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American Journal of Obstetrics and... Sep 2019While there is a significant body of literature on cervical cancer in HIV-positive women, little is known about other gynecologic cancers in this population. (Meta-Analysis)
Meta-Analysis
BACKGROUND
While there is a significant body of literature on cervical cancer in HIV-positive women, little is known about other gynecologic cancers in this population.
OBJECTIVE
The objective of this systematic review and meta-analysis is to describe the incidence, presentation, treatment, and outcomes for HIV-positive women with non-acquired immunodeficiency syndrome-defining gynecologic cancers.
STUDY DESIGN
We searched MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for English-language studies published from 2000 to May 1, 2017. Studies containing 1 or more HIV-positive women with endometrial, ovarian, or vulvovaginal cancer and reporting incidence, treatment regimen, or survival were included. Two authors independently reviewed abstracts and full-text articles for inclusion and assessed study quality (details of the review protocol were registered as PROSPERO-CRD42017064525). Pooled estimates of incidence were calculated using random-effects models. Pooled estimates of cancer presentation and outcomes were averaged from case studies.
RESULTS
Of 5744 abstracts screened, we identified 70 articles on 58 studies on 292,202 women with HIV and 528 women with HIV and gynecologic cancer for inclusion. Most articles (53%) focused on incidence, and only 3, 4, and 20 articles focused on treatment and outcomes of endometrial, ovarian, and vulvovaginal cancers, respectively. The standardized incidence ratios for endometrial, ovarian, and vulvovaginal cancers were 4.38 (95% confidence interval 0.26-8.49) for endometrial cancer, 3.21 (95% confidence interval 2.29-4.13) for ovarian cancer, and 21.93 (95% confidence interval 13.50-30.35) for vulvovaginal cancer. Fifty-seven percent of women were diagnosed at an early stage, and all received cancer treatment.
CONCLUSION
In women with HIV, the incidence of ovarian and vulvovaginal cancer were higher than the general population, while incidence of endometrial cancer was similar. However, there was a paucity of data on treatment and outcomes for non-acquired immunodeficiency syndrome-defining gynecologic cancers. Given the increased incidence of gynecologic cancer, specific research on this population is essential to improve treatment and outcomes for HIV-positive women.
Topics: Combined Modality Therapy; Female; Genital Neoplasms, Female; Global Health; HIV Infections; Humans; Incidence; Prognosis
PubMed: 30771344
DOI: 10.1016/j.ajog.2019.02.022 -
Gynecological Endocrinology : the... Aug 2021It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this...
INTRODUCTION
It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving various pharmacological or endocrine treatments or radiotherapy.
AIM
To determine clinical and diagnostic exams required to confirm the presence of VVA (also referred to as atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause) and rule out other genital or pelvic clinical conditions.
MATERIALS AND METHODS
Literature review searches were carried out on the main scientific article search engines (PubMed, SciELO, Cochrane) using different clinical terms, treatments or interventions and comorbidity related to VVA.
RESULTS
The development and severity of VVA depend mainly on the duration of hypoestrogenism. Hypoestrogenism causes changes in the urogenital tissue, generating signs and symptoms, such as dryness, burning, soreness, itching, and irritation of the genital skin. The diagnosis can be made through anamnesis (patient history), questionnaires, physical exam, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be completed with the Vaginal Health Index, the Vaginal Maturation Index, or vaginal pH in the absence of infection or semen. The exclusion of other vulvovaginal organic pathology is essential to reach an accurate diagnosis and provide adequate treatment.
CONCLUSIONS
The specialist should be able to identify VVA, rule out other pathologies that make a differential diagnosis and conduct proper management.
Topics: Atrophic Vaginitis; Atrophy; Diagnosis, Differential; Dyspareunia; Estrogens; Female; Female Urogenital Diseases; Humans; Postmenopause; Surveys and Questionnaires; Syndrome; Urogenital Diseases; Vagina; Vaginal Diseases; Vulva; Vulvar Diseases
PubMed: 34036849
DOI: 10.1080/09513590.2021.1931100 -
Climacteric : the Journal of the... Aug 2017To evaluate the efficacy and safety of estriol for the treatment of vulvovaginal atrophy in postmenopausal women. (Review)
Review
OBJECTIVES
To evaluate the efficacy and safety of estriol for the treatment of vulvovaginal atrophy in postmenopausal women.
METHODS
A systematic literature review was performed. We searched the following electronic databases: Medline, Cochrane, Embase, Lilacs, CINHAL and Google Scholar. The studies selected included controlled clinical trials and quasi-experimental studies. Selections were made in pairs and independently, first by title and abstract and then complete texts.
RESULTS
We identified 188 studies, 22 of which met the inclusion criteria; 13 were controlled clinical trials and nine were quasi-experimental, and 1217 women were included. These studies confirmed the efficacy of local estrogens to treat symptoms of vulvovaginal atrophy with few adverse effects reported. Following treatment, serum estriol levels rose, peaking at 1 h. At the 6-month follow-up, there was no increase in serum estriol in treated women.
CONCLUSIONS
The available evidence (of low and moderate quality) shows that, when administered vaginally, estriol preparations appear to be safe for women who have risk factors related to systemic estrogen therapy.
Topics: Administration, Intravaginal; Adult; Aged; Aged, 80 and over; Atrophy; Endometrium; Estriol; Female; Female Urogenital Diseases; Humans; Hydrogen-Ion Concentration; MEDLINE; Middle Aged; Postmenopause; Vagina; Vulva
PubMed: 28622049
DOI: 10.1080/13697137.2017.1329291 -
The Journal of Sexual Medicine Sep 2018Provoked vulvodynia (PVD) is a chronic vulvar pain condition affecting up to 8.3% of the female population. Despite many years of research, no clear cause for PVD has...
BACKGROUND
Provoked vulvodynia (PVD) is a chronic vulvar pain condition affecting up to 8.3% of the female population. Despite many years of research, no clear cause for PVD has been identified. Several risk factors have been studied, including vulvovaginal candidiasis (VVC). However, to date, the role of Candida infections in PVD has remained unclear. VVC and PVD have an overlap of symptoms that may contribute to diagnostic inaccuracy and mistreatment.
AIM
To systematically review the literature on the relationship between VVC and PVD.
METHODS
Cohort and case-control studies were included that compared women with PVD with healthy controls with respect to the presence of a history of Candida vulvovaginitis. PVD had to be diagnosed by Friedrich's criteria or the International Society for the Study of Vulvovaginal Disease criteria. The inclusion process as well as the quality appraisal of the studies, using the Newcastle-Ottawa Quality Assessment Scale, were performed independently by 2 authors.
MAIN OUTCOME MEASURE
Outcomes of the population-based case-control studies were listed as odds ratio. Outcomes of the pathophysiological studies were based on local pro-inflammatory responses on Candida in vitro.
RESULTS
We included a total of 14 studies, both population and clinic-based case-control, and pathophysiological research. 7 studies were of low methodological quality, and 7 studies were of medium methodological quality. The population-based case-control studies showed a significantly increased odds ratio for self-reported VVC in PVD cases compared with controls. The pathophysiological studies revealed a tendency for an increased local proinflammatory response on Candida in vitro in patients with PVD. Owing to the substantial heterogeneity of the studies, meta-analysis was not performed.
CLINICAL IMPLICATIONS
Health care providers may consider a diagnosis of PVD in women with self-reported VVC, and to act on this properly. Reiteration of antifungal prescriptions by physicians without a decent diagnosis, will lead to mistreatment. Women should be informed by their health care provider that intercourse during (or shortly after) the treatment of VVC might worsen the vulnerability of the vulvar skin.
STRENGTH AND LIMITATIONS
This is the first systematic review performed to describe the relation between VVC and PVD. An independently performed in- and exclusion process and quality appraisal, ensured optimal internal validity. However, there were important methodological limitations and the size of heterogeneity prevented establishing a meta-analysis.
CONCLUSION
This systematic review is unable to draw conclusions regarding a relationship between actual VVC and PVD because studies were based on self-reported VVC. Until new evidence becomes available, we advocate that PVD should be considered as an unexplained chronic pain condition. In women with recurrent or persistent VVC-like complaints, physicians should consider a diagnosis of PVD. Leusink P, van de Pasch S, Teunissen D, et al. The Relationship Between Vulvovaginal Candidiasis and Provoked Vulvodynia: A Systematic Review. J Sex Med 2018;15:1310-1321.
Topics: Adult; Candidiasis, Vulvovaginal; Case-Control Studies; Cohort Studies; Female; Humans; Pain Measurement; Self Report; Vulvodynia
PubMed: 30145093
DOI: 10.1016/j.jsxm.2018.07.011 -
American Journal of Obstetrics and... Oct 2021This study aimed to systematically review the relative effectiveness of preincision cefazolin with or without adjunctive prophylaxis (macrolides or metronidazole) vs... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to systematically review the relative effectiveness of preincision cefazolin with or without adjunctive prophylaxis (macrolides or metronidazole) vs cefazolin alone in decreasing the incidence of postcesarean delivery surgical site infections.
DATA SOURCES
We performed a systematic search on PubMed, Ovid EMBASE, Google Scholar, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from October 25, 2020, to November 25, 2020, to identify studies comparing cefazolin with adjunctive macrolides or metronidazole with cefazolin alone. The reference lists were reviewed, and a manual search of articles published after the last database search was performed.
STUDY ELIGIBILITY CRITERIA
Overall, 3 randomized controlled trials and 1 prospective observational study of reproductive-age women undergoing cesarean deliveries were included in the study. We excluded studies of women who were immunocompromised (eg, patients who were HIV positive) or women with a diagnosis of chorioamnionitis before cesarean delivery. All patients received first-line cefazolin (either cefazolin 1 g or 2 g). We compared preincision cefazolin alone with preincision cefazolin plus adjunctive therapy (500 mg, oral or intravenous formulations of azithromycin, metronidazole, or clarithromycin).
METHODS
A total of 6 review authors independently assessed the risk of bias for each study, using the Cochrane Risk of Bias criteria. Synthesis and further appraisal were done using the Grading of Recommendations, Assessment, Development, and Evaluation levels and the American College of Obstetricians and Gynecologists appraisal guidelines. Disagreements were resolved by discussion. Treatment effects were evaluated using meta-analysis, and pooled relative risks and 95% confidence intervals were generated using random-effects models using the Review Manager 5 software (version 5.4.1).
RESULTS
Overall, 3 randomized controlled trials and 1 prospective observational study representing 2613 women met the criteria for inclusion. Significant reductions in surgical site infections (relative risk, 0.46; 95% confidence interval, 0.34-0.63; 3 randomized controlled trials) and the duration of hospital stay (weighted mean difference, -1.46; 95% confidence interval, -2.21 to -0.71; 2 randomized controlled trials) were observed with preincision cefazolin and adjunctive prophylaxis compared with cefazolin alone. No significant difference was observed in maternal febrile morbidity (relative risk, 0.38; 95% confidence interval, 0.11-1.25; 2 randomized controlled trials).
CONCLUSION
Our findings have provided evidence for the use of preincision adjunctive extended-spectrum prophylaxis with cefazolin over cefazolin alone. However, future investigations are required to establish the relative efficacies of different adjunctive antibiotic options.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Cesarean Section; Drug Therapy, Combination; Female; Humans; Length of Stay; Macrolides; Metronidazole; Pregnancy; Puerperal Infection; Surgical Wound Infection
PubMed: 33964219
DOI: 10.1016/j.ajog.2021.04.259 -
Menopause (New York, N.Y.) Sep 2020Genitourinary symptoms affect 40% to 60% of postmenopausal women. Evidence-based approaches to diagnosing and managing these symptoms are limited by inconsistencies in...
IMPORTANCE
Genitourinary symptoms affect 40% to 60% of postmenopausal women. Evidence-based approaches to diagnosing and managing these symptoms are limited by inconsistencies in outcomes and measures used in clinical trials.
OBJECTIVE
The aim of the study was to systematically review all outcomes and measurement tools reported in randomized clinical trials of interventions for genitourinary symptoms associated with menopause.
EVIDENCE REVIEW
We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to December 2018. Randomized controlled trials with a primary or secondary outcome of genitourinary symptoms associated with menopause, English language, and sample size of 20 or more women per study arm were included. Study characteristics, outcomes, and measurement methods were collected.
FINDINGS
The search yielded 3,478 articles of which 109 met inclusion criteria. Forty-eight different outcomes were reported with "atrophy" as the most common (56/109, 51%) followed by measures of sexual function (19/109, 17%). Almost all (108/109, 99%) trials included patient-reported measures, with 21 different measures and 39 symptom combinations. Clinician-reported scales of vulvovaginal appearance were used in 36 of 109 (33%) trials, with extensive variation in what was measured and reported. Cytological measures from the vaginal epithelium were the most commonly used objective tools (76/109, 70%).
CONCLUSIONS AND RELEVANCE
There is heterogeneity in reported outcomes and measures used in clinical trials of treatments for genitourinary symptoms at menopause and uncertainty as to which outcomes best reflect patient priorities and symptoms. The findings from this systematic review have informed an international survey of stakeholders to determine priorities for outcome selection and reporting. This survey will then inform the development of a Core Outcome Set for use in future clinical trials by the COMMA (Core OutcoMes in MenopAuse) consortium. : Video Summary:http://links.lww.com/MENO/A599.
Topics: Atrophy; Female; Humans; Menopause; Postmenopause; Randomized Controlled Trials as Topic; Surveys and Questionnaires
PubMed: 32852462
DOI: 10.1097/GME.0000000000001570 -
European Journal of Obstetrics,... Oct 2022One of the most common adverse events reported by gynecological cancer survivors with spontaneous or iatrogenic menopause is vulvo-vaginal atrophy (VVA). An increasing... (Review)
Review
INTRODUCTION
One of the most common adverse events reported by gynecological cancer survivors with spontaneous or iatrogenic menopause is vulvo-vaginal atrophy (VVA). An increasing number of women have this kind of discomfort related to the menopause induced by different cancer therapies. In this regard, fractional CO2 laser may be a valid therapeutic choice for these patients.
METHODS
We performed a literature search of PubMed, EMBASE, SCOPUS and Web of Science databases with search terms of laser CO2 treatment of vulvovaginal atrophy and gynecologic cancer survivors and reviewed major US Society Guidelines to create this narrative review of this topic. Breast, ovarian endometrial and cervical cancers were included.
RESULTS
Nine studies were included. Fractional CO2 laser improves clinical symptoms and sexual function, in terms of VHI (vaginal health index) and FSFI (female sexual function index). Non severe adverse event occurred.
CONCLUSION
According to the best evidence available, fractional CO2 laser treatment for VVA is an effective and safe therapeutic option for gynecological cancer survivors, improving sexual life and quality of life (QoL).
Topics: Atrophy; Carbon Dioxide; Female; Genital Neoplasms, Female; Humans; Lasers, Gas; Quality of Life; Treatment Outcome; Vagina; Vaginal Diseases; Vulva
PubMed: 36037664
DOI: 10.1016/j.ejogrb.2022.08.012 -
Cureus Apr 2024Urinary tract infections (UTIs) are a significant health concern globally, with a pronounced impact on women's health in India. This systematic literature review aims to... (Review)
Review
Urinary tract infections (UTIs) are a significant health concern globally, with a pronounced impact on women's health in India. This systematic literature review aims to elucidate the factors associated with UTIs among women of reproductive age in India and focus on demographic, behavioral, and physiological factors to inform targeted public health and clinical interventions. A systematic literature search was conducted on PubMed and Google Scholar using specific MeSH terms and preferred reporting items for systematic literature reviews and meta-analyses (PRISMA) guidelines to investigate the correlates of UTIs among Indian women. Studies were selected based on their relevance to the correlates of UTIs among Indian women, including risk factors, prevention strategies, and treatment outcomes. The review identified a significant prevalence of UTIs among pregnant women, with being the most common causative agent. Younger women, particularly those pregnant, were found to be at a higher risk, likely due to physiological changes during pregnancy and increased sexual activity. Behavioral and lifestyle factors, such as inadequate water intake and poor sanitation practices, were strongly associated with increased risks for UTIs. Factors that increase the risk of UTIs in women include frequent sexual activity, involvement with a new sexual partner, spermicide use that can potentially alter vaginal pH and impact its bacterial composition, and vulvovaginal atrophy. Additionally, nearly 60% of women globally with recurrent UTIs experienced sexual dysfunction, indicating the broader implications of UTIs on women's sexual health and quality of life. UTIs among women in India are influenced by a complex interplay of factors. There is a critical need for enhanced public health initiatives focusing on sanitation, hydration, and hygiene, alongside holistic clinical management strategies that address both the infection and its broader health impacts. Future research should aim at developing innovative prevention and treatment strategies, with a particular focus on high-risk groups such as pregnant women, to mitigate the burden of UTIs in India.
PubMed: 38774177
DOI: 10.7759/cureus.58681 -
Heliyon Nov 2023Recurrent Vulvovaginal Candidiasis (RVVC) is defined as 3 or more episodes of symptomatic Vulvovaginal Candidiasis (VVC) within a year. Out of 75 % of women with VVC,...
BACKGROUND
Recurrent Vulvovaginal Candidiasis (RVVC) is defined as 3 or more episodes of symptomatic Vulvovaginal Candidiasis (VVC) within a year. Out of 75 % of women with VVC, this debilitating infection is experienced by 9 % of women. Although standard guidelines recommend oral and topical fluconazole as its treatment regimen, approval of another drug Oteseconazole has drawn the attention because of its better safety profile and lower recurrence rate by its use.
AIM
The purpose of our Meta-analysis is to evaluate the safety and efficacy of Oteseconazole (Vivjoa) (VT-1161) in the treatment of Recurrent Vulvovaginal Candidiasis (RVVC).
METHODOLOGY
Four databases namely PubMed, Google Scholar, Cochrane CENTRAL and Clinical Trial.gov were used from inception till June 2023. Studies that met the predefined inclusion criteria were statistically analyzed on RevMan (Version 5.4). A random effect model was used to pool the studies. A p value of less than 0.05 was considered significant and results were presented as Odds ratio with 95 % Confidence Intervals (CIs).
RESULT
The pooled analysis of our selected studies showed that Oteseconazole was associated with significantly reduced incidence of Recurrent Vulvovaginal Candidiasis (OR = 0.07; 95 % CI = 0.05-0.11; p < 0.00001, I = 0 %) through week 48. Additionally, Vivjoa has also been shown by our analysis to reduce incidence of RVVC through week 24. (OR = 0.05; 95 % CI = 0.03-0.09; p < 0.00001, I = 0 %) Furthermore, Oteseconazole was non-significantly associated with developing serious adverse effects during the treatment for Recurrent Vulvovaginal Candidiasis in comparison to the placebo (OR = 0.79; 95 % CI = 0.33-1.89; p = 0.60, I2 = 0 %).
CONCLUSION
The available evidence suggests Oteseconazole to be safer and more efficacious. However, limited patient population points towards the need of further large and dedicated trials for definitive conclusion.
PubMed: 37920530
DOI: 10.1016/j.heliyon.2023.e20495 -
Climacteric : the Journal of the... Apr 2015Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years. (Review)
Review
OBJECTIVE
Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years.
METHODS
A systematic literature search of English-language publications was performed using MEDLINE, EMBASE, CINAHL, and PsycINFO. Twenty-three studies that included information on the prevalence of vasomotor and/or urogenital atrophy symptoms among older women (65 + years) met our inclusion criteria. Risk of bias of the included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies.
RESULTS
The available data suggest that vasomotor symptoms are experienced by a considerable proportion of older women, that symptoms of urogenital atrophy including urinary incontinence are widespread, and that women remain sexually active well into later life. A high degree of variability was observed for the prevalence of estrogen deficiency symptoms for women age 65+ years. Discrepancies in modes of recruitment, sampling procedures, time frames over which symptoms were assessed and use of different and non-validated assessment tools contributed to the inconsistencies across the published studies.
CONCLUSION
Larger and appropriately sampled studies, employing validated questionnaires, are still needed to establish the prevalence of persistent estrogen depletion symptoms in women aged 65+ years.
Topics: Aged; Atrophy; Estrogens; Fecal Incontinence; Female; Female Urogenital Diseases; Hot Flashes; Humans; MEDLINE; Sexual Behavior; Sweating; Urinary Incontinence; Urogenital System; Vagina; Vasomotor System; Vulva
PubMed: 25382674
DOI: 10.3109/13697137.2014.978754