation-inhibiting effect of various orally-administered estrogen-progestin combinations (COCs) are examined for their components alone or in the various combined formulations. Special emphasis is given to products containing natural estrogens. Areas covered: Inhibition of ovulation with progesti...

Preeclampsia is an important cause of maternal and perinatal morbidity, especially in first-time pregnant adolescent women. Although prevention of preeclampsia has been attempted for many decades, effective intervention can only be achieved upon the full elucidation of the risk factors and mechanisms of disease. As the pathogenesis of preeclampsia...

After some 60 years of ever-increasing utilization, hormonal contraception (HC) has made a major impact in the lives of women worldwide. This chapter discusses the different meaning that family planning has taken today in industrialized and in developing countries, the reason being that in the former fertility is almost always at, or below, replace...

To confirm the origin of cancer found in both the endometrium and the myometrium is difficult. Cancer may spread from the endometrium into adenomyotic foci or vice versa. Also, premalignant changes may arise at either or both sites. Investigating disease origin enhances our understanding of pathophysiology and prognosis. Additional critical questio...

Neonatal uterine bleeding (NUB), or neonatal menstruation is today a totally neglected phenomenon, labelled as “perfectly normal and therefore not worth investigating”. Yet, over the last two centuries, its frequency, characteristics and pathophysiology have been carefully investigated, leading to the conclusion that its occurrence is a strong mark...

Introduction and hypothesis: We reviewed reported cases of endocervicosis, endosalpingiosis, and müllerianosis of the bladder or ureters in women in order to highlight these conditions as distinct from endometriosis or adenomyosis. Methods: Medline and Scopus searches of all cases published till the October 1, 2017. All retrieved references were...

Unintended pregnancy is a public health concern throughout Europe. There is no common definition and no standard way to measure unintended pregnancy. Identifying unintended births is difficult and prevalence estimates vary depending on how and when the question is asked. Abortion rates are not a proxy and are themselves notoriously inaccurate. An e...

Aim: The present paper intends in the first place to clarify the confusing terminology for describing the vascular pathology of the placental bed in relation to long-term risk of cardiovascular disease. Methods: Systematic review of relevant topics. Results: The maternal blood supply to the placenta is achieved by some 100 utero-placental spir...

Increasing evidence indicates that early onset endometriosis (EOE), starting around menarche or early adolescence, may have an origin different from the adult variant, originating from neonatal uterine bleeding (NUB). This implies seeding of naïve endometrial progenitor cells into the pelvic cavity with NUB; these can then activate around thelarche...

Worldwide, 200 million girls and women have been estimated as living with female genital mutilation/cutting. Today, this phenomenon does not only concern the countries where this practice is widespread, but also in many other nations where the immigrant female population comes from the countries with high prevalence, or is clandestinely practiced i...

Introduction: The pharmacodynamic effects of various combined oral estrogen-progestin combinations (COC) are examined for their components alone or in the various combined formulations. Special emphasis is given to products containing natural estrogens. Areas covered: Recent information on the effect of androgens, estrogens, progestins, as well as...

Pregnant nulliparous adolescents are at increased risk - inversely proportional to their age - of major obstetric syndromes, including preeclampsia, fetal growth restriction and preterm birth. Emerging evidence indicates that biological immaturity of the uterus accounts for the increased incidence of obstetrical disorders in very young mothers, pos...

Background: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare, life-threatening event, particularly relevant to women with endometriosis or deciduosis. Methods: To determine the type of lesions leading to SHiP, a literature search was conducted among all published SHiP cases. From a total of 1,339 publications, information on pathological...

We present a review of available diagnostic tools for adolescent endometriosis, a condition that may have a different pathogenesis than the adult form and therefore necessitates specific methodologies. The new theory provides that endometrial stem/progenitor cells in neonatal uterine bleeding may be causally linked to early-onset endometriosis, the...

There continues to be debate over the nature and progression of ovarian endometriomas in adolescence due to the possibility that they may have a different origin and to the impossibility to be able to predict progress. The hypothesis of a different origin traces its roots in the phenomenon called “neonatal menstruation” (NUB), occurring in approxim...

Neonatal uterine bleeding (NUB) has been carefully studied in the past through case reports, small series, clinical cohort studies, pathology investigations of fetal and neonatal. Following a historical recount, this review summarizes biological mechanisms conditioning NUB, starting from the persistence till birth of an 'ontogenetic progesterone re...

Introduction: The risk-benefit profile of any pharmacologic agent must be evaluated against risks connected with the events to be avoided. This is especially true in the case of hormonal contraception, not intended to combat a disease. Over the six decades during which their use has progressively expanded, the risk-benefit profile of combined oral...

Objective: To analyze adherence to an oral contraceptive (OC) regimen and correlate results to participants’ socio-demographic and behavioral characteristics. Methods: Women were prospectively enrolled and followed for 6 months. At enrollment, subjects were given a card for recording daily pill intake; its completion was checked at 6 months when wo...

If and how endometriosis impact on obstetric outcome are two questions that have generated considerable debate in recent years—with limited cohort and large population studies often arriving at different answers. A new population-based study from Glavind and colleagues (1) seems to settle the “if” question. Analysis of 82,793 singleton pregnancies...

Objectives: The aim of the study was to retrieve data on the characteristics and profile of women attending an emergency service (ES) to receive a prescription (mandatory until May 2015) for emergency contraception (EC). Methods: In a retrospective study the following data were collected for all women requesting EC between January 2014 and June 201...

Introduction: Treatment of ovarian endometriomas is commonly achieved through laparoscopic surgery and this can be effective in eliminating the disease, although a majority of recent trials documented an adverse effect of surgery on ovarian reserve markers. With the advancement in imaging techniques, ovarian endometriomas are increasingly diagnosed...

Neonatal uterine bleeding (NUB) occurs in approximately 5% of newborns and is generally considered to be of little clinical significance. However, the real clinical importance of this condition and its long-term implications remain to be determined. The reason why NUB is rare despite high circulating levels of progesterone can be attributed to a pr...

Objective: To evaluate existing evidence of a possible association in women with endometriosis between controlled ovarian hyperstimulation plus embryo transfer (COH-ET) and the occurrence of spontaneous hemoperitoneum in pregnancy (SHiP). Design: Comprehensive review. Setting: Not applicable. Patient(s): None. Intervention(s): An electroni...

As of today, there is no proof that the ovarian endometrioma in an adolescent represents a progressive condition, although evidence is accumulating that active management of this phenotype of endometriosis is warranted. Indeed, although symptoms will often start at a young age, even before menarche, a major delay between their onset and final diagn...

Accumulating evidence indicates that adolescent endometriosis is common and often severe. Here we explore the possibility that seeding of naive endometrial progenitor cells into the pelvic cavity early in life, that is, at the time of neonatal uterine bleeding or soon after the menarche, results in more florid and progressive disease, characterized...

Management of ovarian endometrioma is a matter of debate between those advocating early treatment and those believing that cysts less than 3 cm in diameter should not be submitted to surgery. To explore a new approach to its management capable of preserving future fertility, the molecular pathology of ovarian endometrioma is reviewed and mechanisms...

Although adenomyosis has been linked to hyper-estrogenism and with increased endometrial “invasiveness”, whether adenomyosis predisposes to endometrial cancer remains a matter of debate. Literature contains few case reports of cancer identified solely in the ectopic endometrium within the myometrium. The origin of cancer detected in both eutopic an...

This useful book examines the full spectrum of data available on uterine adenomyosis, covering early to modern literature. The authors look at the recent scientific advancements in the pathophysiology of this disease, giving the reader insight into its diagnosis before hysterectomy and its clinical impact on fertility. Uterine Adenomyosis is an in...

The default for the Commenting tool bar is set to 'off' in version 9. To change this setting select 'Edit | Preferences', then 'Documents' (at left under 'Categories'), then select the option 'Never' for 'PDF/A View Mode'. (Changing the default setting, Adobe version 9) To make annotations in the PDF file, open the PDF file using Adobe Reader XI, c...

For more than a century the diagnosis of adenomyosis was only possible through pathological examination of hysterectomy specimens but this has changes with the introduction of transvaginal ultrasound and MRI. Despite the large number of published studies reporting on the incidence and the clinical correlates of adenomyosis, there is no agreement on...

Classically adenomyosis is defined by the presence of ectopic endometrial glands surrounded by ‘hyperplastic-hypertrophic myometrium’. Whilst there remains disagreement on the definition and diagnostic criteria, the diagnosis of adenomyosis by modern imaging relies on the identification of features that distinguish the inner from the outer myometri...