The LADY study: epidemiological characteristics of prevalent and new genitourinary syndrome of menopause cases in Greece

OBJECTIVE

The genitourinary syndrome of menopause (GSM) is often underdiagnosed and undertreated despite its significant impact on postmenopausal quality of life. We assessed the prevalence of GSM and associated symptoms in Greek perimenopausal/postmenopausal women attending gynecology clinics.

METHODS

Four hundred and fifty women, aged 40-70 years (93.1% postmenopausal), attending three gynecology clinics at university hospitals completed a validated questionnaire and underwent pelvic examination.

RESULTS

GSM was diagnosed in 87.6% of the women at the study visit, whereas only 16% of the overall sample had been previously diagnosed with the condition. Vaginal dryness (72.7%), vulvar burning sensation or itching (58.0%) and dyspareunia (52.7%) were the most prevalent symptoms. Pelvic signs consisted of vaginal dryness (89.1%), loss of vaginal rugae (80.6%) and vulvovaginal pallor (86.9%). However, only 31.3% of the participants had discussed genitourinary symptoms with their health-care professionals (HCPs). Regarding management, only 11.1% of women had prior experience with any form of therapy, and currently only 8.7% were receiving treatment.

CONCLUSION

GSM is highly prevalent in this Greek perimenopausal/postmenopausal population. Nevertheless, the majority of women remain undiagnosed and untreated. Education for both women and HCPs regarding GSM will lead to improved diagnosis and better management of this syndrome.

The prevalence of vulvovaginal symptoms in Japanese women of reproductive and perimenopausal ages: A cross-sectional study across generations

AIM

This cross-sectional study evaluated vaginal health and hygiene practices among reproductive and perimenopausal women in Japan using an online-based questionnaire.

METHODS

The questionnaire included 11 well-structured questions concerning vulvovaginal symptoms and hygiene care practices. Participants' responses were anonymized and analyzed descriptively. The relationships of age, family income, occupation, and childbearing with women's concerns regarding vaginal or vulvar problems were analyzed by chi-square tests.

RESULTS

About 80% of women in their 20s to 50s in Japan reported experiencing vulvovaginal symptoms. Women in their 40s had significantly fewer symptoms than women in their 20s (p = 0.04), and women in their 50s had significantly fewer symptoms than all other age groups (20s, 30s, and 40s) (p < 0.001). Among symptomatic women, 77.5% did not discuss their symptoms with anyone else and only 10% visited doctors. About 12.5% of women reported taking special care of their vagina or vulva regularly, whereas 38.2% expressed a desire to try some form of care but had not yet done so. Of the women who did not take special care of their vagina or vulva, 46.2% lacked knowledge about proper care, 42.2% did not want to spend money on care, 30.5% did not want to discuss care with others, and 21.3% were psychologically reluctant.

CONCLUSION

Determination of the prevalence of vulvovaginal symptoms among Japanese women can enhance understanding of this prevalent condition and its impact on women's health. These findings may help formulate effective public health interventions and promote better hygienic practices, thus improving the well-being of women in Japan.

Lower Urinary Tract Symptoms in Greek Women After Menopause: The LADY Study

INTRODUCTION AND HYPOTHESIS

The genitourinary syndrome of menopause (GSM), apart from symptoms related to vulvovaginal atrophy (VVA), also consists of lower urinary tract symptoms (LUTS). Based on the common embryological origin of the genital and lower urinary system, the presence of estrogen receptors, and the high prevalence of VVA and LUTS in the menopausal population, the two conditions can coexist. This study is aimed at investigating the prevalence and risk factors of LUTS in a sample of Greek peri- and postmenopausal women.

METHODS

Four hundred and fifty (450) women, aged 40-70 years, attending three outpatient gynecology clinics for routine examination, completed a structured interview and responded to a validated questionnaire (International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms, ICIQ-FLUTS).

RESULTS

Urinary urgency or frequency affected 51.6% and dysuria 43.6% of the participants. Mild urgency or frequency was described by 25.6%, moderate by 14.4%, and severe by 11.6% of the women. Mild dysuria was reported by 26.26%, moderate by 5.8%, and severe by 11.6%. Age, weight, BMI, and number of pregnancies and abortions correlated with a higher ICIQ-FLUTS score. Women with moderate/severe symptoms of VVA, such as irritation, a burning sensation, and pruritus of the vulva or vagina, had a higher ICIQ-FLUTS score than women without such symptoms (beta coefficient 2.42, CI 1.204, 3.635, p < 0.001).

CONCLUSIONS

Lower urinary tract symptoms are very common among peri- and postmenopausal women and are linked to symptoms of VVA. Our data support the need for prompt evaluation of women transitioning to menopause, as these symptoms compromise the quality of life.

HPV infection and vaginal microecological disorders in women with intrauterine adhesion: cross-sectional study in a Chinese population

BACKGROUND

The purpose of this study was to evaluate the vaginal microecology and the distribution of human papillomavirus (HPV) subtypes in patients with uterine adhesions and explore the correlation between HPV infection and vaginal microecology imbalance and the occurrence of intrauterine adhesion (IUA).

METHODS

A total of 479 women were enrolled in the study, including 259 in the normal group and 220 in the IUA group. Vaginal microecological and HPV analyses were performed on all participants. Significant differences between the two groups were analyzed, and Spearman correlation analysis was performed.

RESULTS

The incidence of IUA in patients between 31 and 40 years of age was high. The I-II degree of vaginal cleanliness in the IUA group was significantly lower than that in the normal group, and the number of III-IV degree was significantly higher than that in the normal group. Moreover, the incidences of VVC (vulvovaginal candidiasis) and vaginal disorders and infections with HPV 16 and HPV 52 subtypes were significantly higher in the IUA group than in the normal group. The incidence of high-risk HPV infection combined with vaginal disorders in the IUA group was higher than that in the normal group. Correlation analysis showed that the occurrence of IUAs was positively correlated with HPV infection and negatively correlated with PH and vaginal microecological imbalance.

CONCLUSION

The HPV infection rate and vaginal microecology disorders affect the occurrence of IUAs. For patients with IUAs, control of the HPV infection rate and the prevention of vaginal microecological disorders should be improved.

Relationships between the vaginal microbiota and genitourinary syndrome of menopause symptoms in postmenopausal women: the Study of Women's Health Across the Nation

OBJECTIVE

To describe vaginal microbiota classified by community state types (CST) in a diverse cohort of postmenopausal women and evaluate relationships among genitourinary syndrome of menopause (GSM) symptoms (vaginal dryness, vulvovaginal irritation, sexual pain, dysuria, urinary urgency), CSTs, estrogen, vaginal maturation index (VMI), and vaginal pH.

METHODS

In the Study of Women's Health Across the Nation, 1,320 women aged 60.4 to 72.5 years self-collected (2015-2017) vaginal samples analyzed for microbiota composition and structure (CSTs) using 16S rRNA gene amplicon sequencing, VMI, and pH. GSM symptoms were collected with self-administered questionnaires; interviewers elicited estrogen use and measured body mass index. Serum E2 and E1 were measured using high-performance liquid chromatography. We analyzed data using Pearson χ2 tests, analysis of variance, Kruskal-Wallis tests, and binomial logistic regression.

RESULTS

The most frequently occurring CST was low Lactobacillus species IV-C (49.8%); 36.4% of women had CSTs dominated by Lactobacillus species. More than half of the women with vaginal atrophy biomarkers (VMI <50 and pH >5) had CST IV-C0, whereas women using estrogen or with higher E1 and E2 levels had a higher prevalence of Lactobacillus crispatus -dominated CST I ( P values < 0.001). Sexual pain was associated with atrophy biomarkers and independently associated with Streptococcus species-dominated CST IV-C1 (odds ratio, 2.26; 95% confidence intervals, 1.20-4.23). For all other GSM symptoms, we found no consistent associations with E1 or E2 levels, atrophy biomarkers, or any CST.

CONCLUSIONS

Although close relationships exist among estrogen, CSTs, VMI, and pH, sexual pain was the only GSM symptom associated with the structure of vaginal microbiota and atrophy biomarkers.

Pediatric and Adolescent Obstetric and Gynecologic Encounters in US Emergency Departments: A Cross-Sectional Study

STUDY OBJECTIVE

To describe pediatric and adolescent obstetric and gynecologic diagnoses presenting at emergency departments (EDs) in the United States.

METHODS

This was a retrospective, cross-sectional study design that utilized the Nationwide Emergency Department Sample (NEDS), which comprised hospital-owned EDs throughout the United States in 2018. The participants included a sample set of female patients from birth to 18 years old. All obstetric and gynecologic (OB/GYN) International Classification of Disease (ICD-10) codes were categorized. Descriptive, bivariate, and multivariate analyses were used to assess diagnoses by age group, hospital type, ED disposition (eg, admission and transfer), payer, and median household income.

RESULTS

In 2018, there were 518,244 OB/GYN ED visits by female patients aged less than or equal to 18 years. Vulvovaginal disorders and abnormal uterine bleeding were among the top 5 presentations in all age groups. The top diagnoses varied by age group. Diagnoses with higher morbidity and mortality (ovarian torsion and ectopic pregnancy) had higher admission and transfer rates compared with diagnoses that can be commonly managed in the outpatient setting (vulvar or vaginal disorders).

CONCLUSIONS

This is the first study that evaluated OB/GYN diagnoses in pediatric and adolescent patients presenting to the ED. Educational and referral efforts should focus on not only emergency diagnoses, such as ovarian torsion, adnexal masses, and ectopic pregnancy, but also common presentations that can often be managed in the outpatient setting, such as vulvovaginal disorders and abnormal uterine bleeding.

Vaginal foreign bodies in children: a single-center retrospective 10-year analysis

OBJECTIVE

To evaluate the clinical features and outcome in girls with a vaginal foreign body.

METHODS

The clinical data of 97 girls with a vaginal foreign body were collected between 2010 and 2020. The descriptive analysis was used to summarize the clinical characteristics.

RESULTS

The patients were aged between 1.5 and 14.8 years, and the age of peak incidence was shown to be 3-10 years, which accounted for 88% of the cases. Blood-stained vaginal discharge or vaginal bleeding was the most common symptom (48%). The most common foreign bodies were small hard objects (57%), followed by bits of cloth or toilet tissue (22%). The patient whose foreign object was a disk battery had the most severe symptoms. When an injury of the vaginal mucosal was suspected, antibiotics were used to prevent infection, with full recovery of all patients without any additional treatment after removal of the foreign object.

CONCLUSION

If there is no damage to the vaginal mucosa, no additional treatment is needed after the foreign body is removed. When a vaginal foreign body is suspected to be a battery, emergency surgery is needed to prevent further damage.

Efficacy and safety of prolonged-release hyaluronic acid derivative vaginal application in the postpartum period: a prospective randomised clinical trial

INTRODUCTION

In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.

MATERIAL AND METHODS

This was a prospective, randomized, controlled, open-label study (NCT04560283) for evaluating the effects of application of a prolonged-release hyaluronic acid derivative vaginal gel in restoring sexual function during the postpartum period. Eighty-five patients were randomized to apply prolonged-release Hydeal-D 0.2% vaginal gel (Fidia Farmaceutici, Abano Terme, Italy; n = 43) every three days for 12 consecutive weeks or expectant management (n = 42).

RESULTS

Women undergoing treatment had a more elevate increase in Female Sexual Function Index (FSFI) total score (+15.1 ± 11.9 vs +6.5 ± 8.9, p < 0.001) and a higher decrease in vaginal pH (-1.2 ± 0.7 vs -0.2 ± 1.1; p < 0.001). Moreover, the proportion of vaginal smears with maturation index (VMI) >65 was significantly higher in patients treated (80.6% vs 35.3%; p = 0.004). Edinburgh Postnatal Depression Scale (EPDS) decreased significantly in both groups with no inter-group difference (p = 0.459). Only two cases (4.8%) of moderate vaginal burning sensation were reported in patients undergoing local vaginal therapy.

CONCLUSIONS

The results of our study demonstrated that hyaluronic acid derivative vaginal gel (Hydeal-D) was able to improve sexual function of puerperal women in the short-term treatment.KEY MESSAGEIn the puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction.Hydeal-D is a prolonged-release hyaluronic acid derivative characterised by elevated resistance to enzymatic breakdown. During puerperium, its local application may improve the vaginal microenvironment by ensuring a better migration and proliferation of cells involved in local tissue repair.Among puerperal women, Hydeal-D vaginal gel causes a significant improvement of sexual function, including desire, arousal, and lubrification, compared to expectant management. Furthermore, it leads to a decrease in vaginal pH and an increase of the trophic status of vaginal epithelium.

Menopausal Symptoms among Postmenopausal Women of a Selected Municipality: A Cross-sectional Survey

Introduction: Postmenopausal women experience various menopause-specific somatic, psychological, and urogenital symptoms which tend to affect their overall well-being. However, there is a scant focus on menopausal health problems of postmenopausal women in Nepal. The aim of the study was to find out the prevalence of menopausal symptoms among postmenopausal women of a Municipality. Methods: A cross-sectional survey was conducted in selected wards of Tokha Municipality of Kathmandu district among postmenopausal women aged 45-60 years from September to October 2019. Ethical approval was taken from the Ethical Review Board, Nepal Health Research Council (reference number 694). Random sampling was used as the sampling technique. Face-to-face interview was used for data collection while a semi-structured interview schedule including the Nepali version of Menopause Rating Scale was used as a tool for measuring menopausal symptoms. EpiData version 3.1 was used for data entry while data analysis was performed using Statistical Packages for the Social Sciences version 20. Results: Amongst the postmenopausal women, all 203 (100%) had menopausal symptoms with majority reporting milder symptoms as found in 143 (70.4%). The mean Menopause Rating Scale (MRS) score was obtained as 13.21±5.1. The most prevalent moderate and mild symptoms were vaginal dryness 94 (46.3%), and depressive mood 71 (35%) respectively while physical and mental exhaustion 175 (86.2%) was the most common in all forms. Over half 102 (50.2%) of the respondents were unaware of menopausal symptoms and almost three-fifth 121 (59.6%) reported menopause related symptoms affected their daily work activities. Conclusions: The majority of postmenopausal women in this study had milder menopausal symptoms, which parallels findings from other national studies.

Ospemifene in clinical practice for vulvo-vaginal atrophy: results at 3 months of follow-up of use

OBJECTIVE

To assess the effect of ospemifene 60 mg/day in vulvovaginal atrophy (VVA) in postmenopausal women under conditions of routine clinical practice after 3 months of follow-up.

METHODS

The AYSEX study is a Spanish observational, prospective, and unicentric study in which 5 gynecologists recruited postmenopausal women with VVA in routine clinical practice treated with ospemifene 60 mg/day as an appropriate therapeutic option. Vaginal health, sexual health, dryness, dyspareunia, quality of life, and satisfaction with treatment were assessed at baseline and after three months using validated scales.

RESULTS

A total of 100 postmenopausal women cytologically and clinically diagnosed with VVA were included in the study. After 3 months of treatment with ospemifene, vaginal health index increased and vaginal pH, dryness, and dyspareunia decreased significantly (p < .0001). A significant improvement was observed in sexual function and quality of life.

CONCLUSIONS

This study in routine clinical practice conditions confirms the results previously reported by randomized controlled trials, including a significant improvement in VVA, sexual function, quality of life, and satisfaction with the treatment.

Vaginal microbiota evaluation and prevalence of key pathogens in ecuadorian women: an epidemiologic analysis

Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes. The most common forms of infection include bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and aerobic vaginitis (AV). Our main goals were to evaluate different types of vaginal infections in Ecuadorian women in a large urban area (Quito) and to characterize the vaginal microbiota colonization by opportunistic species. We collected vaginal swabs and epidemiological surveys from 414 women from June 2016 to July of 2017. We analyzed vaginal samples for the presence of any vaginal infection. The microbiological examination was done through Gram-stain, wet mount smears, and polymerase chain reaction (PCR) assays using primers for target genes, such as 16S rRNA (Atopobium vaginae, Mobiluncus mulieris, and Gardnerella species), ddl (Enterococcus faecalis), adk (Escherichia coli) and KER1 (Candida albicans) genes. Most women showed a healthy vaginal microbiota (66.7%). Nearly one-tenth (10.4%) of the participants had intermediate microbiota, and the remaining women (22.9%) had a single vaginal infection (BV, AV, or VC) or coinfections. From the 95 participants that had an infection, AV was the main diagnosed vaginal infection (51.6%), followed by BV (24.2%) and finally VC (7.4%). The remaining women (16.8%) showed coinfections, being BV and AV the most common coinfection. Using univariable logistic regression analyses we found an increased odds of healthy microbiota in women with a sexual partner (P = 0.02, OR = 1.64). Also, women in a free union relationship (P = 0.000, OR = 16.65) had an increased odds of having coinfections. On the other hand, the use of birth control (condom OR = 0.388 or other contraceptive method OR = 0.363) was associated with significantly lower odds of intermediate microbiota (P ≤ 0.05). We found no statistically significant differences between women with infection and a particular group age. Using multivariate logistic regression analyses we initially found an increased odds of having BV in women with M. mulieris (P = 0.020, OR = 4.98) and Gardnerella species (P = 0.010, OR = 4.16). Women with E. coli showed an increased odds of having AV (P = 0.009, OR = 2.81). The presence of C. albicans in women showed an increased odds of having VC (P = 0.007, OR = 17.94). Finally, women with M. mulieris showed a reverse odds of having healthy microbiota (P = 0.008, OR = 0.06). We found no statistically significant differences between women with symptomatic and asymptomatic infections or the presence of Enterococcus faecalis. We found using logistic regression analyses that M. mulieris was the most prevalent opportunistic pathogen among women with vaginal infection. Further studies should evaluate the possibility to use M. mulieris as a potential key predictor for vaginal infections.

Persistence of group B Streptococcus vaginal colonization and prevalence of hypervirulent CC-17 clone correlate with the country of birth: a prospective 3-month follow-up cohort study

To identify factors associated with vaginal colonization and persistence by group B Streptococcus (GBS) and by the hypervirulent neonatal CC-17 clone in late pregnancy and after delivery, a multicentre prospective observational cohort with 3-month follow-up was established in two university hospitals, Paris area, France. Pregnant women were recruited when antenatal screening for GBS vaginal colonization at 34-38 weeks of gestational age was positive. Vaginal samples were analysed by conventional culture methods at antenatal screening, delivery, and 21 and 60 days following delivery. Identification of the hypervirulent neonatal GBS CC-17 was performed. Colonization was defined as persistent when all vaginal samples were positive for GBS. A total of 754 women were included. GBS vaginal colonization was persistent in 63% of the cases (95% CI 59%-67%). Persistent colonization was more likely in women born in Sub-Saharan Africa compared with women born in France (OR = 1.88, 95% CI 1.05-3.52), and GBS CC-17 was overrepresented in women born in Sub-Saharan Africa (OR = 2.09, 95% CI 1.20-3.57). Women born in Sub-Saharan Africa are at higher risk for GBS vaginal persistence than women born in France. This observation correlates with an increased prevalence of the hypervirulent GBS CC-17 in the former group, which likely reflect variations linked to ethnicity and vaginal community-state types and might account for the increased susceptibility of black neonates to GBS infections.

Metabolic syndrome is the key determinant of impaired vaginal lubrication in women with chronic spinal cord injury

PURPOSE

Spinal cord injury (SCI) affects sexual health of both male and female, but little attention has been given to sexuality of SCI women. Similar to penile erection, vaginal lubrication represents a neurovascular event and then both denervation and vascular damage might contribute to its impairment. Nevertheless, the relative weight of lesion location/degree and vascular risk factors in determining hypolubrication in women with SCI has not yet been investigated. The aim of this study was to recognize among putative determinants of poor sexual arousal in women with SCI, neurogenic and vascular/metabolic independent predictors of vaginal hypolubrication.

METHODS

Twenty-eight consecutive female patients admitted to a rehabilitation program because of chronic SCI (≥ 1 year) underwent clinical and biochemical evaluations, including assessment of vaginal lubrication by the Female Sexual Function Index (FSFI). As, in people with SCI, waist circumference overestimates visceral fat mass due to abdominal muscle paralysis, metabolic syndrome (MetS) was defined according to specific criteria proposed for SCI population: BMI ≥ 22 kg/m² and two or more of the following: triglycerides ≥ 150 mg/dL (or actual treatment), HDL < 50 mg/dL, hypertension (or actual treatment), fasting glucose ≥ 100 mg/dL or diabetes mellitus type 2.

RESULTS

A FSFI lubrication sub-score < 3.6, suggestive for impaired vaginal lubrication, was exhibited by 53.7% of the study population. When compared to the group with normal lubrication, a significantly higher proportion of these women had paraplegia (93.3% vs 38.5%, p = 0.003) and met the SCI-specific criteria for MetS (73.4% vs 7.6%, p = 0.0006), whereas, no significant differences were found between the two groups in the proportion of women exhibiting the single components of MetS. At the multiple logistic regression analysis, only the presence of MetS exhibited a significant independent association with impaired vaginal lubrication (OR = 3.1, 95% CI 1.2, 5.8, p = 0.01).

CONCLUSIONS

In women with SCI, a clustering of modifiable vascular/metabolic risk factors, constituting the MetS, could contribute to sexual dysfunctions by affecting the vaginal lubrication, independently of the level of the spinal cord lesion.

Vaginal Health in Menopausal Women

The aim of this review is to provide an overview of genitourinary health in peri- and postmenopause, particularly of vulvovaginal atrophy (VVA), which is part of genitourinary syndrome (GSM). This condition has a high prevalence among post-menopausal women and negatively affects a woman's quality of life. Epidemiology, signs, symptoms, diagnostic criteria of VVA and target treatments for restoring vaginal health are discussed in light of the most recent literature. Issues related to this condition in menopausal women are under-diagnosed, lack objective diagnostic criteria, and consequently under-treated. Over the years, many treatments have been developed but their long-term effectiveness and safety have yet to be clearly defined. Patients are often dissatisfied and stop treatment, suggesting the need for a more personalized and tailored approach to achieve better compliance and thereby effectiveness. The aim of this paper is to provide an overview of the most recent literature on VVA in order to help the gynecologist in the management of this condition.

Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study

This cross-sectional study included postmenopausal women, aged 45-75 years, with the aim to assess the presence of vulvovaginal atrophy (VVA) confirmed by a clinical assessment in the Italian population attending menopausal/gynecological centers. Apart from baseline variables, women scored vaginal, vulvar and urinary VVA symptoms. Impact of VVA on sexual function and quality of life (QoL) was assessed thorough EuroQoL questionnaire (EQ5D3L), Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-revised (FSDS-R). A physical examination was carried out in accordance with routine gynecological practice. VVA was confirmed in 90% of the 1226 evaluable patients (aged 59.0 ± 7.3 years). The prevalence of postmenopausal women with VVA confirmed by gynecological clinical assessment was 75.3%. The patients with VVA confirmed (n = 926) had more severe symptoms (p < .0005), lower QoL (EQ-visual analog scale, p = .008 and DIVA, p < .0005) and worsened sexual function (FSFI and FSDS-R, p < .0005 for both) when compared with the patients having nonconfirmed VVA (n = 140). VVA is highly prevalent among postmenopausal Italian women. The objective of VVA confirmation is associated with severe symptoms and impaired QoL and sexual function. A proactive approach of Italian clinicians to promote regular and early gynecological evaluation should be performed in order to delay the advancing of the disorder.

Incidence of vaginal erosion with different synthetic materials for suburethral sling in the treatment of Stress Urinary Incontinence: A systematic review

INTRODUCTION

The aim of this systematic review is to compare the vaginal erosion rates in different synthetic materials used in suburethral slings in Tension Free Vaginal Tape (TVT-O /TOT) procedures in management of female stress urinary incontinence.

METHODS

PRISMA 2009 framework was adopted for study design. Scholarly literature search was done using MEDLINE, EMBASE, the Cochrane Library and Clinical Trials.gov using selected keywords. Five articles fulfilled the inclusion and exclusion criteria. Our main outcome of interest is to review the ideal properties of the suburethral sling, procedure of insertion and post-surgical complication following the sling insertion primarily vaginal erosion. Results were compared using one way-ANOVA test and independent T- test.

RESULTS

Total of 1725 subjects were available for analysis in the five studies. Monofilament polypropylene constituted 92.5% of the total sample size from one study alone. Polyester (n= 16/51) causes higher incidence rate of vaginal erosion compared to monofilament polypropylene (31.4 vs., 4.7; p = 0.01). There was no difference in the vaginal erosion rate between monofilament polypropylene and multifilament polypropylene (4.7 vs, 14.1; p=0.055) as well as between multifilament polypropylene and polyester (14.1 vs, 31.4; p=0.068). Although there was a marginally lower rate of vaginal erosion in TVT-O over TVT, the difference was not significant. (5.6 vs., 6.4, p=0.468). Common presentations of vaginal erosion were vaginal discharge, perineal pain and dyspareunia.

CONCLUSION

Given the limited sample size, polyester sling material appears to cause higher rates of vaginal erosion. No difference in erosion rate was seen between TVT and TVT-O.

Physical after-effects of colposcopy and related procedures, and their inter-relationship with psychological distress: a longitudinal survey

OBJECTIVE

To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress.

DESIGN

Longitudinal survey.

SETTING

Two hospital-based colposcopy clinics.

POPULATION

Women with abnormal cytology who underwent colposcopy (±related procedures).

METHODS

Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables.

MAIN OUTCOME MEASURES

Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress.

RESULTS

Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up.

CONCLUSIONS

The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress.

TWEETABLE ABSTRACT

Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.

Macro-regional variation in attitudes toward and experiences of vulvar and vaginal atrophy among Italian post-menopausal women: a post hoc analysis of REVIVE survey data

Italian participants in the European REVIVE survey reported that vaginal and vulvar atrophy (VVA) impaired various aspects of their lives, notably the ability to enjoy sex. The aim of the present study was to explore regional differences in knowledge, experiences, and treatment of VVA in the Italian REVIVE sample (n = 1000), which was analyzed according to region of residence. While many respondents were unfamiliar with the VVA condition, most could relate their VVA symptoms to the menopause. The rate of diagnosis of VVA was twice as high in Central Italy as in the North-East. For individual VVA symptoms, 25.4-41.6% of respondents judged that the symptom had worsened over time. There were no significant regional differences for symptoms in terms of reported rate, change in severity, impact on sexual activity, or health-care visits. Testosterone cream and OTC medication based on hyaluronic acid showed significant regional differences in lifetime rates of use. In Italy, there are modest regional differences in knowledge, diagnosis, and treatment of VVA, some of which may be explained by inter-regional differences in health care. Further efforts are needed to ensure that Italian women are properly informed about VVA and have access to appropriate health care and treatments.

Diagnosis of endometriotic lesions by sonovaginography with ultrasound gel

AIMS

The aim of the study was to evaluate the diagnostic ability of sonovaginography (SVG) with ultrasound gel in patients with endometriosis.

MATERIAL AND METHODS

We conducted a multicentre prospective study, which included 193 patients with symptoms highly suggestive for endometriosis. All patients were investigated by transvaginal sonography and SVG with gel and afterwards underwent laparoscopic surgery. For each category of endometriotic lesions investigated, we calculated and compared the sensitivity, specificity,  positive predictive value and negative predictive value of the imagisticinvestigations used.

RESULTS

In the case of endometriotic lesions of the uterosacral ligaments, SVG with gel had a sensitivity of 78.5% and a specificity of 96% (p=ns). The lesions of the vagina and rectovaginal septum were diagnosed with a sensitivity of 79%, respectively 94% (p=ns), obtaining a specificity of 99%, respectively of 97% (p=0.007). The lesions of the Douglas pouch were identified with a sensitivity of 81% (p=0.015), and those of the rectosigmoid with a 94% sensitivity (p=0.010). We obtained lower sensitivity (67%) in detecting the lesions of the urinary bladder (p=ns).

CONCLUSIONS

SGV with ultrasound gel represents a useful investigation tool for the evaluation of endometriotic lesions in the posterior pelvic compartment.

Associations Between Vaginal Infections and Potential High-risk and High-risk Human Papillomavirus Genotypes in Female Sex Workers in Western Kenya

PURPOSE

Infection with and persistence of high-risk human papillomavirus (HR HPV) are the strongest risk factors for cervical cancer. Little is known about the prevalence and role of concurrent sexually transmitted infections (STIs) found in HPV-infected female sex workers (FSW) in Africa. This study purports to test our a priori hypotheses that STIs are associated with genotypes pertaining to the α-group species 9. The objectives were to determine the prevalence of bacterial vaginosis (BV), Trichomonas vaginalis, and Candida spp in FSW, the association between these STIs and the prevalence of any potential HR and HR HPV genotypes in FSWs.

METHODS

A cross-sectional study design of 616 FSW from Western Kenya aged between 18 and 61 years during 2009-2015 using a peer recruitment sampling strategy. Inclusion criteria for the study entailed female sex and >18 years of age and having engaged in transactional sex in exchange for money, goods, services, or drugs in the last 3 months. Women were excluded if they were pregnant, <18 years of age, had a history of cervical dysplasia or cancer, had current abnormal bleeding, or had a hysterectomy.

FINDINGS

Of the FSW, 33.3% had HIV and 57.7% harbored a potential HR and HR HPV genotype. The 2 most prevalent potential HR and HR genotypes were HPV 16 (16.10%) and HPV 59 (12.20%). BV was the most common infection (48.3%), followed by Trichomonas vaginalis (31.4%) and Candida spp (19.9%). A multivariate regression revealed significant associations with both α-group 9 and 6; BV and HPV 58 (adjusted odds ratio [aOR] = 2.3; 95% CI, 1.0-5.2; P = 0.05), Trichomonas vaginalis and HPV 31 and HPV 35 (aOR = 2.0; 95% CI, 1.0-3.8; P = 0.04 and aOR = 1.8; 95% CI, 1.0-3.3, P = 0.05 respectively); and between Candida spp and HPV 53 (aOR = 2.0; 95% CI, 1.1-4.0; P = 0.03) and 16 (aOR = 1.9; 95% CI, 1.1-3.3; P = 0.03).

IMPLICATIONS

Snowball sampling may have inadvertently excluded FSW less likely to benefit from a social network. Significant associations between BV and HPV 58 and between Candida spp and HPV 16 and 53 suggest the need for sexually transmitted disease management within a cervical cancer prevention program. The probable synergistic effects of the vaginal microbiota should be elucidated, especially within this vulnerable population. Given the potential for FSW to transmit STIs, robust epidemiologic sampling methods are urgently required that account for the heterogeneity of the FSW population.

Predictive factors for preterm delivery under rural conditions in post-tsunami Banda Aceh

OBJECTIVE

To assess the risk for preterm deliveries <37 week of gestation and associated prevalence of vaginal infection in a rural setting after the tsunami in Banda Aceh, Indonesia.

METHODS

Wet mount microscopy, vaginal pH and vaginal swabs for microbiological culture were collected in pregnant women during the 2nd trimester from February to June of 2005 in four temporary outpatient clinics and the patients were followed up until delivery.

RESULTS

One hundred and fifty-nine pregnant patients were screened. Sixty-two could be followed up until delivery. Thirty-nine (62.9%) delivered at term and 23 (37.1%) delivered prematurely. Significant risk factors for preterm delivery were a history of preterm delivery and group B streptococcus infection. Increased vaginal pH alone had no significant influence on preterm delivery, although there was a trend.

CONCLUSION

The rate of preterm delivery was high in this cohort. We suggest risk stratification for preterm delivery in rural conditions by performing a vaginal pH and wet mount microscopy. If either is suspect we suggest collecting a vaginal swab for microbiological culture for targeted treatment. Patients with a history of preterm delivery are at increased risk and should be monitored closely.

Recommendations for the management of vaginismus: BASHH Special Interest Group for Sexual Dysfunction

We present the British Association for Sexual Health and HIV (BASHH) Special Interest Group for Sexual Dysfunction recommendations for the management of vaginismus. The recommendations outline the history, prevalence, aetiological factors, patient assessment and management for this sexual problem. Treatment strategies are discussed along with general recommendations and auditable outcomes.

Vulvovaginal-gingival Lichen Planus: Association with Lichen Planopilaris and Stratified Epithelium-specific Antinuclear Antibodies

Vulvovaginal-gingival lichen planus (VVG-LP) consists of a triad of symptoms: vulval, vaginal and gingival lichen planus lesions. The aim of this study was to analyse the prevalence of lesions in various anatomical locations in patients with VVG-LP. The study included 126 consecutive patients with lichen planus. Sixteen (12.7%) patients fulfilled the criteria of VVG-LP. In 12/16 (75%) patients with VVG-LP scalp lesions were also observed. Stratified epithelium-specific antinuclear antibodies (SES-ANA) and anti-ΔNp.3α antibodies were detected in 10/16 (75%) patients with VVG-LP and in 15/110 (13.6%) patients with other forms of lichen planus (p < 0.05). In conclusion, VVG-LP is frequently associated with lichen planopilaris. The new entity may be termed "vulvovaginal-gingival-pilar lichen planus" and our study indicates that SES-ANA is a marker of this type of lichen planus with extensive, severe and refractory-to-therapy involvement of the mucous membranes, skin and scalp.

The prevalence of Group B Streptococus recto-vaginal colonization and antimicrobial susceptibility pattern in pregnant mothers at two hospitals of Addis Ababa, Ethiopia

BACKGROUND

Group B streptococcus (GBS) has been implicated in adverse pregnancy outcomes. GBS recto-vaginal colonization rates significantly vary among different communities and geographic locations. Limited data is available on the prevalence and effects of GBS recto-vaginal colonization among pregnant mothers in developing countries like Ethiopia.

OBJECTIVE

To assess the prevalence of GBS recto-vaginal colonization among near term pregnant mothers and the antimicrobial susceptibility pattern of the isolates.

METHODS

A cross sectional descriptive study was conducted on pregnant mothers at gestational age of 35-37 weeks attending Ante Natal Clinics at Ghandi Memorial (GMH) and Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa. Samples from lower genital tract and rectum were collected and cultured for GBS on CHROM agar Strep B.

RESULTS

Twenty two of the 300 pregnant mothers (7.2%) studied were found to have positive GBS recto-vaginal culture. Twelve isolates (55%) were sensitive to penicillin while 20 (91%) were sensitive to ampicilline. All isolates except one were sensitive to Erythromycin.

CONCLUSION

The study showed recto-vaginal GBS colonization among near term pregnant mothers is reasonably high in our community calling for the need to screen mothers near term and provide appropriate antimicrobial prophylaxis to prevent potential adverse maternal and neonatal outcome.

[Mobile health initiative for foreign prostitutes in the Region of Central Jutland and the Region of North Jutland]

Some foreign prostitutes are victims of traffiquing, do not speak Danish and are not familiar with the services offered in the Danish Health Service. The mobile health initiative localises foreign prostitutes and offers health checks and help in case of illness or pregnancy. The article reports method and findings from the first two-year period with this initiative.

Incidence of genitourinary conditions in women with a diagnosis of vulvar/vaginal atrophy

OBJECTIVES

Vulvar/vaginal atrophy (VVA) is one genitourinary condition associated with a decline in estrogen. This may be bothersome for women following menopause. Although the clinical features of VVA and other conditions after menopause have been documented, few studies have quantified the magnitude of association between VVA and other genitourinary conditions.

METHODS

A VVA cohort was identified from two United States administrative claims databases. A matched cohort of an equal number of controls was randomly selected from a pool of women 40-79 years of age without VVA. Baseline characteristics and medical history were tabulated for the VVA cohort and matched controls. Six genitourinary conditions ('urinary tract infections', 'other/unspecified genitourinary symptoms', 'other inflammatory diseases of female pelvic organs', 'menopausal disorders', 'female genital pain and other symptoms', and 'other/unspecified female genital disorders') were hypothesized a priori to be associated with VVA. Adjusted incidence rate ratios measured the strength of association of VVA with each condition.

RESULTS

A total of 9080 women aged 40-79 years with newly diagnosed VVA during 2000-2010 were identified. The mean age of VVA patients and matched controls was 60.2 years. At baseline, a significantly (p < 0.001) higher proportion of women in the VVA cohort had a diagnosis of angina, osteoporosis, migraines, insomnia, or anxiety, or received estrogen supplementation or selective estrogen receptor modulators. VVA patients had a significantly (p < 0.001) higher incidence of each of the genitourinary conditions compared to controls. The condition most strongly associated with VVA with a relative risk of 6.2 was 'other inflammatory diseases of female pelvic organs'.

CONCLUSIONS

Women with VVA have a greater risk of genitourinary conditions compared to those without. The overall prevalence of VVA and other genitourinary conditions may be underreported as claims data only captures information for patients under medical care and many women do not seek consultation for VVA symptoms.

Survey of the prevalence of sexual dysfunctions in Kurdish women

This study evaluates the prevalence of female sexual dysfunctions among Kurdish women. Participants in the study were 196 women between 15 and 55 years of age who attended the gynecological clinic of Be'sat Hospital in Sanandaj Province, Iran. The authors collected relevant data using the Female Sexual Function Index. The mean score was 22.71 (SD = 5). Using a cutoff score of 26.55, the authors found that 151 women (77%) had some sexual dysfunction. Scores declined as patients' age increased; further, an older age at marriage was associated with a higher score. This study, the first about sexual dysfunctions in Kurdish society, shows that sexual dysfunctions are prevalent among women of this ethnicity. Clinicians should complete further studies to assess the factors contributing to this phenomenon.

Vaginal cuff dehiscence after hysterectomy

OBJECTIVE

To determine the incidence of vaginal cuff dehiscence (VCD) among women undergoing hysterectomy according to clinico-surgical factors including surgical route, and to describe patient characteristics associated with VCD.

METHODS

In a retrospective study, the medical records of all women who underwent hysterectomy between January 2005 and March 2011 at a university teaching hospital in Seoul, Republic of Korea, were reviewed. The incidence of VCD was determined in relation to the following factors: patient age, hysterectomy route, indication for hysterectomy, and extent of resection (either simple or radical hysterectomy).

RESULTS

Among 9973 hysterectomies, 37 (0.37%) cases of VCD were identified. The incidence of VCD was significantly higher after abdominal hysterectomy (0.6%) than after laparoscopic (0.2%) or vaginal (0.4%) hysterectomy (P=0.016). Compared with laparoscopic approaches, abdominal hysterectomy was associated with a higher risk of VCD (odds ratio, 2.735; 95% confidence interval, 1.380-5.420). However, there was no significant difference in the incidence of VCD according to surgical indication or extent of resection.

CONCLUSION

Laparoscopic hysterectomy was found to be associated with a lower risk of VCD compared with abdominal hysterectomy. The lower risk is probably related to the different techniques used for colpotomy and cuff closure.

Prevalence and accompanying signs of pneumovagina and urovagina in dairy cows in the Southern Marmara region

OBJECTIVE

Studies on the prevalence of pneumo- and urovagina in cows are rare. The aim of this study was to determine the prevalence and the most common accompanying clinical signs of pneumo- and urovagina in dairy cows.

MATERIAL AND METHODS

Between 2007 and 2010 a total of 1167 Holstein and Brown Swiss cows were examined clinically and bacteriologically. Pneumovagina was diagnosed if air was sucked in or expelled from the vagina spontaneously at any time. Urovagina was defined as the accumulation of urine at the fornix of the vagina.

RESULTS

The prevalence of pneumovagina and urovagina were 19.2% (n=224) and 3.1% (n=36), respectively. Several clinical findings were accompanying pneumovagina in affected cows. 77.7% of cows having pneumovagina additionally displayed foamy vaginal discharge during estrous. Passive urinary flow out of the vulva could be observed due to pressure during rectal examination in some cows with urovagina. Bacteriological examination of uterine swaps from 111 cows with pneumovagina yielded a positive result in 95.5% of the cases. Uterine samples from 20 control animals were bacteriologically positive in 45% of the cases.

CONCLUSIONS AND CLINICAL RELEVANCE

Pneumovagina in cows has a much higher prevalence than published before and causes uterine infection, endometritis and infertility due to fecal contamination. Urovagina is always an accompanying sign in severe cases of pneumovagina. Foamy vaginal discharge during estrous can be regarded as pathognomonic and early sign of pneumovagina also in very mild cases. Evacuation of the uterus after parturition and a decrease in body condition score due to negative energy balance causes an increased negative intraabdominal pressure. These conditions seem to trigger the development of pneumo- and urovagina. For this reason repeat-breeders and especially cows with foamy vaginal discharge during estrous, passive urinary leakage and an angulated vulva dorsal to the ischiadic arch should be carefully examined for pneumovagina.

Sexual arousal and lubrication problems in women with clinically diagnosed hypoactive sexual desire disorder: preliminary findings from the hypoactive sexual desire disorder registry for women

Sexual desire and arousal difficulties are often correlated in women. However, no studies have examined characteristics of women with clinically diagnosed hypoactive sexual desire disorder (HSDD) that increase the likelihood of co-occurring arousal difficulties. The authors examined combined HSDD and arousal/ lubrication problems using baseline cross-sectional data from the HSDD Registry for Women. Their analyses were restricted to women who could be classified with certainty as having arousal or lubrication difficulties by the Female Sexual Function Index (requiring sexually activity in the past 4 weeks). Results showed that among 426 premenopausal women with HSDD, 50.2% had arousal problems, 42.5% lubrication problems, 39.0% combination, and 46.2% neither. Among 174 postmenopausal women, prevalence percentages were 58.0% arousal, 56.9% lubrication, 49.4% combined, and 34.5% neither. The strongest predictor of combined arousal/lubrication problems was self-reported severity of HSDD. Among premenopausal women, race/ethnicity, depression, and lower relationship happiness were also associated with combined arousal/lubrication problems. Among postmenopausal women, surgical menopause and use of selective serotonin reuptake inhibitors were positively associated with arousal problems. Arousal and lubrication problems were present in approximately half of this subsample of HSDD Registry participants, with distinctions in prevalence and predictors by menopausal status and type of arousal difficulty (arousal vs. lubrication).

[The usefulness of combined gynecologic and endocrinologic consultation in pediatrics: a retrospective study of the reasons for consultation and the practical approach]

The gynaecological issues encountered in children and teenagers lay at the intersection of paediatric endocrinology and gynaecology. More than ten years ago, an outpatient clinic in paediatric endocrinology and gynaecology has been created. Here, we review the last 6 years. 214 girls were included, considering only the first visit for each patient. Collected data are initial concern for this consultation, age at first consultation and confirmed or suspected diagnosis. A classification is done according to the initial concern of patients in six categories. Principal queries concern pubertal development, precocious pilosity or abnormalities in menstrual cycles. Vulvovaginitis and morphologic abnormalities are also frequently encountered. This consultation suggests a paediatric approach with a child feeling confident and a gynaecological examination with a specialist knowing the anatomy particularities and the development of the children. This article focuses on the importance of specific gynaecological examination in children and reviews the main diseases encountered.

Vaginal bleeding in early pregnancy and preterm birth: systemic review and analysis of heterogeneity

OBJECTIVE

To systemically review published studies of vaginal bleeding and the risk of preterm birth (PTB) and explore sources of heterogeneity between them.

METHODS

The literature was searched for peer-reviewed articles from 1980 to 2009 in which the primary analysis was the risk of PTB among low-risk subjects with and without bleeding. Heterogeneity was assessed through I(2) statistics, and sources of heterogeneity were explored through subgroup analyses and meta-regression.

RESULTS

218 studies were initially identified, 64 reviewed and 23 included. The pooled Odds Ratio for PTB was 1.74, though significant heterogeneity was present (I(2)  =  49.7%). Meta-regression demonstrated a significant association between a study's incidence of bleeding and quality assessment and subsequent odds ratio, such that studies with a lower quality assessment or lower incidence of bleeding demonstrated an increased odds of PTB.

CONCLUSIONS

Bleeding in early pregnancy is associated with an increased risk of PTB; however, excessive heterogeneity exists among published studies. The heterogeneity arises in part from differences in the reported incidence of bleeding within study populations. Presumably studies that identify bleeding in a larger percentage of subjects consequently dilute the magnitude of the risk.

Cancers, infections, and endocrine diseases in women with endometriosis

OBJECTIVE

To assess the prevalence of patient-reported, physician-diagnosed comorbid conditions in women with endometriosis.

DESIGN

Cross-sectional study of self-reported survey data.

SETTING

Academic research.

PATIENT(S)

Four thousand three hundred thirty-one Endometriosis Association (EA) members reporting surgically diagnosed endometriosis.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Self-reported, physician-diagnosed infectious diseases, cancers, and endocrine diseases.

RESULT(S)

Nearly two-thirds of women reported one or more of the assessed conditions. Recurrent upper respiratory infections and recurrent vaginal infections were common and more likely in women responding to the EA survey. Melanoma was reported by 0.7% (n=29), breast cancer by 0.4% (n=16), and ovarian cancer by 0.2% (n=10). While ovarian cancer and melanoma were significantly more common than in the general population, breast cancer was surprisingly less common. Addison's disease and Cushing's syndrome were rare (0.2% and 0.1%, respectively).

CONCLUSION(S)

Respondents reported a higher prevalence of recurrent upper respiratory or vaginal infections, melanoma, and ovarian cancer than the general population. These findings document other potential associations related to the immune system, which may help focus future research into this disease.

[Analysis of prevalence and risk factors of pelvic organ prolapse of women underwent gynecologic health care in Peking Union Medical College Hospital]

OBJECTIVE

To investigate prevalence and risk factors of pelvic organ prolapse in women underwent routine gynecologic health care in Peking Union Medical College Hospital (PUMCH).

METHODS

From Jan. 2008 to Aug. 2009, 972 women underwent gynecological health care in PUMCH were enrolled in this study. Questionnaires and pelvic examinations were given. The pelvic organ prolapse quantitive examination (POP-Q) system was used as the assessment tool.

RESULTS

(1) Among all participants, the mean ages were (42 ± 10) years (range 22 to 78 years), the mean height were (162 ± 5) cm (range 142 to 180 cm), and the mean weight were (59 ± 8) kg (range 42 to 91 kg). 83.8% (815/972) of women were multipara. The mean total vaginal length (TVL) of 972 women was 8.20 cm. No women met the standard of pelvic organ prolapse, while 35.5% (345/972) of women presented mild posterior vaginal descent and 96.7% (940/972) presented mild anterior vaginal descent, all of them were asymptomatic. (2) The length of genital hiatus (gh), TVL and C, D proximal to the hymen in nullipara were (2.26 ± 0.32), (8.08 ± 0.30), (-7.08 ± 0.24) and (-8.08 ± 0.30) cm, which were significantly less than (2.33 ± 0.39), (8.22 ± 0.35), (-7.14 ± 0.28) and (-8.22 ± 0.35) cm in multipara (P < 0.05). Ap and Pb proximal to the hymen of (-2.87 ± 0.22) and (-2.87 ± 0.22) cm in nullipara were significantly larger than (-2.81 ± 0.25) and (-2.81 ± 0.25) cm in multipara (P < 0.05). When compared with nullipara, the incidence of posterior and anterior vaginal wall protrusion were increased (OR = 1.819). (3) The index of POP-P were compared among women at groups of 22 - 34 years, 35 - 49 years and more than 50 years (P < 0.05). Those index did not show statistical difference between women at group of 22 - 34 years and group of 35 - 49 years (P > 0.05). However, those in women at group of 22 - 34 years and 35 - 49 years showed statistical difference when compared with women at group of more than 50 years (P < 0.05). When compared with women at group of 22 - 34 years, the incidence of posterior and anterior vaginal wall protrusion were increased (OR = 1.713, 3.765). (4) Menopause status was associated with severities of all kinds of descent (P < 0.05) and presence of posterior vaginal protrusion (OR = 3.354).

CONCLUSIONS

Mild anterior and posterior vaginal descent by POP-Q were common among women in China. The risk of anterior vaginal descent is relatively higher than posterior vaginal descent. However, most of the women with descent are asymptomatic and need no treatment. The most important factors associated with the severity and detectable ratio of descent is parity and age.

Chlamydia trachomatis and cervical intraepithelial neoplasia in married women in a Middle Eastern community

The objective of this study was to determine the association between vaginal Chlamydia infection and cervical intraepithelial neoplasia (CIN). Data were collected in a case-control study for 60 patients with CIN in biopsy and 85 control subjects with normal colposcopy and biopsy. Serum antibodies to C trachomatis were associated with an increased risk for CIN [odds ratio (OR) = 7.3; 95% confidence interval (CI) 1.5-35.2)]. There was also a significant association between presence of inclusion bodies for C. trachomatis and CIN (OR = 5.5; 95% CI 2.4-12.4). These results indicate a strong association between CIN and chlamydial cervicitis.

Home sampling and pooling of vaginal samples are effective tools for genetic screening of Chlamydia trachomatis among high school female students in Lithuania

The aims were 1) to estimate the prevalence of C. trachomatis infection among sexually active female students in Kaunas, Lithuania; 2) to investigate the usefulness of personal invitation, self-sampling, and pooling of samples for screening; and 3) to evaluate the costs of the approaches used. A cross-sectional study inviting 795 female students (18-31 y of age) from 7 high schools and 1 college in Kaunas was performed. The response rate was 67% (533/795). Self-obtained vaginal samples were analysed, individually and pooled (n = 3), using Digene Hybrid Capture II CT/NG Test. The overall prevalence of C. trachomatis infection was 5.6%. Among the sexually active female students 20-24 y of age (n = 424), the prevalence was 7.1%; however, the prevalence varied from 0% to 14.2% at the different schools. For estimation of the population prevalence based solely on identification of C. trachomatis positive pools, the pooling strategy reduced the costs by 85%. For estimation of population prevalence and for diagnosis of each individual sample, pooling reduced the costs by 70%. Targeted screening, using pooling to reduce the expenses, mainly of 3rd and 4th y Lithuanian female students could be recommended. By extended personal contact and internet-based communication, increased participation rates may be attained.

The pathophysiology of an enterocele and its management

This paper describes 130 patients with enteroceles and their treatment. It includes analysis of all cases with enterocele over a 17-month period in a pelvic floor dysfunction database. Procedures performed included the Moschcowitz procedure with suspension of the vaginal vault to the sacrum in 13 patients (10%), colposacrosuspension (CSS) (mesh from the upper posterior half of the vagina to the sacrum with mobilisation and fixation of the rectum to the mesh) in 39 patients (30%), perineocolposacrosuspension (PCSS) (similar to CSS, but the mesh is inserted further down to the perineum) in 48 patients (37%) and perineopubo-colposacrosuspension (PPCSS) (as PCSS, but with a second mesh between the bladder and vagina extending to the sacrum) in 30 patients (23%). An additional modified Burch colposuspension was performed in 87 patients (67%). A failure was defined as a recurrent vaginal prolapse of Grade II or more, or urinary incontinence requiring surgical correction. The patients' mean age was 60.5 years, their mean parity 3.3 and 92.3% were white. Preoperatively, 33.8% of the patients complained of constipation, 33.1% of difficulty in defaecation and 77% had bladder symptoms, suggesting urinary stress incontinence or detrusor instability. In 74.6% of the patients part of the vagina protruded through the vaginal introitus. The mean period of follow-up was 7.4 months (range 1-26) with only 13 patients (10%) not followed. Only two patients (1.5%) developed Grade II vaginal prolapse (both cystoceles and both from the PCSS group). Urinary stress incontinence in need of further treatment developed in 13 patients (10%). The failure rate, therefore, was 11.5%. In six patients (4.6%) the mesh had to be removed due to mesh reaction. In all cases the mesh was unabsorbable. Vaginal suspension procedures with mobilisation of the rectum provided satisfactory results for severe enterocele over the short term.

[The lifestyle of Pilsner University female students and its effect on vaginal mycosis]

BACKGROUND

Up to now, it does not exit whole look at the life quality of the Pilsner female University students, especially in connection with gynecological history. It is reality that in last years the number of gynecological problems among young women increases such as the number of diseases with immunological background.

METHOD

We prepared questionnaire with 36 questions directed to life style, gynecological history, partner's life, food and hygienic habits, and nicotinism.

RESULTS

28 female students from the total group of 141 suffered from vaginal mycosis--22 (78.6%) use pills, 6 (21.4%) no hormonal contraception. 17 (60.7%) prefer flyaway cloth and 9 (32.1%) tight cloth. 141 students mentioned various number (0-25) of their sexual partners: 1-3 (79 students) in 15 cases (19%) mycoses, more than 4 partners (49 students) in 13 (26.5%) mycoses appeared. The first menstruation appeared in o 13 years (10-17 years). High incidence of vaginal mycosis was proven in students using only tampons than hygienic towels.

CONCLUSION

Vaginal mycosis is affected by many endogenous and exogenous factors. The main factors in pilsner university female students are hormonal contraception, promiscuity and hygienic habits.

Current views on etiology, diagnosis and the treatment of pain connected with sexual intercourse at women

Painful intercourse at women is a diagnostically and therapeutically difficult issue, but most of all there is no accordance to the etiology of this health problem. At present there are six classification systems by menas of which one tries to describe this issue. The layout of presented work is based on International Classification on Female Sexual Disorders, which in point four, includes Sexual Pain Disorders--dyspareunia, vaginismus and pain disorders not connected with sexual intercourse, but caused by other type of sexual stimulation. In context of current views on painful intercourse seen as the pain unit not as the sexual dysfunction, the crucial role of a gynaecologist in the diagnosis of this affliction has been underlined.

[Assessment of painful sexual intercourse occurrence among women in gynaecological practice]

OBJECTIVES

Analysis of painful sexual intercourse occurrence among women who are patients of a gynaecological practice.

MATERIAL AND METHODS

104 women have been examined by means of self-constructed questionnaire consisting of parts A and B. All interviewees had had sexual intercourses. Part A of the questionnaire included questions concerning painful sexual intercourse and was completed by the interviewees, whereas part B included questions concerning the presence of symptoms of vulvar vestibulitis and was completed by the gynaecologist after the examination. Statistical analysis was performed by means of chi-quadrat test.

RESULTS

Out of 104 examined women, 20 patients (19.2%) complained of painful intercourse occurrence.

CONCLUSION

1. Women at all ages experience painful intercourse, although there are different reasons for its occurrence. 2. Women may experience pain connected with sexual intercourse although they never experienced intercourse with vaginal penetration. 3. In case of 1/4 of women, coital pain occurs at the attempt of intercourse or "at the very thought of it". 4. Pain during sexual intercourse occurs in case of almost 50% of post menopausal women, experiencing vaginal dryness. 5. Since 30% women with visible features of vulvar vestibulitis, detected during gynaecological examination, experience painful sexual intercourse, gynaecological examination should constitute a constant element of diagnosis of painful sexual intercourse among women.

SOPHY project: an observational study of vaginal pH and lifestyle in women of different ages and in different physiopathological conditions. Part I

AIM

The importance of vaginal pH and vaginal flora in maintaining a well-balanced vaginal ecosystem is well known and has been widely described. However, no systematic nationwide studies have been carried out concerning the correlation between vaginal pH, life style and different physiopathological conditions in women of different ages.

METHODS

SOPHY (Study on pH and Hygiene) collected data concerning the lifestyle, vaginal pH, and the presence of symptoms, stratified into different subgroups (prepuberal, fertile, pregnancy, postpartum, premenopause and menopause) in a representative sample of the Italian gynecological population (264 gynaecologists for a total of 2 641 women) with the aid of a specific Internet site for data entry.

RESULTS

A more acid vaginal pH was related to a better satisfactory sexual activity and to more healthy genital condition. A positive relationship was detected between education level and good perception of sexuality. Certain clothing habits and a higher frequency of candidiasis and bacterial vaginosis was shown.

CONCLUSION

SOPHY revealed some interesting correlations between clothing and the frequency of candidiasis and bacterial vaginosis, between vaginal pH and satisfactory sexual activity, and between education and sexuality. SOPHY had a considerable educational impact, leading the physicians and women to consider vaginal pH as an important aspect of everyday life.

Human papilloma virus (HPV)-associated gynecological alteration in mothers of children with recurrent respiratory papillomatosis during long-term observation

BACKGROUND

Human papilloma virus (HPV) is one of the most frequently observed sexually transmitted infections. The study' purpose was to investigate the relation between a mother's gynecological history and the local status of her child with recurrent respiratory papillomatosis (RRP).

METHODS

Forty-two patients enrolled in a prospective multicenter study between 1983 and 1990. The study included patients with juvenile-onset and adult-onset RRP. All patients underwent surgery and treatment with alpha-interferon. Thirty-eight patients were followed up until 31.01.2006. Twenty-five mothers of these patients participated in a parallel prospective study of genital HPV infection. In 1989-1990, all received a routine gynecological examination, an expanded colposcopy, a Pap smear, and a cervical biopsy. The mothers were followed up until February 2006.

RESULTS

74% of patients with RRP were the first-born children. Five (20%) mothers had condylomata acuminata, newly diagnosed during pregnancy. Indicators of HPV infection such as koilocytes, koilocytotic dysplasia and condyloma acuminatum were revealed cytologically in 17% of cases and histologically in 71.4% of cases. Six (24%) of mothers had had a hysterectomy. HPV type 11 was prevalent in the children of mothers who had had a hysterectomy. Among the patients with juvenile-onset RRP, the death rate from squamous cell carcinoma of the lung was significantly higher in those patients whose mothers had a hysterectomy (p=0.028).

CONCLUSIONS

Mothers of patients with RRP demonstrated cytological and histological indicators of HPV infection in the genital tract. An adverse outcome of the disease in the child was associated with adverse gynecological history in the mother.

Predicting the presence of rectovaginal endometriosis from the clinical history: a retrospective observational study

Rectovaginal endometriosis is a severe variant of endometriosis. Common presenting symptoms for endometriosis include dysmenorrhoea, pelvic pain and dyspareunia. It is now recognised that there are other less traditional symptoms of endometriosis that are also relatively common. The aim of this study is to assess the relative strength of each of the potential symptoms of rectovaginal endometriosis and compare these with the laparoscopic and histological findings. In this retrospective, observational study the overall prevalence of rectovaginal endometriosis in the group was 31.4%. The presence of dyschesia gave a likelihood ratio of 1.27 (95% CI: 0.56 - 2.89) with a predictive prevalence of rectovaginal endometriosis of 37%. Apareunia and nausea or abdominal bloating were particularly strong markers for rectovaginal disease with a predictive prevalence of 87% and 89%, respectively. The classical symptoms often attributed to irritable bowel syndrome are also common in women with rectovaginal disease.

[Specific features of urethral diseases in spinal cord injury patients]

This article discusses all of the urethral diseases observed in patients with neurogenic bladder. The frequency of these disorders has decreased considerably with progress in intermittent catheterization and bladder retraining. However, urologists may occasionally be required to manage an urethral diverticulum, or an ulcer of the urethra over an indwelling catheter and must be familiar with the specific features in this setting.

Prevalence and factors associated with postpartum vaginal infection in the Khyber Agency federally administered tribal areas, Pakistan

OBJECTIVE

To estimate the prevalence and to identify the factors associated with vaginal infection among the married women between the ages of 15-49 years residing in the Khyber Agency (FATA), Pakistan.

METHODS

A cross-sectional study was conducted in the month of July 2005 on 1084 mothers by using random sampling strategy in Khyber Agency Pakistan by trained nurses. The descriptive and multivariate statistics were computed.

RESULTS

The multivariate analysis showed that the associated factors with vaginal infection were the use of unhygienic material to soak up the lochia [aOR = 3.45, 95% CI (1.36, 8.75)], bathing after 40 days [aOR = 2.10, 95% CI (1.55, 3.14)], and women who did not receive antenatal care [OR = 3.87, 95% CI (1.93, 7.75)]. Also women who did not have medical facilities available [OR = 2.45, 95% CI (1.23, 5.06)] reported of vaginal infection.

CONCLUSIONS

This study concluded that there is considerable need for health education among women and the entire community for the maintenance of hygiene, safe delivery through medical personnel and improvement in the mobility of mothers and female education.

Vaginal symptoms and urinary incontinence in the elderly women

Urogenital symptoms of vaginal dryness, urogenital irritation and itching, vaginal discharge, and urinary incontinence are common among postmenopausal women. Several studies have documented a lower rate of treatment-seeking behavior with increasing age in patients with urinary symptoms, and our clinical experience indicates a need for physician-initiated queries on vaginal/urinary symptoms. These urogenital conditions are amenable to treatment with pharmacotherapy and behavioral and/or surgical treatment.

Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies

STUDY OBJECTIVE

The purposes of this study were to estimate and compare the incidence of vaginal cuff dehiscence after different modes of hysterectomies (abdominal, vaginal, laparoscopic-assisted vaginal and laparoscopic) and to review the characteristics of hysterectomies complicated by vaginal dehiscences.

DESIGN

Observational case series (Canadian Task Force classification II-3).

SETTING

Large, urban, university teaching hospital.

PATIENTS

All patients undergoing a total hysterectomy or vaginal dehiscence repair at Magee-Womens Hospital (MWH) from January 2000 through March 2006 were analyzed.

INTERVENTIONS

Vaginal repair of vaginal cuff separation with reduction of eviscerating organ when appropriate.

MEASUREMENTS AND MAIN RESULTS

From January 2000 through March 2006, 7286 hysterectomies (7039 total and 247 supracervical) were performed at MWH by abdominal, vaginal, laparoscopic-assisted vaginal, or laparoscopic approach. Ten of these hysterectomies were complicated by vaginal cuff dehiscences and were repaired during this time period. The resulting overall cumulative incidence of vaginal cuff dehiscence after total hysterectomy at MWH was 0.14%. The annual cumulative incidence of vaginal dehiscences after total hysterectomy was 0%, 0%, 0%, 0%, 0.09%, 0.70%, and 0.31% from January 2000 to March 2006, respectively. There was a notable increase in the cumulative incidence of dehiscence in 2005 and thereafter. From January 2005 through March 2006, the cumulative incidence of vaginal dehiscence by mode of hysterectomy was 4.93% among total laparoscopic hysterectomies (TLH), 0.29% among total vaginal hysterectomies (TVH), and 0.12% among total abdominal hysterectomies (TAH). The relative risks of a vaginal cuff dehiscence complication after TLH compared with TVH and TAH were 21.0 and 53.2, respectively. Both were statistically significant, with 95% CIs of 2.6 to 166.9 and 6.7 to 423.4, respectively. Among the 10 dehiscences repaired, 8 (80%) were complications of TLHs, 1 (10%) was associated with TAH, and 1 (10%) followed a TVH. The median age at time of dehiscence was 39 years, and the median time between initial hysterectomy to vaginal dehiscence was 11 weeks. Six of the 10 patients presented with both cuff dehiscence and bowel evisceration. Six patients reported first postoperative intercourse as the trigger event. Half the patients with dehiscence report smoking cigarettes. All patients with dehiscence received preoperative prophylactic antibiotics at the time of hysterectomy. Until October 2006, there have been no reported recurrent dehiscences at MWH.

CONCLUSIONS

Total laparoscopic hysterectomies may be associated with an increased risk of vaginal cuff dehiscence compared with other modes of total hysterectomy. We postulate that the use of thermal energy in addition to other factors unique to laparoscopic surgery may be responsible; however, prospective randomized trials are needed to support this hypothesis. When performing laparoscopic hysterectomies, a supracervical approach should be considered unless a clear indication for a TLH is present.

Urogenital symptoms of postmenopausal women in Turkey

OBJECTIVE

The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey.

DESIGN

The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice.

RESULTS

The mean age of participants was 58.64 +/- 8.14 years. The mean age of menopause was 47.21 +/- 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency.

CONCLUSIONS

Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.