-
The Cochrane Database of Systematic... Sep 2010Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina).... (Review)
Review
BACKGROUND
Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation "three times weekly for an indefinite time period". The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy "as soon as is comfortably possible" and "certainly within four weeks and to continue for three years or indefinitely if possible". However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum.
OBJECTIVES
To review the benefits and harms of vaginal dilation therapy associated with pelvic radiotherapy for cancer.
SEARCH STRATEGY
Searches included the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE (1950 to 2008), EMBASE (1980 to 2008) and CINAHL (1982 to 2008).
SELECTION CRITERIA
Any comparative randomised controlled trials (RCT) or data of any type which compared dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer.
DATA COLLECTION AND ANALYSIS
The review authors independently abstracted data and assessed risk of bias. We analysed the mean difference in sexual function scores and the risk ratio for non-compliance at six weeks and three months in single trial analyses. No trials met the inclusion criteria.
MAIN RESULTS
Dilation during or immediately after radiotherapy can, in rare cases, cause damage and there is no persuasive evidence from any study to demonstrate that it prevents stenosis. Data from one RCT showed no improvement in sexual scores in women who were encouraged to practice dilation. Two case series and one comparative study using historical controls suggest that dilation might be associated with a longer vaginal length but these data cannot reasonably be interpreted to show that dilation caused the change in the vagina.
AUTHORS' CONCLUSIONS
Routine dilation during or soon after cancer treatment may be harmful. There is no reliable evidence to show that routine regular vaginal dilation during or after radiotherapy prevents the late effects of radiotherapy or improves quality of life. Gentle vaginal exploration might separate the vaginal walls before they can stick together and some women may benefit from dilation therapy once inflammation has settled but there are no good comparative supporting data.
Topics: Constriction, Pathologic; Dilatation; Female; Humans; Pelvis; Radiotherapy; Rupture; Time Factors; Vagina
PubMed: 20824858
DOI: 10.1002/14651858.CD007291.pub2 -
BioMed Research International 2013Endometriosis is a chronic benign gynecologic disease that can cause pelvic pain and infertility affecting almost 10% of reproductive-age women. Deeply infiltrating... (Review)
Review
BACKGROUND
Endometriosis is a chronic benign gynecologic disease that can cause pelvic pain and infertility affecting almost 10% of reproductive-age women. Deeply infiltrating endometriosis (DIE) is a specific entity responsible for painful symptoms which are related to the anatomic location of the lesions. Definitive diagnosis requires surgery, and histological confirmation is advisable. The aim of this paper is to review the current literature regarding the possibility of diagnosing DIE accurately before surgery. Despite its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should not be completely omitted as a basic diagnostic tool in detecting endometriosis and planning further therapeutic interventions. Recently, transvaginal ultrasound (TVUS) has been reported as an excellent tool to diagnose DIE lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid, and vesical wall) with good accuracy.
CONCLUSION
There are neither sufficiently sensitive and specific signs and symptoms nor diagnostic tests for the clinical diagnosis of DIE, resulting in a great delay between onset of symptoms and diagnosis. Digital examination, in addition to TVS, may help to gain better understanding of the anatomical extent and dimension of DIE which is of crucial importance in defining the best surgical approach.
Topics: Endometriosis; Female; Humans; Sensitivity and Specificity; Ultrasonography; Vagina
PubMed: 24089684
DOI: 10.1155/2013/564153 -
Fertility and Sterility Oct 2020To demonstrate various types of longitudinal vaginal septa (LVS), their classification, and the surgical management of typical and unique morphologic conditions of LVS.
OBJECTIVE
To demonstrate various types of longitudinal vaginal septa (LVS), their classification, and the surgical management of typical and unique morphologic conditions of LVS.
DESIGN
Video presentation of clinical appearance and surgical techniques for treatment of LVS.
SETTING
University hospital and two private.
PATIENT(S)
Representative cases from 121 consecutive women treated from 2013 to 2018 with LVS as a part of complex uterovaginal malformations or in isolated forms with [1] typical morphologic configuration of LVS, [2] rarer variants, or [3] specific anatomic restrictions.
INTERVENTION(S)
Resection of LVS performed as a main surgical procedure in cases with didelphys and bicornuate uterus in symptomatic women and as a part of corrective surgery of complete septate uterus. The three main nonsuturing techniques used were speculoscopy and septum excision using three different electrosurgical modalities; speculoscopy with laparoscopic devices; and vaginoscopy with hysteroscopic instruments.
MAIN OUTCOME MEASURE(S)
Clinical appearance and suggested classification, feasibility of surgery, and perioperative and anatomic results in a short follow-up period (3 months).
RESULT(S)
We identified distinct types of longitudinal vaginal septa. Considering clinical appearance, we suggest classification of LVS based on four main features: [2] completeness of vaginal division: partial and complete type; [2] the symmetricity: symmetric and asymmetric position (with dominant left and right side); [3] association with the cervix: merged and isolated forms; and [4] concomitant vaginal openings: normal, and narrow openings: vaginal stenosis and hymen persistent (Fig. 1). Vaginoscopic techniques by hysteroscope were successful in atraumatic treatment of women with substantial anatomic restrictions, and all of the presented techniques can be effectively used for typical LVS. However, vessel-sealing systems allow for bloodless surgery in contrast with other methods. This study was based on previously acquired data during large prospective study approved by the local ethics committee, and written informed consent to participate in the prospective study and permit publishing anonymous data regarding the medical images, videos of procedures, and results was obtained from all patients.
CONCLUSION(S)
A new classification of longitudinal vaginal septum allows better characterization compared with the currently available classification systems. Different surgical modalities are discussed with their respective advantages and disadvantages. Vaginoscopic incision using resectoscope is a reasonable alternative for women with an intact hymen and vaginal stenosis. The impact of vaginal septum resection on obstetric, reproductive, and sexual outcomes should be assessed in randomized controlled trials and large well-designed studies.
Topics: Female; Humans; Vagina
PubMed: 32826051
DOI: 10.1016/j.fertnstert.2020.06.014 -
Environmental Health Perspectives Oct 1995Neonatal treatment of female mice with diethystilbestrol (DES) is known to induce ovary-independent persistent proliferation and cornification of vaginal epithelium.... (Review)
Review
Neonatal treatment of female mice with diethystilbestrol (DES) is known to induce ovary-independent persistent proliferation and cornification of vaginal epithelium. This irreversibly changed vaginal epithelium persistently expressed higher levels of c-jun and c-fos mRNAs, which was not altered by postpubertal estrogen. Sexual dimorphism was encountered in mouse pelvis and anococcygeus muscle. Postpubertal estrogen changed the shape of the pelvis to the female type and postpubertal androgen changed it to the male type. Neonatal exposure to DES and to the antiestrogen tamoxifen altered the developmental pattern of the pelvis, which contained lower concentrations of calcium and phosphorus than controls. The size of anococcygeus muscle was increased by postpubertal androgen but decreased by postpubertal estrogen. However, neonatal estrogen (DES) exposure permanently enlarged the anococcygeus muscle. Thus, neonatal treatment of mice with estrogen and antiestrogen results in irreversible changes in nonreproductive as well as reproductive structures.
Topics: Animals; Female; Gene Expression Regulation, Neoplastic; Gonadal Steroid Hormones; Male; Mice; Muscle Development; Muscle, Smooth; Oncogenes; Pelvis; Sex Characteristics; Vagina
PubMed: 8593880
DOI: 10.1289/ehp.95103s779 -
International Urogynecology Journal Dec 2013The pathophysiology of pelvic organ prolapse (POP) is incompletely understood. The purpose of this study is to describe the current knowledge about histology of the... (Review)
Review
INTRODUCTION AND HYPOTHESIS
The pathophysiology of pelvic organ prolapse (POP) is incompletely understood. The purpose of this study is to describe the current knowledge about histology of the vaginal wall and its possible involvement in the pathogenesis of pelvic organ prolapse.
METHODS
Eligible studies were selected through a MEDLINE search covering January 1986 to December 2012. The research was limited to English-language publications.
RESULTS
Investigations of changes in the vaginal tissue that occur in women with genital prolapse are currently still limited and produced contrary results. The heterogeneity of the patients and the control groups in terms of age, parity and hormonal status, of the localization of biopsies and the histological methods as well as the lack of validation of the quantification procedures do not allow clear and definitive conclusions to be drawn.
CONCLUSIONS
This review shows that current knowledge of the histological changes observed in women with POP are inconclusive and relatively limited. More studies are needed in this specific field to better understand the mechanisms that lead to POP.
Topics: Collagen; Connective Tissue; Elastin; Female; Humans; Pelvic Organ Prolapse; Vagina
PubMed: 23649687
DOI: 10.1007/s00192-013-2111-1 -
The British Journal of Venereal Diseases Oct 1979Although tetracycline preparations are widely used in departments of genitourinary medicine, or sexually transmitted diseases clinics, little is known of the...
Although tetracycline preparations are widely used in departments of genitourinary medicine, or sexually transmitted diseases clinics, little is known of the concentrations of these preparations in genital secretions. For this reason a microbiological method was used for estimating oxytetracycline concentrations in vaginal secretions. These concentrations varied from 0.6 to 6.5 microgram/ml in 19 women who had had sexual contact with a man with non-specific urethritis and who were taking oxytetracycline dihydrate 250 mg four times daily. They were well in excess of the minimum inhibitory concentration of oxytetracycline (0.2 microgram/ml) for the strains of Chlamydia trachomatis isolated from the patients with positive culture results. Thus, oxytetracycline 250 mg four times daily appears to be a satisfactory regimen for the treatment of chlamydial genital infection in women.
Topics: Adolescent; Adult; Biological Assay; Body Fluids; Chlamydia trachomatis; Drug Administration Schedule; Female; Humans; Oxytetracycline; Vagina
PubMed: 509190
DOI: 10.1136/sti.55.5.348 -
Frontiers in Immunology 2023Exploring the human microbiome in multiple body niches is beneficial for clinicians to determine which microbial dysbiosis should be targeted first. We aimed to study...
BACKGROUND
Exploring the human microbiome in multiple body niches is beneficial for clinicians to determine which microbial dysbiosis should be targeted first. We aimed to study whether both the fecal and vaginal microbiomes are disrupted in SLE patients and whether they are correlated, as well as their associations with immunological features.
METHODS
A group of 30 SLE patients and 30 BMI-age-matched healthy controls were recruited. Fecal and vaginal samples were collected, the 16S rRNA gene was sequenced to profile microbiomes, and immunological features were examined.
RESULTS
Distinct fecal and vaginal bacterial communities and decreased microbial diversity in feces compared with the vagina were found in SLE patients and controls. Altered bacterial communities were found in the feces and vaginas of patients. Compared with the controls, the SLE group had slightly lower gut bacterial diversity, which was accompanied by significantly higher bacterial diversity in their vaginas. The most predominant bacteria differed between feces and the vagina in all groups. Eleven genera differed in patients' feces; for example, and increased, whereas decreased. Almost all the 13 genera differed in SLE patients' vaginas, showing higher abundances except for . Three genera in feces and 11 genera in the vagina were biomarkers for SLE patients. The distinct immunological features were only associated with patients' vaginal microbiomes; for example, was negatively associated with serum C4.
CONCLUSIONS
Although SLE patients had fecal and vaginal dysbiosis, dysbiosis in the vagina was more obvious than that in feces. Additionally, only the vaginal microbiome interacted with patients' immunological features.
Topics: Female; Humans; Gastrointestinal Microbiome; Dysbiosis; RNA, Ribosomal, 16S; Microbiota; Bacteria; Feces; Lupus Erythematosus, Systemic; Vagina
PubMed: 36969178
DOI: 10.3389/fimmu.2023.1135861 -
Journal of Pediatric and Adolescent... Oct 2016To explore adolescent's perceptions of vaginal health, practices, and vaginally-placed products.
STUDY OBJECTIVE
To explore adolescent's perceptions of vaginal health, practices, and vaginally-placed products.
DESIGN
Semistructured interviews were audio-recorded and transcribed until theoretical saturation was achieved.
SETTING
Adolescent medicine clinics in New York City.
PARTICIPANTS
Female adolescents (N = 22) who were sexually experienced, predominately Hispanic (73%, n = 16) with a mean age of 17.7 years (range, 15-20 years).
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Interviews were used to assess perspectives on vaginal health, specific vaginal hygiene practices, and attitudes about vaginally-placed products (contraceptive rings, intrauterine devices), and proposed multipurpose technologies administered as ring or gel). The interviews were transcribed and coded for relevant themes.
RESULTS
Overlapping themes included young women's view of their vagina as a space that needed to be healthy for sexual partners and future fertility. The vagina could not be presumed to be healthy and conversations about vaginal health were limited to include only specific individuals. All reported a variety of practices to maintain their vaginal health, including showering 1-5 times a day and using soaps specifically for the vagina. Attitudes about vaginally-placed products revealed concerns about the sensory experience of having a product in the vagina, safety concerns and interest in the product's objective (prevention of pregnancy or infection).
CONCLUSION
Adolescents have very specific views and practices about their vaginas. Clinicians should initiate conversations about vaginal health and hygiene with adolescents and focus on the normalcy of the vagina. Development of vaginally-placed products should focus on the sensory experience, safety, and purpose of the product.
Topics: Adolescent; Adult; Attitude to Health; Female; Health Knowledge, Attitudes, Practice; Humans; Hygiene; Intrauterine Devices; New York City; Pregnancy; Qualitative Research; Sexual Behavior; Sexual Partners; Vagina; Young Adult
PubMed: 27133374
DOI: 10.1016/j.jpag.2016.04.003 -
Fertility and Sterility Aug 2018For more than a century, the uterine cavity has been considered a sterile site maintained by the cervical plug. Humans are like coral that need symbiosis with...
For more than a century, the uterine cavity has been considered a sterile site maintained by the cervical plug. Humans are like coral that need symbiosis with microorganisms to be completely functional. In the era of precision medicine, the endometrial factor and specifically the microbiological view have long been neglected in reproduction, because it was considered an old concept with no potential improvement. In the last decade, important discoveries, led by improving technology, namely next generation sequencing, have been made in the study of microbial communities not only in the vagina but also in the endometrial cavity and its implication in reproductive health and disease, particularly chronic endometritis. From these studies, we have learned that microbes interact with the host cells along the female reproductive tract generating the physical, chemical and biological environment that the embryo will encounter during the peri-implantation period and throughout pregnancy.
Topics: Embryo Implantation; Endometrium; Female; Humans; Microbiota; Pregnancy; Reproduction; Uterus; Vagina
PubMed: 30037698
DOI: 10.1016/j.fertnstert.2018.06.041 -
Medicine Sep 2022Cellular angiofibroma (CAF), a rare benign mesenchymal tumor, is histologically characterized by abundant thick-walled vessels with a spindle cell component. As one of... (Review)
Review
BACKGROUND
Cellular angiofibroma (CAF), a rare benign mesenchymal tumor, is histologically characterized by abundant thick-walled vessels with a spindle cell component. As one of the female reproductive system tumors, its clinical and pathological features are not well characterized.
METHODS
A 47-year-old woman presented for the removal of intrauterine device on October 28, 2021, as she had achieved menopause one year back. The patient had no discomfort or awareness of any mass in her vagina. She has history of breast cancer and papillary thyroid cancer. Till date, no progression of thyroid cancer or breast cancer has been observed. Her menstrual cycle was regular, and she had one child delivered vaginally.
RESULTS
Pelvic examination revealed a mass sized 2.5 × 2.0 cm located near the fornix in the upper segment of the left vaginal wall. Thin prep cytologic test (TCT) revealed negative intraepithelial lesion or malignancy (NILM). HPV test was negative and leucorrhea routine inspection cleanliness II degree. No cervical mass was detected by ultrasound examination. The patients underwent the operation for intrauterine device removal plus vaginal tumor resection on November 1, 2021. Postoperative antibiotics (intravenous cefuroxime sodium 0.75 g bid for 1 day) were administered to prevent infection. The patient showed no signs of recurrence at one-month follow-up.
CONCLUSION
In summary, CAF is a rare benign soft tissue tumor. Surgery is the only treatment method, and the definitive diagnosis of CAF is based on histopathological examination of surgical specimen. Long-term follow-up is needed for surveillance of recurrence.
Topics: Angiofibroma; Breast Neoplasms; Cefuroxime; Female; Humans; Middle Aged; Sodium; Vagina
PubMed: 36107545
DOI: 10.1097/MD.0000000000030293