This article gives an overview over the huge topic of 'female genital mutilation' (FGM). FGM means non-therapeutic, partial or complete removal or injury of each of the external female genitals. It concerns about 130 million women around the world. FGM is performed in about 30 countries, most of which are located in Africa. Four types of FGM are distinguished: type I stands for the removal of the clitoral foreskin, type II means the removal of the clitoris with partial or total excision of the labia minora. Type III is the extreme type of FGM. Not only the clitoris but also the labia minora and majora were removed. The orificium vaginae is sewn up, leaving only a small opening for urine or menstruation blood. Other types like pricking, piercing of clitoris or vulva, scraping of the vagina, etc. were defined as type IV of FGM. The mentioned reasons for FGM are: encouragement of the patriarchal family system, method for birth control, guarantee of moral behaviour and faithfulness to the husband, protection of women from suspicions and disgrace, initiation ritual, symbol of feminity and beauty, hygienic, health and economic advantages. Acute physical consequences of FGM include bleeding, wound infections, sepsis, shock, micturition problems and fractures. Chronic physical problems like anemia, infections of the urinary tract, incontinence, infertility, pain, menstruation problems and dyspareunia are frequent. Women also have a higher risk for HIV infections. During pregnancy and delivery, examinations and vaginal application of medicine are more difficult. Women have a higher risk for a prolonged delivery, wound infections, a postpartum blood loss of more than 500 mL, perineal tears, a resuscitation of the infant and an inpatient perinatal death. Mental consequences after FGM include the feelings of incompleteness, fear, inferiority and suppression. Women report chronic irritability and nightmares. They have a higher risk for psychiatric and psychosomatic diseases. FGM carried out by doctors, nurses or midwives is also called medicalisation of FGM and is definitely unacceptable. Regarding human rights, FGM refuses women the right of freedom from bodily harm. Specific laws that ban FGM exist in many countries in Europe, Africa, USA, Canada, New Zealand and Australia.

Introduction !Breast cancer is the most common malignancy in women worldwide. It accounts for 14 % of all cancer diagnoses in Europe [1]. In the industrialized countries of the northern hemisphere, between one in eight and one in ten women will be diagnosed with breast cancer in their lifetime [2,3]. Due to the enormous advances in adjuvant and palliative treatment, it has, in many cases, become a controllable chronic disease [4]. Abstract !The aim of this prospective, randomized, controlled trial was to investigate the impact of yoga on newly diagnosed patients with early breast cancer in the immediate postoperative phase. 93 women newly diagnosed with early breast cancer were randomized into an intervention group (IG) and a control group (waiting group, WG). The IG started yoga immediately after the operation. The WG started yoga 5 weeks after surgery. Both groups attended yoga classes twice weekly for 5 weeks. Quality of life (QoL) was evaluated using the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires before the intervention, immediately after the operation and after 3 months. After 3 months the patients were asked whether yoga improved their physical activity and whether they wished to continue with yoga. The overall QoL (p = 0.002) and the functional status (p = 0.005) increased significantly in the IG, while physical symptoms decreased over time in both groups. 86 % of patients in the IG and only 59 % of patients in the WG (p = 0.04) confirmed a positive change in their physical activity through yoga. More women in the IG intended to continue with yoga (p = 0.03). Early initiation of yoga as a supportive treatment in cancer had a positive impact on QoL. Teaching yoga allowed patients to practice yoga by themselves, enhanced the patientsʼ QoL and was found to improve physical activity. Zusammenfassung

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Zusammenfassung Fragestellung: Wie gut sind Patientinnen prätherapeutisch über Myome und Myomtherapien informiert? Welches sind dabei die wichtigsten Informationsquellen, welche Rolle spielt der Frauenarzt? Welchen Einfluss haben Myome auf die Lebensqualität der Patientinnen? Welche Therapie wünschen sich die Frauen selbst und welche Faktoren beeinflussen ihre Entscheidung für ein Therapieverfahren? Methodik: Grundlage der Untersuchung ist ein anonymer Fragebogen mit 13 Fragen, den Patientinnen mit Myomen in einer Myomsprechstunde beantworteten. Ergebnisse: Der Fragebogen wurde von 544 Patientinnen beantwortet. Die wichtigsten Informationsquellen über Myome und Myomtherapien waren neben dem Frauenarzt (82 %) das Internet (45 %) und Bücher (25 %). Insgesamt sahen 88 % der Patientinnen einen Einfluss der Myome auf ihre Lebensqualität, z. B. Gesundheitssorgen (49 %) und Ängste (28 %). 94 % der befragten Frauen hatten einen Therapiewunsch, wobei 48 % der Patientinnen hinsichtlich der Wahl des konkreten Therapieverfahrens noch unentschieden waren. Die meisten Frauen wünschten sich eine nichtoperative Behandlungsmethode (61 %). Patientinnen, die sich von ihrem Frauenarzt gut informiert fühlten, wünschten sich häufiger eine Hysterektomie als andere Frauen und lehnten die nichtoperativen Therapieverfahren häufiger ab. Schlussfolgerung: Die Untersuchung zeigt einen starken Einfluss von Myomen auf die Le- AbstractPurpose: How good is the pretherapeutic knowledge of patients with uterine fibroids? Which are the most important sources of information, and which role does the gynecologist play? How do uterine fibroids influence the quality of life of the patients? Which therapy do women wish themselves and which factors influence their decision concerning the choice of treatment? Methods: The basis of the study is an anonymous questionnaire with 13 questions that was answered by patients with uterine fibroids in a special consultation. Results: The questionnaire was answered by 544 patients. The most important sources of information were the gynecologist (82 %), the internet (45 %) and books (25 %). Altogether, 88 % of patients noticed an impact on their quality of life by uterine fibroids, for example worries about health (49 %) and fears (28 %). 94 % of women definitely wanted treatment for their fibroids, 48 % of patients were undecided concerning the method of therapy. Most women wished for a nonoperative treatment (61 %). Patients, who felt well informed by their gynecologist, more often wanted a hysterectomy and were more likely to refuse the non-operative therapies. Conclusion: The present study shows a strong impact of uterine fibroids on the quality of life of affected women. Many gynecologists did not sufficiently inform their patients about non-operative methods of therapy, which many patients wished for. The gynecoloOriginalarbeit 763 Institutsangaben

The demand for minimal or non-invasive therapies especially in tumor therapy is increasing constantly. High frequency focussed ultrasound represents an effective and safe alternative to established thermoablative procedures. In this article we report the advantages of MR-guidance for focussed ultrasound. We describe first clinical experiences in the treatment of uterine fibroids, breast cancer and fibroadenomas of the breast employing MR-guided focussed ultrasound surgery (MRgFUS). This method offers strong potential in the treatment also of other tumorentities since it provides excellent accuracy. Currently numerous efforts are undertaken to introduce MRgFUS for the therapy of liver or cerebral tumors.