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Medicina (Kaunas, Lithuania) Nov 2023: Signs and symptoms of vulvovaginitis, especially when recurrent, have a significant impact on a woman's quality of life. The aim of this study was to survey... (Observational Study)
Observational Study
Efficacy of a Novel Rigenase and Polyhexanide (Fitostimoline Septagel) Hydrogel Device for the Treatment of Vulvovaginitis Symptoms: Cross-Sectional Analysis of a National Survey and Prospective Observational Study.
: Signs and symptoms of vulvovaginitis, especially when recurrent, have a significant impact on a woman's quality of life. The aim of this study was to survey gynecologists about their habits regarding the treatments of the pathology and to evaluate the efficacy of a novel vaginal hydrogel composed of wheat extracts and polyhexanide aimed at reducing vulvovaginitis symptomatology. : A cross-sectional analysis of a national survey using 155 Italian gynecologists and a prospective, open-label, observational study were carried out in 75 outpatient clinics across Italy. Pre- and postmenopausal women with suspicion of vulvovaginitis due to at least four of the following symptoms (leucoxanthorrhea, bad odor from genitalia, vulvovaginal dryness, petechiae, burning, and pruritus) while waiting for microbiological swab analysis were included and treated with one hydrogel application every 3 days for 1 week. Primary endpoint was the complete resolution of symptomatology. : The pre-study survey reported that, for most clinicians, local or oral treatment (65.7% and 82.8%, respectively) with antibiotics or antifungals is used very often. Therefore, we proceeded to carry out an observational study. Overall, 615 (362 of fertile age and 253 in postmenopause) women were included in this study. At the 28th follow-up examination, complete resolution of symptomatology was achieved in 578/615 (94.1%; < 0.001) within 12.72 ± 6.55 and 13.22 ± 6.33 days for those of fertile age and in postmenopause, respectively ( = 0.342). All of the evaluated symptoms were significantly reduced after treatment ( = 0.001) without differences according to the patient's menopausal status. A slightly significant reduction in ( = 0.040) and ( = 0.049) was found after treatment. No patient reported side effects, adverse reactions, or discontinued therapy. : This pilot study showed that a hydrogel based on Rigenase (wheat extract) and polyhexanide could be a promising treatment for the relief of vulvovaginitis symptoms. However, these results are limited by the absence of a control group. Additional comparative and randomized controlled trials between the hydrogel and other non-antibiotic devices as well as local antibiotic therapy should be performed to increase the validity of the findings.
Topics: Female; Humans; Cross-Sectional Studies; Hydrogels; Prospective Studies; Pilot Projects; Quality of Life; Vulvovaginitis; Anti-Bacterial Agents
PubMed: 38004053
DOI: 10.3390/medicina59112004 -
International Journal of Impotence... Nov 2023While vulvar lichen sclerosus (VLS) causes intense pruritus, associated risks of mood disorders and prescription patterns and impact of concurrent sexual dysfunction are...
While vulvar lichen sclerosus (VLS) causes intense pruritus, associated risks of mood disorders and prescription patterns and impact of concurrent sexual dysfunction are unknown. We queried TriNetX Diamond Network between 2009 and 2022, conducting three comparisons after propensity-score matching for demographics and relevant comorbidities: (1) women with lichen sclerosus (LS) sparing the vulva vs. women with VLS; (2) VLS patients who received treatment within 6 months of diagnosis vs. patients who did not and (3) VLS patients with vs. without sexual dysfunction. Outcomes included new depressive episodes, anxiety disorder, major depressive disorder (MDD), and prescriptions of antidepressants or benzodiazepines. After matching, VLS was associated with increased depressive episode [risk ratio (RR) 1.39], anxiety disorder (RR 1.93), and MDD (RR 2.00) diagnoses compared to LS sparing the vulva. Next, VLS treatment was associated with decreased risk of depressive episode (RR 0.60) and anxiety disorder (RR 0.72). Finally, concurrent sexual dysfunction was associated with increased benzodiazepine (RR 3.50), vaginal estrogen (RR 6.20), antipruritic agents (RR 3.90), and topical anti-inflammatory (RR 2.61) prescriptions. In conclusion, vulvar involvement is associated with increased risk of antidepressant and benzodiazepine prescriptions, and diagnosis of depressive episode, anxiety disorder, or MDD.
PubMed: 37973860
DOI: 10.1038/s41443-023-00793-3 -
Frontiers in Pharmacology 2023We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in...
We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review. A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms. Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: : reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); : duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); : bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); : citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); : mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); : mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); : agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); : duloxetine (back pain); : sertraline (upper gastrointestinal bleeding); : mianserin (restless legs syndrome); and : bupropion (seizures). Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.
PubMed: 37829299
DOI: 10.3389/fphar.2023.1271776 -
Journal of Korean Medical Science Sep 2023This study analyzed common gynecologic problems among Korean patients younger than ten years.
BACKGROUND
This study analyzed common gynecologic problems among Korean patients younger than ten years.
METHODS
We performed a retrospective analysis of medical records of patients younger than ten years who visited the Pediatric and Adolescent Gynecology Clinic at Samsung Medical Center between 1995 and 2020.
RESULTS
Among the 6,605 patients who visited the Pediatric and Adolescent Gynecology Clinic, data from 642 patients younger than ten years were analyzed in this study. The most common chief complaint was genital anomalies, followed by increased vaginal discharge and abnormal findings on clinical examinations. The most common disease entity was agglutination of the labia minora, which was commonly discovered incidentally during routine screenings. Vulvovaginitis, the second most common disease, was identified by symptoms of vaginal discharge, pruritus, and vaginal spotting. Neoplasm, issues with vaginal bleeding, and "other causes" were additional categories of gynecologic problems. 245 patients (38.2%) were referred from primary care sources, 175 patients (27.4%) sought care directly at the clinic, 169 patients (26.3%) were referrals from the institution's pediatric department, and the remainder were referrals from other departments.
CONCLUSION
This study provides information about the gynecologic problems most frequently encountered in pediatric patients. The study provides helpful insight for primary care physicians into the proper management and timing of referrals for these gynecologic problems of pediatric patients.
Topics: Adolescent; Child; Female; Humans; Ambulatory Care Facilities; Asian People; Republic of Korea; Retrospective Studies; Uterine Hemorrhage; Vaginal Discharge; Genital Diseases, Female
PubMed: 37724492
DOI: 10.3346/jkms.2023.38.e279 -
Cureus Aug 2023Plasma cell, or Zoon's, vulvitis (PCV) is a rare inflammatory disorder of the female genital tract. Clinically, it is characterized by erythematous mucosal lesions...
Plasma cell, or Zoon's, vulvitis (PCV) is a rare inflammatory disorder of the female genital tract. Clinically, it is characterized by erythematous mucosal lesions associated with burning, pruritus, and dyspareunia. Histologically, it is characterized by the thinning of the epithelium with the infiltration of plasma cells in the underlying dermis. There are few case reports describing predominantly vaginal symptoms. Our patient is a 53-year-old postmenopausal female presenting for the gynecologic evaluation of a vaginal pinching sensation and vulvar irritation for three months. On examination, vaginal mucosa was notable for erythematous macules and papules with focal tenderness. Initial evaluation was significant for bacterial vaginosis. This was treated, but it did not improve the patient's presenting symptoms. Our preliminary working diagnosis was vulvovaginal atrophy. Biopsies showed plasmacytosis mucosae consistent with Zoon's vaginitis. The patient was treated with external clobetasol ointment and hydrocortisone 25 mg vaginal suppositories with improvement in symptoms. Female genital tract lesions engender a range of differential diagnoses, including infectious, immunologic, and malignant causes. In this patient, our initial working diagnosis of genitourinary syndrome of menopause suggested that local hormonal treatment was indicated. However, histological diagnosis directed the use of steroid treatment, ultimately improving the patient's symptoms.
PubMed: 37692699
DOI: 10.7759/cureus.43260 -
JSLS : Journal of the Society of... 2023Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine).
METHOD
This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications.
RESULTS
Fifty patients were identified and randomized into each arm. Prior to surgery, the surgical team prepared the vaginal field using 10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine, according to group assignment. Cultures were collected from the vagina after initial preparation, prior to the colpotomy, and on surfaces of the uterine manipulator. Bacterial count from the baseline vaginal fornix/cervical canal cultures did not differ significantly among the three groups. There was a difference in bacterial count among the second cervical canal/vaginal fornix cultures (p < 0.01), with the Povidone-iodine arm demonstrating the highest level of growth of cultures (93.8%), followed by 2% Chlorhexidine (47.4%), and 4% Chlorhexidine (20%). There was no difference in growth on the uterine manipulator handle and no difference in vaginal itching or burning was found across the three arms postoperatively.
CONCLUSION
Bacterial growth prior to colpotomy was the lowest with 4% Chlorhexidine followed by 2% Chlorhexidine, the Povidone-iodine group exhibited the highest bacterial growth. There was no difference in moderate to severe vaginal itching or burning. This showed that 4% Chlorhexidine is superior in reducing bacterial growth when used in laparoscopic hysterectomy.
Topics: Female; Humans; Adolescent; Povidone-Iodine; Chlorhexidine; Prospective Studies; Hysterectomy; Vagina; Laparoscopy; Pruritus; Hysterectomy, Vaginal
PubMed: 37663434
DOI: 10.4293/JSLS.2023.00013 -
Clinical Laboratory Aug 2023The aim was to discover the infectivity characteristics of recurrent vulvovaginal candidiasis (RVVC) in Chengdu, Sichuan Province, and provide a reference for RVVC...
BACKGROUND
The aim was to discover the infectivity characteristics of recurrent vulvovaginal candidiasis (RVVC) in Chengdu, Sichuan Province, and provide a reference for RVVC clinical diagnosis and treatment.
METHODS
The clinical data of 500 patients with RVVC were retrospectively analyzed, including life history, clinical symptoms, combined gynecological diseases, age, and distribution of pathogenic fungi, and the in vitro drug sensitivity of isolated fungi to antifungal drugs was assessed.
RESULTS
Among the 500 patients with RVVC, 486 (97.20%) had a sexual history, and the main clinical symptoms were vulva pruritus (394, 78.80%) and abnormal discharge (232, 46.40%). Common gynecological diseases were cervicitis (156 patients, 31.20%), human papillomavirus infection (130 patients, 26.00%), and coinfection with oth-er pathogens (127 patients, 25.40%). The high-incidence population was mainly concentrated in the 31 to 40-year-old age group, followed by the 20 to 30- and 41 to 50-year-old age groups. The number of patients gradually increased with time. Fungal culture was dominated by Candida albicans (69.80%), followed by Candida glabrata (28.40%), and Candida cerevisiae (0.60%). In vitro susceptibility testing showed that the highest drug resistance rate to antifungal drugs was to terbinafine (96.40%), followed by voriconazole (32.00%), fluconazole (26.40%), and itraconazole (17.40%), whereas the drug resistance rates to 5-fluorocytosine, caspofungin, amphotericin B, and micafungin were relatively low (1.80%, 0.60%, 0.40%, and 0.00%, respectively); the drug resistance rate to azoles gradually increased with age.
CONCLUSIONS
The occurrence of RVVC is closely related to sexual history. The most common cases are in women of childbearing age aged 20 - 50. The main pathogen is C. albicans, and the resistance rate to common azole antifungal drugs is increasing over time.
Topics: Humans; Female; Antifungal Agents; Candidiasis, Vulvovaginal; Retrospective Studies; Microbial Sensitivity Tests; Drug Resistance, Fungal; Candida albicans; Communicable Diseases
PubMed: 37560852
DOI: 10.7754/Clin.Lab.2023.230304 -
Alternative Therapies in Health and... Sep 2023To investigate the effect of Wandai decoction combined with traditional Chinese medicine fumigation and washing in patients with chronic vaginitis after sintilimab...
Efficacy Analysis of Wandai Decoction Combined with Traditional Chinese Medicine Fumigation and Washing in Patients with Chronic Vaginitis After Sintilimab Treatment for Small Cell Lung Cancer.
OBJECTIVE
To investigate the effect of Wandai decoction combined with traditional Chinese medicine fumigation and washing in patients with chronic vaginitis after sintilimab treatment for small cell lung cancer.
METHODS
We recruited 80 patients who developed chronic vaginitis after sintilimab treatment for small cell lung cancer from Hainan General Hospital from January 2020 to June 2022; using a random number table, 40 were assigned to a control group and 40 were assigned to an observation group. The control group was treated with Wandai decoction, and the observation group was treated with Wandai decoction combined with traditional Chinese medicine fumigation and washing. The 2 groups were compared for improvement of the symptoms of vulvar pruritus subsidence time, leukorrhea recovery time, and traditional Chinese medicine symptom score; levels of the vaginal microecological environment factors immunoglobulin G, secretory immunoglobulin A, and pH; levels of the serum inflammatory factors C-reactive protein, tumor necrosis factor, and interleukin-6; and clinical efficacy.
RESULTS
After treatment, the observation group had significantly higher vulvar pruritus subsidence time, leukorrhea recovery time, traditional Chinese medicine symptom score, and pH value; significantly lower levels of C-reactive protein, tumor necrosis factor, and interleukin-6; and significantly higher levels of immunoglobulin G, secretory immunoglobulin A, and total effective rate compared with the control group (all P < .0.001).
CONCLUSIONS
Wandai decoction combined with traditional Chinese medicine fumigation and washing was effective in treating chronic vaginitis after sintilimab treatment for small cell lung cancer. The treatment ameliorated symptoms of leukorrhea abnormalities, vulvar pruritus, and local inflammation, and promoted the recovery of the vaginal microbial environment. Despite the limitations of our study (small sample size and lack of comparison between different types of chronic vaginitis, which hinders the confirmation of extensive efficacy), we consider Wandai decoction combined with traditional Chinese medicine fumigation and washing worthy of promotion and application in clinical practice.
Topics: Female; Humans; Leukorrhea; Small Cell Lung Carcinoma; C-Reactive Protein; Fumigation; Interleukin-6; Medicine, Chinese Traditional; Vaginitis; Tumor Necrosis Factors; Immunoglobulin A, Secretory; Immunoglobulin G; Lung Neoplasms; Pruritus
PubMed: 37318889
DOI: No ID Found -
Translational Pediatrics Apr 2023Vulvovaginitis is one of the most common pediatric gynecological diseases and easily causes the negative emotions for the parents. However, there are few studies on the...
BACKGROUND
Vulvovaginitis is one of the most common pediatric gynecological diseases and easily causes the negative emotions for the parents. However, there are few studies on the influence of parental anxiety and depression on children's disease and prognosis. This study aimed to analyze the risk factors of negative parental emotions and their effects on the prognosis of children, in order to improve life quality of children.
METHODS
We retrospectively analyzed 303 pediatric patients who developed bacterian vulvovaginitis from April 2017 to April 2022 based on our inclusion and exclusion criteria. The Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to assess the negative emotions and binary logistic regression was used to analyze the independent risk factors for negative emotions among the parents of children with vulvovaginitis. The relationship between the prognosis of children and parents' negative emotions was analyzed by independent sample -test, and the relationship between the recovery rate of children within 2 weeks, clearance rate of urine, and parents' negative emotions was analyzed by chi-square test.
RESULTS
In our study, 44.6% of the parents showed anxiety and 35.0% showed depression. The binary logistics regression of the clinical characteristics of the children showed that vulvar pruritus [odds ratio (OR) =1.664, P=0.048], increased vaginal secretions (OR =2.289, P=0.001), vulvar ulcerations (OR =1.831, P=0.024), and so on were independent influences on the anxiety of the parents, whereas vulvar pruritus (OR =2.722, P=0.000), increased vaginal secretions (OR =1.758, P=0.041), dysuria, frequent urination (OR =1.761, P=0.040), and so on were independent influences on depression among the parents. Besides, it was found that parental negative emotions significantly prolonged the improvement of the child's prognosis.
CONCLUSIONS
Parents of children with vulvovaginitis are highly susceptible to have negative emotions due to the various clinical features of the child. The negative emotions of the parents significantly prolong the recovery time of the child. In clinical practice, adequate communication should be established with the parents of patients, and detailed education should be carried out to reduce the psychological burden of patients' parents, so as to improve the prognosis of children.
PubMed: 37181022
DOI: 10.21037/tp-23-183 -
European Journal of Obstetrics,... Jun 2023Vaginal atrophy is a condition where the vaginal epithelium gets thinner and includes symptoms, such as vaginal dryness, abnormal vaginal discharge, vaginal bleeding,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVE
Vaginal atrophy is a condition where the vaginal epithelium gets thinner and includes symptoms, such as vaginal dryness, abnormal vaginal discharge, vaginal bleeding, dyspareunia, and sexual problems. Hormone therapy is associated with some problems and some women prefer herbal medicine to reduce vaginal atrophy. Considering the phytoestrogenic compounds present in the nettle, this study aimed to investigate the effect of the nettle vaginal cream on subjective symptoms of vaginal atrophy in postmenopausal women.
MATERIALS AND METHODS
This triple-blind randomized placebo-controlled clinical trial study was conducted on 84 eligible postmenopausal women aged 45-60 years, who referred to comprehensive health service centers in Aliabad Katul in 2021-2022. Women eligible for the study received 5% nettle vaginal cream and placebo for 8 weeks. Subjective symptoms of vaginal atrophy were assessed before, four and eight weeks after the intervention. Data collection tools included a checklist for research unit selection, individual and midwifery characteristics questionnaire, vaginal assessment scale (VAS), vaginal pH, laboratory results of the vaginal maturation value (VMV). Data analysis was performed using SPSS software (version 21) and independent t-test, Mann-Whitney, chi-square, Two-way analysis of variance and analysis of covariance. P value less than 0.05 was considered significant.
RESULTS
Subjective symptoms of vaginal atrophy decreased significantly after the intervention compared to before the intervention in both the nettle and placebo groups (p < 0.001), but in the comparison between groups four weeks and eight weeks after the intervention, the subjective symptoms of vaginal atrophy in nettle group decreased significantly (p < 0.001). In the nettle group, the scores of vaginal burning, vaginal dryness, vaginal itching and dyspareunia significantly improved after the intervention compared to before the intervention (p < 0.001). Also, in the nettle group compared to the placebo group, after the intervention, vaginal burning and vaginal dryness score (p < 0.001) and vaginal itching score (0.004) improved significantly.
CONCLUSION
Based on the results of the present study, Nettle vaginal cream reduced subjective symptoms of vaginal atrophy, including vaginal burning, vaginal dryness, vaginal itching, and dyspareunia in postmenopausal women, so it is a cost-effective, available and do not have the side effects product that can be useful for menopausal women.
Topics: Female; Humans; Vaginal Creams, Foams, and Jellies; Postmenopause; Dyspareunia; Administration, Intravaginal; Vaginal Diseases; Vagina; Atrophy; Pruritus; Treatment Outcome
PubMed: 37044017
DOI: 10.1016/j.ejogrb.2023.03.037