The experience of pregnancy, accompanied by physical and emotional changes, will have an impact on the couple's sexuality. The purpose of this study is to focus on the issue of sexuality during pregnancy, to look at its variations and describe the different changes in sexual parameters. In our study about 170 cases, 91.76% continue to have sexual intercourse during pregnancy, 7.6% thought it could be responsible for miscarriages, infection or bleeding in 26% and 20% respectively. The main reason for the continuation of the sexual intercourse was looking for husband’s pleasure and the preparation and facilitation of delivery. In contrast, female pleasure was expressed in only 4% of women, discomfort at the time of the sexual act dominated the reasons for which sex was stopped or spaced. There has been a gradual downward trend in most sexual parameters: frequency of sexual intercourse, sexual desire, sexual satisfaction, and frequency of orgasm.

Background: The clinical reasoning is expressed daily in the ability to solve clinical problems of patients. Its supervision is essential to establish an individualized educational plan that encourages its development. Objective: To analyze the impact of clinical reasoning learning sessions as remediation strategy of clinical reasoning difficulties. Method: exploratory retrospective study of medical students analyzing the difficulties of clinical reasoning and pedagogic practice of supervision promoting its development through the introduction of clinical reasoning learning sessions guided by a course book and grids evaluation as remediation strategy. Results: After the application of our supervision model of the clinical reasoning, 94.6 % of students were satisfied. They thus suggested the introduction of clinical reasoning evaluation before clinical examinations 7th year. Conclusion: the introduction of clinical reasoning learning sessions both in diagnosis and remediation of difficulties reasoning proves a real need. It would be appropriate to propose models applicable in other disciplines and to integer its evaluation in university program of internship

Juvenile granulosa tumor is a sex cord stromal tumor extremely rare, with usually estrogenic effects, while virilizing form is exceptional, often discovered at a stage confined to the ovary, justifying therefore a conservative treatment. Its prognosis appears favorable, depending on early management. However, its evolvement may be hampered by early and aggressive recurrence.
We report a new case compiled in Obstetrics Gynecology Service (HMIMV) of virilizing form of juvenile granulosa cell tumors, discovered during a recent exacerbation of a preexisting androgen syndrome in a girl of 24 years. It's extreme rarity prompted us to report it highlighting, through a literature review, its diagnostic features, therapeutic and evolutionary.

The neurofibromatosis type 1 (NF1) or von Recklinghausen's disease is an autosomal dominant disease. The association of NF1 to breast cancer is unusual and rarely r eported in literature. We report a case of this rare association. The discovery of breast cancer at a 51 years old patient in an advanced stage (T3N1M0), occasioned the appearance of dermatological lesions which are pathognomonic of neurofibromatosis1. Monitoring of patients with neurofibromatosis type1 seems justified to detect Early a possible association to breast cancer.

Bowen vulvar disease is defined as squamous cell carcinoma strictly intraepithelial, it's a viral infection which mostly affects postmenopausal women. It can be associated to other lesions specially gynecological cancers. The diagnosis is essentially histological. The evolution can go to invasion. Its treatment is based on surgery. We report the case of a female patient of 46 years, who consulted for a vulvar ulceration range of 5 cm in diameter, treated with wide excision, the histological examination is in favor of Bowen's disease. Through a review of litterature, we focus on the clinical, evolutionary and therapeutic features of this pathology.

Ovaries are a frequent site of metastasis of the breast cancer. The annexielles metastases of breast cancer often present as a challenge for diagnosis and therapeutic.. Distinction between ovarian metastasis and primary ovarian cancer may sometimes be difficult. The surgical resection tends to increase survival a surgical option should consist of at least bilateral oophorectomy, even when the contralateral ovary appears to be normal. We presente cas of patient of 36years old female, followed by breast cancer since 2011 stade 1 initially (T1N1Mx), was underwent Patey (infiltrating ductal carcinoma) followed radiotherapy and chemotherapy, hormonotherapy, four years later the patient complaint of abdominal distention, abdominal ultrasound showed ovarian masse then open laparoscopy was done, left adnexectomy was realized and finally histological diagnosis revealed Ovarian metastasis of the breast cancer.

The obesity, factor of morbimortalite, is considered as a real health public problem. In gynecology, its consequences on the fertility and the contraception are sever and the obesity is at the origin of important obstetric complications that must make consider these pregnancies as at risk. Our practices have to take into account these complications by assuring an adapted and premature care to improve the maternal and neonatal outcomes.

Feto-maternal red cell alloimmunization is defined by the presence in a pregnant woman of alloantibodies directed against blood group antigens present on the red blood cells of the fetus and inherited by the father. It arises from the immune response to a first contact to these same antigens during a prior transfusion, transplant or pregnancy. The placental transfer and the fixation of the antibodies on the fetal red cells antigenic targets lead to a haemolysis in the fetus and the newborn. The resulting haemolytic disease can show different clinical forms, from a mild anaemia with neonatal hyperbilirubinemia to a major fetal damage with stillbirth caused by hydrops fetalis. The objective of management strategies of feto-maternal alloimmunization is to detect and monitor maternal alloimmunization and to appreciate the effects on the fetus or the newborn.

Endometrial stromal tumors are rare and are less than 5% of uterine tumors. They are composed of cells closely resembling endometrial stromal cells in the proliferative phase. They are classified into two categories: the stromal nodules, benign, and endometrial stromal sarcomas, including endometrial stromal sarcoma (low grade) and undifferentiated endometrial sarcoma (formerly high grade).
The diagnosis is most often does retrospectively after histological analysis of the surgical specimen. The classical treatment is abdominal hysterectomy with bilateral oophorectomy. The adjuvant treatment are not yet established and the optimal treatment of this entity is still not clear. We report the case of a patient of 46 years, admitted for pelvic pain with abdomino-pelvic mass
Ultrasound and MRI have found a polymyomatous uterus with interstitial body mass with a compression effect on the endometrium. The patient underwent total hysterectomy with bilateral oophorectomy, Histology with additional immunohistochemical concluded endometrial stromal sarcoma of low grade, stage IB, hormone receptor-negative.
Through this rare case and with a literature review, we focus on the epidemiological, diagnostic, therapeutic and prognostic of that entity.

The Uterine fibroma pathology is common and the relationships between fibroids and pregnancy are triple: Fibroids can prevent conception and implantation; the fibroid may complicate the course of pregnancy, at delivery and postpartum period 'and pregnancy-induced condition can facilitate the development of fibroids to complications. We report the case of a patient who was followed in our department from 17 weeks+2days of pregnancy whose ultrasound revealed fibroid located in the uterine isthmus .Through our case and with the support of the literature, We will insist the complications that can occur and understand the importance of diagnosis and early management of this entity.

The malignant germinal tumors of the ovary are rare, but a rest curable whatever is the stage. We report the observation of 24 years old patient, married, never get pregnant , who was sent in our hospital for pelvic pains, the gynecological examination revealed an abdominal mass in the umbilical level . The pelvic ultrasound and the abdominal CT scan showed a heterogeneous solid mass in depends on the ovary. A laparotomy was indicated, allowed a right adnexectomy. The anatomopathologique examination is returned in favor of a dysgerminoma. The germinal tumors of the ovary are rare tumors which affect the girls and the young women, they have a good prognosis whether his stage with an optimal treatment and the majority of the patients keep their reproduction functions.

L'endom

Maternal benefits of fetal extraction have been clearly demonstrated in the case of hemodynamic failure. However, in case of respiratory failure very little data are available. The aim of our study is to discuss the management of patients with respiratory distress during pregnancy secondary to a pleuropulmonary disease.

Vaginal Angioleiomyoma is a rare entity. We report a case of vaginal Angioleiomyoma with literature review. Our case was about a 48 years old woman who consulted for a nodule in the posterior wall of the vagina. The surgery allowed removal of a tissue-like structure of 2 cm. The final histologic diagnosis was a vaginal Angioleiomyoma.