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Journal of Plastic Surgery and Hand... Feb 2021In this study, we have evaluated the efficiency of fractional carbon dioxide laser in the treatment of vaginal laxity and urinary incontinence. Thirty patients with...
In this study, we have evaluated the efficiency of fractional carbon dioxide laser in the treatment of vaginal laxity and urinary incontinence. Thirty patients with vaginal laxity, sexual dysfunction and urinary incontinence complaints were treated with fractional carbon dioxide laser. Results were evaluated with patient questionnaires relating to comfort during the procedure and general satisfaction following the procedure. In the survey regarding comfort during the procedure, 90% (:27) of the patients reported that they were comfortable during the procedure. The survey on the level of general satisfaction six months following the procedure revealed high-moderate level of satisfaction in 86% (:26) of the patients. 66% (:20) of the patients reported improved vaginal tightness and 63% (:19) of the patients reported improvement in the quality of their sexual activity. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire(PISQ-12) scores six months following the procedure were not significantly different when compared to the scores prior to the procedure. The average of Questionnaire for Urinary Incontinence Diagnosis(QUID) score prior to the procedure and six months following the procedure was 7.5 and 0.9 respectively ( < 0.05). Fractional carbon dioxide laser treatment results in high level of satisfaction and improvement in vaginal laxity, sexual dysfunction and urinary incontinence symptoms in patients with genitourinary syndrome.
Topics: Atrophy; Dyspareunia; Female; Humans; Lasers, Gas; Middle Aged; Patient Satisfaction; Pruritus; Surveys and Questionnaires; Urinary Incontinence, Stress; Vagina
PubMed: 33030095
DOI: 10.1080/2000656X.2020.1828897 -
Case Reports in Women's Health Oct 2020A 31-year-old woman, gravida 3 para 1, at 10 weeks of gestation presented to a vulvar specialty clinic with a 6-month history of vulvar pruritus that had not responded...
A 31-year-old woman, gravida 3 para 1, at 10 weeks of gestation presented to a vulvar specialty clinic with a 6-month history of vulvar pruritus that had not responded to the treatment prescribed by her referring gynecologist. Examination was consistent with vaginitis and vulvar lichen simplex chronicus. Fungal cultures ultimately revealed and . The organisms were eradicated with oral fluconazole and intravaginal terazole. Few cases of isolation of in humans have been reported. Both immunosupressed and immuno-competent hosts have been identified, with the most common sites of isolation being the genitourinary and gastrointestinal tracts. Asymptomatic colonization and superficial disease have been noted; no invasive cases of have been described. Even fewer cases of infection during pregnancy have been reported, and symptomatic vulvovaginal disease has been described only once prior to this case report.
PubMed: 32983910
DOI: 10.1016/j.crwh.2020.e00254 -
Acta Obstetricia Et Gynecologica... Feb 2021Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease characterized by pruritus and abnormal liver function tests and it has been associated... (Comparative Study)
Comparative Study
INTRODUCTION
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease characterized by pruritus and abnormal liver function tests and it has been associated with intrauterine fetal distress and stillbirth. We compared two guidelines of the management of ICP: one mandating induction at 38 weeks of gestation (Rigshospitalet and Hvidovre Hospital before 2012) and another separating ICP into mild and severe forms, and only women with severe ICP were recommended for induction at 38 weeks (Hvidovre Hospital after 2012).
MATERIAL AND METHODS
We performed a historical cohort study at two Copenhagen Hospitals from 2004 to 2015. We included 62 937 women with singleton deliveries at Rigshospitalet and 71 015 at Hvidovre Hospital, of whom 971 women (1.5%) and 998 women (1.4%) were diagnosed with ICP at Rigshospitalet and Hvidovre Hospital, respectively. Data were retrieved from a local medical database. For the analysis of induction and comparison of obstetrical outcomes we only included pregnancies with an ICP diagnosis and excluded women with other medical conditions that could mandate induction. Main outcome measures were induction and cesarean section rates, asphyxia and stillbirth.
RESULTS
We found no changes in the rate of spontaneous labor, cesarean section and induction over the years at Rigshospitalet (P = .17) and Hvidovre Hospital (P = .38). For women with intended vaginal delivery we found no change in the final mode of delivery over the years at Rigshospitalet (P = .28) and Hvidovre Hospital (P = .57).
CONCLUSIONS
The two approaches to the management of mild ICP regarding the timing of induction are comparable. Women with mild ICP and their clinicians should be encouraged to engage in shared decision-making when discussing timing of induction.
Topics: Adult; Asphyxia Neonatorum; Cesarean Section; Cholestasis, Intrahepatic; Cohort Studies; Delivery, Obstetric; Denmark; Female; Humans; Labor, Induced; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Severity of Illness Index; Stillbirth
PubMed: 32970824
DOI: 10.1111/aogs.13998 -
European Journal of Obstetrics,... Oct 2020Intrahepatic cholestasis of pregnancy (ICP) is associated with a distinctive maternal pruritus, abnormal liver function tests, raised serum total bile acids, and...
INTRODUCTION
Intrahepatic cholestasis of pregnancy (ICP) is associated with a distinctive maternal pruritus, abnormal liver function tests, raised serum total bile acids, and increased rates of adverse fetal outcomes, including intrauterine fetal death. Progesterone has been implicated in the pathogenesis of ICP. We aimed to evaluate whether the incidence of ICP is altered in women receiving long-term daily vaginal progesterone, indicated for a short cervical length.
STUDY DESIGN
A matched 1:3 case-control study of pregnant women between January 2014 and January 2019. Study cases included pregnant women with the diagnosis of ICP. Control cases were women without ICP. The primary outcome was the rate of vaginal progesterone treatment among the groups.
RESULTS
The use of vaginal progesterone throughout pregnancy was higher in the ICP group compared with the control group (8/174 [4.6 %] versus 6/522 [1.1 %], respectively, P = 0.03, odds ratio 4 [95 % confidence interval 1.4-11.7]).
CONCLUSIONS
Pregnant women treated with long-term vaginal progesterone preparations for the prevention of preterm birth are at increased risk of developing ICP. In the presence of pruritus during pregnancy, we recommend an early consultation and diagnostic test to confirm or rule-out ICP.
Topics: Case-Control Studies; Cholestasis, Intrahepatic; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Premature Birth; Progesterone
PubMed: 32866855
DOI: 10.1016/j.ejogrb.2020.08.043 -
European Review For Medical and... Jul 2020The aim of the study is to evaluate the efficacy and safety of hydroxytyrosol for the prevention of the vulvar vaginal candida infections recurrence. (Observational Study)
Observational Study
Efficacy and safety of oral administration of a product based on hydroxytyrosol as preventive therapy for recurrent vulvo-vaginal candidosis: a prospective observational pilot study.
OBJECTIVE
The aim of the study is to evaluate the efficacy and safety of hydroxytyrosol for the prevention of the vulvar vaginal candida infections recurrence.
PATIENTS AND METHODS
This study is a prospective observational pilot study. Eligible subjects were at least 18 years old, with at least 4 documented episodes of vulvovaginal candidiasis in the last 12 months. Patients were instructed to therapy (2 tabs daily for the first month and then 1 tab daily for 2 other months). Each capsule consists of hydroxytyrosol (HT) and other components: tea tree oil, tabebuia, juglans regia, and copper. Clinical and microbiological assessments took place at baseline and 12 weeks after. The impact on Quality of Life (QoL) was evaluated with the SF-36 and the Patient Global Impression of Improvement (PGI-I) after 3 months of treatment was calculated.
RESULTS
Sixty patients were enrolled in the study. In the last 1 year the mean number of previous infections was 5.83 ± 2.76. Forty-nine patients (83%) did not have candida episodes during 3 months of treatment. A significant reduction in clinical symptoms, vaginal signs, such as pruritus, burning and vulvar erythema (< 0.0001). The SF-36 showed a significant change (55.67±8.43 vs. 84.56±11.56, p < 0.0001) and the total success at PGI-I was reported in 54 patients (90%).
CONCLUSIONS
The HT-based product is effective and safe in preventing recurrent candida episodes and improves the quality of life and sexual function of treated women.
Topics: Administration, Oral; Adult; Antifungal Agents; Candidiasis, Vulvovaginal; Copper; Drug Combinations; Female; Humans; Middle Aged; Phenylethyl Alcohol; Pilot Projects; Plant Extracts; Prospective Studies; Quality of Life; Reinfection; Sexual Behavior; Time Factors; Treatment Outcome
PubMed: 32706082
DOI: 10.26355/eurrev_202007_21911 -
Journal of Gynecology Obstetrics and... Jun 2021Tuberculosis remains a worrying public health problem. But if pulmonary tuberculosis's symptomatology is well known by the medical profession, this is not the case of...
Tuberculosis remains a worrying public health problem. But if pulmonary tuberculosis's symptomatology is well known by the medical profession, this is not the case of genital tuberculosis. We take advantage of a case of vaginal tuberculosis to review the international literature about clinical diagnosis, further tests, and treatment of this extremely rare tuberculosis localization.
Topics: Diagnosis, Differential; Female; Humans; Middle Aged; Pelvic Pain; Pruritus; Rare Diseases; Tuberculosis, Female Genital; Urinary Incontinence, Urge; Vaginal Diseases
PubMed: 32693050
DOI: 10.1016/j.jogoh.2020.101873 -
Contraception: X 2020The objective was to evaluate the contraceptive effectiveness, safety, and acceptability of a novel vaginal pH regulator over seven cycles of use.
OBJECTIVE
The objective was to evaluate the contraceptive effectiveness, safety, and acceptability of a novel vaginal pH regulator over seven cycles of use.
STUDY DESIGN
A single-arm, open-label, phase 3 study was conducted across 112 sites in the United States in sexually active 18-35-year-old women at risk of pregnancy. Women administered the study treatment ≤ 1 h before each episode of intercourse. Women recorded use of study drug, coital information, and any symptoms experienced in electronic diaries. The primary outcome was the seven-cycle cumulative pregnancy rate as calculated using the Kaplan-Meier methodology; secondary outcomes included safety. Overall satisfaction was assessed via written questionnaires.
RESULTS
A total of 1384 women were enrolled in the study from July 2017 to November 2018. Mean age was 27.7 ± 4.4 years; most women were white (69.0%). The seven-cycle cumulative pregnancy percentage was 13.7% [95% confidence interval (CI): 10.0%-17.5%], meeting the prespecified primary endpoint of having the upper bound 95% CI ≤ 21%. Most common adverse events (AEs) occurring in ≥ 2% of women were vulvovaginal burning sensation, vulvovaginal pruritus, urinary tract infection, vulvovaginal pain, mycotic infection, bacterial vaginosis, and nasopharyngitis. Of 1330 women who used the study drug at least once, fewer than 2% of women discontinued due to any AEs, and < 1% of women discontinued due to genitourinary symptoms. Overall, > 80% of women reported being "very satisfied" or "satisfied" with study treatment.
CONCLUSIONS
In this phase 3 study, the novel vaginal pH regulator demonstrated 86.3% contraceptive effectiveness, was safe and well tolerated, and was highly acceptable.
IMPLICATIONS
This novel vaginal pH regulator is a safe, nonhormonal, woman-controlled method of contraception that expands women's options.
PubMed: 32685920
DOI: 10.1016/j.conx.2020.100031 -
Obstetrics and Gynecology Jul 2020Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common...
Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common presenting symptoms in vulvar clinics (). Vulvovaginal symptoms often are chronic and can adversely affect sexual function and sense of well-being. The purpose of this Practice Bulletin is to provide updated diagnostic and management recommendations for the most common vulvar skin conditions associated with inflammation: contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus. Other vulvovaginal disorders such as vaginitis, vulvar low-grade squamous intraepithelial lesions and vulvar high-grade squamous intraepithelial lesions (previously termed vulvar intraepithelial neoplasia), genitourinary syndrome of menopause (vulvovaginal atrophy), and vulvar pain (vulvodynia) are addressed in other documents from the American College of Obstetricians and Gynecologists ().
Topics: Dermatitis; Female; Gynecology; Humans; Lichen Planus; Obstetrics; Practice Guidelines as Topic; Skin Neoplasms; Societies, Medical; United States; Vulvar Diseases
PubMed: 32590724
DOI: 10.1097/AOG.0000000000003944 -
Obstetrics and Gynecology Jul 2020Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common...
Vulvar skin disorders include a variety of inflammatory conditions of the vulva that also may affect the extragenital area. Pruritus and pain are two of the most common presenting symptoms in vulvar clinics (). Vulvovaginal symptoms often are chronic and can adversely affect sexual function and sense of well-being. The purpose of this Practice Bulletin is to provide updated diagnostic and management recommendations for the most common vulvar skin conditions associated with inflammation: contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus. Other vulvovaginal disorders such as vaginitis, vulvar low-grade squamous intraepithelial lesions and vulvar high-grade squamous intraepithelial lesions (previously termed vulvar intraepithelial neoplasia), genitourinary syndrome of menopause (vulvovaginal atrophy), and vulvar pain (vulvodynia) are addressed in other documents from the American College of Obstetricians and Gynecologists ().
Topics: Female; Gynecology; Humans; Obstetrics; Practice Guidelines as Topic; Societies, Medical; United States; Vulvar Diseases
PubMed: 32590722
DOI: 10.1097/AOG.0000000000003945 -
Infectious Diseases in Obstetrics and... 2020A novel fixed-dose combination of 150 mg of econazole with 6 mg of benzydamine formulated in vaginal ovules was investigated in a randomised, double-blind,... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
A novel fixed-dose combination of 150 mg of econazole with 6 mg of benzydamine formulated in vaginal ovules was investigated in a randomised, double-blind, four-parallel group, tolerability, and pharmacokinetic Phase I study in healthy women.
METHODS
The fixed-dose combination was compared to econazole and benzydamine single-drug formulations and with placebo after daily applications for 3 consecutive days. Safety and tolerability were evaluated recording the adverse drug reactions, local and general tolerability scores, clinical laboratory assays, and vital signs. Econazole, benzydamine, and its metabolite benzydamine N-oxide pharmacokinetics were investigated after single and multiple applications.
RESULTS
Local reactions were generally absent. Pruritus and pain at the application site were infrequently reported. According to the subjects' evaluations, the overall tolerability of the ovules was rated as excellent or good. No significant effect of any treatment on laboratory parameters, vital signs, body weight, vaginal pH, or ECG was observed. Very low econazole, benzydamine, and benzydamine-N-oxide concentrations were measured in plasma, though quantifiable in almost all samples.
CONCLUSION
The tested fixed-dose combination showed a good safety profile consistently with the known tolerability of both active substances. In addition, the confirmed low bioavailability of the drugs excludes the possibility of any accumulation effects and limits the risk of undesired systemic effects. This trial is registered at ClinicalTrials.gov with the identifier NCT02720783 last updated on 07 February 2017.
Topics: Administration, Oral; Adult; Antifungal Agents; Area Under Curve; Benzydamine; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Drug Delivery Systems; Econazole; Female; Healthy Volunteers; Humans; Middle Aged; Vagina; Young Adult
PubMed: 32410819
DOI: 10.1155/2020/7201840