-
Neurourology and Urodynamics Jan 2020Oxygen plays a crucial role in wound healing after prolapse surgery. Trauma to the vaginal vasculature might limit the delivery of oxygen to the surgical wound, which...
AIMS
Oxygen plays a crucial role in wound healing after prolapse surgery. Trauma to the vaginal vasculature might limit the delivery of oxygen to the surgical wound, which may negatively affect wound healing and regeneration of connective tissue. This possibly increases the future risk of recurrence. We aimed to determine the effects of vaginal prolapse surgery on the microcirculation of the vaginal wall.
METHODS
We evaluated the vaginal microcirculation in healthy participants without known vascular disease undergoing anterior and/or posterior colporrhaphy. We used incident dark-field imaging for in vivo assessment before and after (1 day, 2 weeks, and 6 weeks) surgery. We studied perfusion (microvascular flow index [MFI]), angioarchitecture (morphology/layout of microvessels) and capillary density.
RESULTS
Ten women were included. Interindividual differences were observed 1 day postoperatively with regard to perfusion and angioarchitecture. Microvascular flow at the surgical site was absent or significantly reduced in some participants, whereas normal microvascular flow was observed in others (MFI range 0-3). Perfusion and angioarchitecture had been restored in all participants after 6 weeks (MFI range 2-3), regardless of the extent of vascular trauma 1 day postoperatively.
CONCLUSIONS
The difference in the extent of vascular trauma between women undergoing seemingly identical surgical procedures suggests that some individuals are more susceptible to vascular trauma than others. Delivery of oxygen to the wound and subsequent wound healing may be compromised in these cases, which could be related to the development of anatomical recurrence. Future studies should investigate whether there is a relationship between the vaginal microvasculature and the recurrence of prolapse.
Topics: Aged; Female; Gynecologic Surgical Procedures; Humans; Microcirculation; Microvessels; Middle Aged; Pelvic Organ Prolapse; Recurrence; Surgical Mesh; Vagina
PubMed: 31691336
DOI: 10.1002/nau.24203 -
Journal of Medicine and Life 2020Vaginal infections are the most common gynecological diseases and one of the causes of sexual dysfunction. In more than 50% of patients, sexual dysfunction is twice as...
Vaginal infections are the most common gynecological diseases and one of the causes of sexual dysfunction. In more than 50% of patients, sexual dysfunction is twice as common. Evaluation of the treatment outcome of vaginal infections can be effective in identifying factors related to the sexual function. This is a descriptive-observational study that included patients referred to Imam Sajjad Shahriar Hospital during 2017-2018. Patients that met the inclusion criteria (with vaginal infections of Candida, Gardnerella and mixed infections - Candida and Gardnerella - Mixed group) completed the Female Sexual Function Index (FSFI) questionnaire before and one month after treatment. Data were analyzed by SPSS 16, paired t-test, ANOVA, and multiple regression. P-value <0.05 was considered significant. After the treatment of vaginitis, there was a significant increase in all aspects of the FSFI questionnaire. The mean and standard deviation of sexual function of women before and after treatment were 18.26 ± 4.36 and 26.27 ± 4.97 in the Candida group, 20.06 ± 4.94 and 25.87 ± 5.32 in the Gardnerella group, and 19.69 ± 4.25 and 27.05 ± 5.12 in the Mixed group. Prior to treatment in the Mixed and Gardnerella group, the most important sexual dysfunction was related to the dyspareunia component, while in the Candida group, the most important sexual dysfunction was related to the desire component. After treatment, the components of dyspareunia in the Mixed and Gardnerella group and the orgasmic component in the Candida group showed the greatest improvement. The regression test showed that the effect of age, body mass index and duration of sex on sexual function was significant (P <0.05). Duration of the disease had the greatest impact on sexual dysfunction, and after treatment of the disease, sexual function improved significantly. Proper diagnosis and treatment are effective in improving women's sexual function. The results of this study can be promoted to midwives and gynecologists.
Topics: Adult; Female; Humans; Infections; Middle Aged; Regression Analysis; Sexual Dysfunction, Physiological; Surveys and Questionnaires; Treatment Outcome; Vagina
PubMed: 33072204
DOI: 10.25122/jml-2020-0051 -
Acta Cirurgica Brasileira 2024To investigate inflammation and cell adhesion molecules in the vagina after ovarian ischemia-reperfusion (IR) injury.
PURPOSE
To investigate inflammation and cell adhesion molecules in the vagina after ovarian ischemia-reperfusion (IR) injury.
METHODS
20 Wistar albino female rats were divided into two groups: control, and IR groups. In IR group, blood flow was restricted for 2 hours for ovarian ischemia. Then, tissues were re-blood 2 hours for reperfusion. Vagina tissues were excised and processed for histopathological analysis. Histopathological and biochemical follow-ups were performed.
RESULTS
Both malondialdehyde and myeloperoxidase values were increased in IR group compared to control group. Glutathione content was decreased in IR group compared to control group. Epithelial degeneration, inflammation, dilatation, and nuclear factor-κB (NF-κB) expression were increased in IR group compared to control group. E-cadherin expression was significantly decreased in IR group. In the IR group, E-cadherin showed a positive reaction in adenomas, gland-like cryptic structures, cellular junctions with clustered inflammatory cells. In the IR group, NF-κB expression was increased in basement membrane, inflammatory cells, in blood vessels.
CONCLUSIONS
Ovarian ischemia caused degeneration of epithelial cells in the vaginal region and disruptions in the cell junction complex, which leads to activation of E-cadherin and NF-κB signaling pathway and alterations in reproductive and embryonal development in the vaginal region.
Topics: Animals; Female; Rats; Cadherins; Inflammation; Ischemia; NF-kappa B; Rats, Wistar; Reperfusion Injury; Ovary; Vagina
PubMed: 38629650
DOI: 10.1590/acb391724 -
Frontiers in Immunology 2019Recurrent vulvovaginal infections (RVVI), a devastating group of mucosal infection, are severely affecting women's quality of life. Our understanding of the vaginal... (Review)
Review
Recurrent vulvovaginal infections (RVVI), a devastating group of mucosal infection, are severely affecting women's quality of life. Our understanding of the vaginal defense mechanisms have broadened recently with studies uncovering the inflammatory nature of bacterial vaginosis, inflammatory responses against novel virulence factors, innate Type 17 cells/IL-17 axis, neutrophils mediated killing of pathogens by a novel mechanism, and oxidative stress during vaginal infections. However, the pathogens have fine mechanisms to subvert or manipulate the host immune responses, hijack them and use them for their own advantage. The odds of hijacking increases, due to impaired immune responses, the net magnitude of which is the result of numerous genetic variations, present in multiple host genes, detailed in this review. Thus, by underlining the role of the host immune responses in disease etiology, modern research has clarified a major hypothesis shift in the pathophilosophy of RVVI. This knowledge can further be used to develop efficient immune-based diagnosis and treatment strategies for this enigmatic disease conditions. As for instance, plasma-derived MBL replacement, adoptive T-cell, and antibody-based therapies have been reported to be safe and efficacious in infectious diseases. Therefore, these emerging immune-therapies could possibly be the future therapeutic options for RVVI.
Topics: Adaptive Immunity; Disease Susceptibility; Female; Genetic Predisposition to Disease; Host-Pathogen Interactions; Humans; Immunity, Innate; Oxidative Stress; Polymorphism, Single Nucleotide; Receptors, Pattern Recognition; Recurrence; Vagina; Vulvovaginitis
PubMed: 31555269
DOI: 10.3389/fimmu.2019.02034 -
American Journal of Reproductive... Sep 2021Access to safe, effective, and affordable contraception is important for women's health and essential to mitigate maternal and fetal mortality rates. The progestin-based... (Review)
Review
BACKGROUND
Access to safe, effective, and affordable contraception is important for women's health and essential to mitigate maternal and fetal mortality rates. The progestin-based contraceptive depot medroxyprogesterone acetate (DMPA) is a popular contraceptive choice with a low failure rate and convenient administration schedule.
AIM
In this review, we compiled observational data from human cohorts that examine how DMPA influences the mucosal biology of the female genital tract (FGT) that are essential in maintaining vaginal health, including resident immune cells, pro-inflammatory cytokines, epithelial barrier function, and the vaginal microbiome MATERIALS AND METHODS: This review focused on the recent published literature published in 2019 and 2020.
RESULTS
Recent longitudinal studies show that DMPA use associates with an immunosuppressive phenotype, increase in CD4+CCR5+ T cells, and alterations to growth factors. In agreement with previous meta-analyses, DMPA use is associated with minimal effects of the composition of the vaginal microbiome. Cross-sectional studies associate a more pro-inflammatory relationship with DMPA, but these studies are confounded by inherent weaknesses of cross-sectional studies, including differences in study group sizes, behaviors, and other variables that may affect genital inflammation.
DISCUSSION & CONCLUSION
These recent results indicate that the interactions between DMPA and the vaginal mucosa are complex emphasizing the need for comprehensive longitudinal studies that take into consideration the measurement of multiple biological parameters.
Topics: Contraceptive Agents, Female; Delayed-Action Preparations; Female; Genitalia, Female; Humans; Medroxyprogesterone Acetate; Microbiota; Mucous Membrane; Vagina
PubMed: 33991137
DOI: 10.1111/aji.13455 -
Frontiers in Immunology 2021Vaginal mucosal surfaces naturally offer some protection against sexually transmitted infections (STIs) including Human Immunodeficiency Virus-1, however topical...
Vaginal mucosal surfaces naturally offer some protection against sexually transmitted infections (STIs) including Human Immunodeficiency Virus-1, however topical preventative medications or vaccine designed to boost local immune responses can further enhance this protection. We previously developed a novel mucosal vaccine strategy using viral vectors integrated into mouse dermal epithelium to induce virus-specific humoral and cellular immune responses at the site of exposure. Since vaccine integration occurs at the site of cell replication (basal layer 100-400 micrometers below the surface), temporal epithelial thinning during vaccine application, confirmed with high resolution imaging, is desirable. In this study, strategies for vaginal mucosal thinning were evaluated noninvasively using optical coherence tomography (OCT) to map reproductive tract epithelial thickness (ET) in macaques to optimize basal layer access in preparation for future effective intravaginal mucosal vaccination studies. Twelve adolescent female rhesus macaques (5-7kg) were randomly assigned to interventions to induce vaginal mucosal thinning, including cytobrush mechanical abrasion, the chemical surfactant spermicide nonoxynol-9 (N9), the hormonal contraceptive depomedroxyprogesterone acetate (DMPA), or no intervention. Macaques were evaluated at baseline and after interventions using colposcopy, vaginal biopsies, and OCT imaging, which allowed for real-time visualization and measurement of ET of the mid-vagina, fornices, and cervix. P value ≤0.05 was considered significant. Colposcopy findings included pink, rugated tissue with variable degrees of white-tipped, thickened epithelium. Baseline ET of the fornices was thinner than the cervix and vagina (p<0.05), and mensing macaques had thinner ET at all sites (p<0.001). ET was decreased 1 month after DMPA (p<0.05) in all sites, immediately after mechanical abrasion (p<0.05) in the fornix and cervix, and after two doses of 4% N9 (1.25ml) applied over 14 hrs in the fornix only (p<0.001). Histological assessment of biopsied samples confirmed OCT findings. In summary, OCT imaging allowed for real time assessment of macaque vaginal ET. While varying degrees of thinning were observed after the interventions, limitations with each were noted. ET decreased naturally during menses, which may provide an ideal opportunity for accessing the targeted vaginal mucosal basal layers to achieve the optimum epithelial thickness for intravaginal mucosal vaccination.
Topics: Animals; Cervix Uteri; Drug Delivery Systems; Epithelial Cells; Epithelium; Female; Macaca mulatta; Mice; Mucous Membrane; Simian Immunodeficiency Virus; Tomography, Optical Coherence; Vaccines; Vagina
PubMed: 34262561
DOI: 10.3389/fimmu.2021.660524 -
MSphere Oct 2022A healthy state of the vaginal microbiome can prevent vaginal disease and promote successful fertilization and healthy pregnancies. Little is known about the stability...
A healthy state of the vaginal microbiome can prevent vaginal disease and promote successful fertilization and healthy pregnancies. Little is known about the stability of the vaginal microbiome and the influence of factors such as diet and probiotics. While less explored, yeast probiotics have an interesting potential because of their immunomodulatory and pathogen inhibition capacities. In this study, we investigated the impact of the oral yeast probiotic Saccharomyces cerevisiae CNCM I-3856 on the vaginal microbiomes of 52 healthy women using 16S and internal transcribed spacer (ITS) amplicon sequencing and quantitative PCR (qPCR). The vaginal fungal loads remained low, even after oral yeast supplementation, complicating the analysis of the vaginal mycobiome. Lactobacillus crispatus and Lactobacillus iners were the most dominant species in our study population and were found to codominate in 23% of the baseline samples. , Streptococcus, and were also frequently found. The microbiome profiles were dynamic: 69% of women showed a shift in the dominant community members at least once during the 42-day sampling period. In addition, lower abundances were observed at the time points after menstruation. Higher relative abundances of with more L. inersdominated samples and a trend toward lower relative abundances of were observed in the probiotic group, but analyses of the effects of the yeast probiotic were complicated by differences already present at the onset of the study. Thus, our findings especially highlighted that the impact of menstruation and the stratification of women based on the dominant vaginal taxa before randomization and inclusion is important for future research: while the impact of the yeast probiotic on vaginal microbiome in healthy women was limited. How to define and promote a healthy state of the vaginal microbiome is not well understood. Knowledge of which underlying factors shape the microbial community composition of the vagina and how to modulate them will contribute to vaginal disease prevention and improve fertility. Here, we found that taking the menstrual cycle into account when designing a microbiome study is highly recommended: menstruation also showed to be poses an interesting time point for intervention because of the drop in the abundance of L. crispatus. Furthermore, the early stratification of groups (e.g., placebo versus treatment) according to the dominant taxa can be of high added value since menstruation impacts vaginal taxa differently, i.e., remains stable, in contrast to .
Topics: Pregnancy; Humans; Female; Saccharomyces cerevisiae; Menstruation; Vagina; Microbiota; Probiotics; Vaginal Diseases
PubMed: 36102507
DOI: 10.1128/msphere.00239-22 -
BMJ Case Reports Mar 2021Herlyn-Werner-Wunderlich syndrome (HWWS), defined by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis, is a rare Mullerian duct...
Herlyn-Werner-Wunderlich syndrome (HWWS), defined by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis, is a rare Mullerian duct malformation, usually diagnosed after menarche, when symptoms related to haematocolpos arise. We report a case of a 14-year-old patient who presented to the emergency department complaining of proctalgia and pelvic pain treated in our medical centre. Ultrasound and abdomino-pelvic MRI imaging studies confirmed the diagnosis. Treatment was surgical incision of the vaginal septum. At the follow-up visit, after the initial procedure, excess vaginal tissue was excised using a hysteroscopic approach during diagnostic vaginoscopy. Vaginoscopy-assisted treatment of the patient proved to be a safe and effective minimally invasive treatment modality that resulted in symptomatic relief and fertility preservation. In conclusion, although premenarche is asymptomatic in the vast majority of cases, HWWS would be optimally diagnosed in childhood to avoid acute late complications, although it is usually first diagnosed after menarche as a result of haematocolpos. Gynaecologists should consider the syndrome in the presence of pelvic mass, renal agenesis, menstrual changes and cyclic pelvic pain.
Topics: Adolescent; Female; Humans; Kidney; Kidney Diseases; Mullerian Ducts; Urogenital Abnormalities; Uterus; Vagina
PubMed: 33664029
DOI: 10.1136/bcr-2020-239160 -
Ultrasound in Obstetrics & Gynecology :... Jul 2022
Review
Topics: Female; Humans; Mullerian Ducts; Uterus; Vagina
PubMed: 35678250
DOI: 10.1002/uog.24905 -
A Review on Microbial Species for Forensic Body Fluid Identification in Healthy and Diseased Humans.Current Microbiology Jul 2023Microbial communities present in body fluids can assist in distinguishing between types of body fluids. Metagenomic studies have reported bacterial genera which are core... (Review)
Review
Microbial communities present in body fluids can assist in distinguishing between types of body fluids. Metagenomic studies have reported bacterial genera which are core to specific body fluids and are greatly influenced by geographical location and ethnicity. Bacteria in body fluids could also be due to bacterial infection; hence, it would be worthwhile taking into consideration bacterial species associated with diseases. The present review reports bacterial species characteristic of diseased and healthy body fluids across geographical locations, and bacteria described in forensic studies, with the aim of collating a set of bacteria to serve as the core species-specific markers for forensic body fluid identification. The most widely reported saliva-specific bacterial species are Streptococcus salivarius, Prevotella melaninogenica, Neisseria flavescens, with Fusobacterium nucleatum associated with increased diseased state. Lactobacillus crispatus and Lactobacillus iners are frequently dominant in the vaginal microbiome of healthy women. Atopobium vaginae, Prevotella bivia, and Gardnerella vaginalis are more prevalent in women with bacterial vaginosis. Semen and urine-specific bacteria at species level have not been reported, and menstrual blood bacteria are indistinguishable from vaginal fluid. Targeting more than one bacterial species is recommended for accurate body fluid identification. Although metagenomic sequencing provides information of a broad microbial profile, the specific bacterial species could be used to design biosensors for rapid body fluid identification. Validation of microbial typing methods and its application in identifying body fluids in a mixed sample would allow regular use of microbial profiling in a forensic workflow.
Topics: Humans; Female; Vaginosis, Bacterial; Vagina; Body Fluids; Gardnerella vaginalis; Saliva; Bacteria
PubMed: 37491404
DOI: 10.1007/s00284-023-03413-x