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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 -
Microbial Genomics Mar 2021The vaginal microbiome plays an important role in human health and species of vaginal bacteria have been associated with reproductive disease. Strain-level variation is...
The vaginal microbiome plays an important role in human health and species of vaginal bacteria have been associated with reproductive disease. Strain-level variation is also thought to be important, but the diversity, structure and evolutionary history of vaginal strains is not as well characterized. We developed and validated an approach to measure strain variation from metagenomic data based on SNPs within the core genomes for six species of vaginal bacteria: , , , , and . Despite inhabiting the same environment, strain diversity and structure varies across species. All species except are characterized by multiple distinct groups of strains. Even so, strain diversity is lower in the species, consistent with a more recent colonization of the human vaginal microbiome. Both strain diversity and the frequency of multi-strain samples is related to species-level diversity of the microbiome in which they occur, suggesting similar ecological factors influencing diversity within the vaginal niche. We conclude that the structure of strain-level variation provides both the motivation and means of testing whether strain-level differences contribute to the function and health consequences of the vaginal microbiome.
Topics: Adult; Bacteria; Cohort Studies; Female; Humans; Microbiota; Phylogeny; Pregnancy; Vagina; Young Adult
PubMed: 33656436
DOI: 10.1099/mgen.0.000543 -
British Medical Journal Jul 1948
Topics: Abdominal Injuries; Coitus; Female; Humans; Urologic Diseases; Vagina
PubMed: 18939231
DOI: 10.1136/bmj.2.4568.226-a -
Acta Obstetricia Et Gynecologica... Dec 2011Bacterial vaginosis (BV) was originally described as a sexually transmitted infection caused by a single microbe. The prevailing concept describes BV as a polymicrobial... (Review)
Review
Bacterial vaginosis (BV) was originally described as a sexually transmitted infection caused by a single microbe. The prevailing concept describes BV as a polymicrobial coitus-associated disease of uncertain origin. In this overview the natural history of BV as a monobacterial and polymicrobial entity is examined with respect to the physiological concept of BV in relation to sexual behavior before and after introduction of the hormonal contraceptive pill. Bacterial vaginosis, characterized by low vaginal acidity (elevated pH) and replacement of vaginal Lactobacillus by Gardnerella vaginalis flora, could be caused by unprotected intercourse when a low pH changes through the neutralizing power of male ejaculate, vaginal coital transudate and vaginal neurogenic transudate. A monobacterial form, G. vaginalis vaginitis, could be a physiological post-coital condition for protection of ejaculated spermatozoa, characterized by 'pure'Gardnerella flora and elevated pH as an immediate result of an incidental unprotected coital act through neutralization of vaginal acid and replacement of Lactobacillus by Gardnerella flora. A polymicrobial form of BV could be autoinfection of the post-coital physiological G. vaginalis flora, characterized by a mixture of G. vaginalis, Mycoplasma hominis and anaerobic bacteria at lower vaginal acidity, possibly resulting from suppression of normal vaginal acidity through repeated sexual acts, with a resultant higher pH and transfer of enteric bacteria from the perianal region. Monobacterial and polymicrobial auto-infectious forms of BV may be clinically distinct and share a common origin. The understanding of BV as a basic physiological entity could influence the prophylaxis and treatment of the largely therapy-resistant polymicrobial BV.
Topics: Coitus; Female; Gardnerella vaginalis; Humans; Hydrogen-Ion Concentration; Vagina; Vaginosis, Bacterial
PubMed: 21916857
DOI: 10.1111/j.1600-0412.2011.01279.x -
Frontiers in Cellular and Infection... 2022Clue cells (epithelial cells heavily covered with adherent bacteria) are an accepted clue to the diagnosis of bacterial vaginosis. However, the exact morphologic...
INTRODUCTION
Clue cells (epithelial cells heavily covered with adherent bacteria) are an accepted clue to the diagnosis of bacterial vaginosis. However, the exact morphologic criteria of clue cells and bacterial adherence were never elaborated.
MATERIALS AND METHODS
We investigated adhesive and cohesive patterns of main microbiota groups in vaginal discharge using fluorescence hybridization (FISH). Samples from 500 women diagnosed with bacterial vaginosis and positive for clue cells with classic microscopy were collected from 42 gynecologic practices in Berlin and reexamined in our FISH laboratory for the spatial distribution of Bifidobacteriaceae, , (); low G+C (guanine+cytosine) bacteria, lactobacilli, ; , Gamma-Proteobacteria; and Enterobacteriaceae, , , and groups.
RESULTS
Bacterial taxa present in vaginal smears were not accidentally assembled according to their relative abundance but were built in group-specific distribution patterns, which can be well described by two features: cohesiveness to each other and adherence to epithelial cells. Accordingly, four patterns can be distinguished: dispersed (non-adherent bacteria), dispersed adherent bacteria, cohesive (non-adherent) bacteria, and cohesive adherent bacteria. Direct cohesive adherence to the epithelial cells representing true clue cells was unique for species and observed only in 56% of the investigated samples. In the remaining vaginal samples, the epithelial cells were mechanically entrapped in bacterial masses, and the composition was unrelated to the epithelial cell surface, building non-adherent pseudo clue cells. The proportion of women with true clue cells in their samples from different gynecologic practices varied from 19% to 80%.
DISCUSSION
Taxon indifferent imaging is inadequate for the exact analysis of the microbial layer adjacent to the vaginal epithelial cells. Morphologically seen bacterial vaginosis is a mix of at least two different conditions: biofilm vaginosis and bacterial excess vaginosis.
Topics: Bacteria; Female; Gardnerella; Gardnerella vaginalis; Humans; In Situ Hybridization, Fluorescence; Microbiota; Vagina; Vaginosis, Bacterial
PubMed: 35719334
DOI: 10.3389/fcimb.2022.905739 -
Fertility and Sterility Dec 2021To describe and assess the feasibility of a novel surgical technique (pneumovaginoscopy) for performing vaginal surgery.
OBJECTIVE
To describe and assess the feasibility of a novel surgical technique (pneumovaginoscopy) for performing vaginal surgery.
DESIGN
Video of a single surgical procedure.
SETTING
A university hospital.
PATIENT(S)
A 42-year-old woman, gravida 2 para 2, presented with chronic pelvic pain. Vaginal examination revealed a 4-cm spherical mass bulging through her posterior vaginal wall. Magnetic resonance imaging identified this mass as either a subserosal pedunculated uterine fibroid (type 7 according to the FIGO classification) or an ectopic fibroid of the posterior vaginal wall (type 8).
INTERVENTION(S)
The whole procedure was performed using pneumovaginoscopy. The GelPOINT V-Path (Applied Medical, Rancho Santa Margarita, California) which is the device most often used to perform transvaginal natural orifice transluminal endoscopic surgical procedures, was introduced into the vagina to create a pneumovagina. Monopolar scissors were used to create an incision through the posterior vaginal wall to reach the fibroid. Myomectomy was performed using traction movements of the fibroid associated with the dissection of the capsule. The absence of a uterine pedicle at the end of the myomectomy was in favor of an ectopic fibroid of the vagina (type 8 of the FIGO classification). The vaginal defect was closed with interrupted sutures using the access points on the GelPOINT.
MAIN OUTCOME MEASURE(S)
The procedure was easily and efficiently performed using the pneumovaginoscopy technique and lasted less than an hour. The patient was discharged on postoperative day 1 without any postoperative complications. She was symptom-free at her 2-month postoperative visit.
RESULT(S)
Compared to the classical vaginal approach, pneumovaginoscopy improves visualization through targeted lighting and close-up vision. This technique is particularly interesting in cases where the vaginal opening is narrow and for lesions located in the upper half of the vagina. Because of the unusual expansion of the vagina, increased caution is required to avoid bladder or rectal injuries.
CONCLUSION(S)
Pneumovaginoscopy is a novel technique that can be performed for vaginal pathologies with the same device used for transvaginal natural orifice transluminal endoscopic surgery. We described this technique and assessed its feasibility.
Topics: Adult; Endoscopy; Female; Humans; Leiomyoma; Vagina; Vaginal Neoplasms
PubMed: 34535294
DOI: 10.1016/j.fertnstert.2021.08.033 -
Canadian Journal of Microbiology Jan 2020Much is made of the need to translate scientific research into improved care of people or other life forms. Grant applications invariably start with the extent of a... (Review)
Review
Much is made of the need to translate scientific research into improved care of people or other life forms. Grant applications invariably start with the extent of a problem and end by claiming that their work will or could result in making an impact. In truth, very few projects ever lead to translation at the level of the host, nor was that really their intent. For those who are focused on applied science, there are many ways to reach the desired goal, sometimes through serendipity or by logical stepwise progress. The following paper will provide personal insight into the stages, pitfalls, and ultimate assessment of relevance in the context of using probiotic lactobacilli for human health and other applications.
Topics: Dietary Supplements; Drug Development; Female; Female Urogenital Diseases; Humans; Lactobacillus; Probiotics; Translational Research, Biomedical; Vagina
PubMed: 31526326
DOI: 10.1139/cjm-2019-0148 -
The Journal of Infectious Diseases Sep 2019Bacterial vaginosis (BV) is the most common cause of vaginal discharge. It is associated with an increased risk of preterm delivery, pelvic inflammatory disease, and an... (Review)
Review
Bacterial vaginosis (BV) is the most common cause of vaginal discharge. It is associated with an increased risk of preterm delivery, pelvic inflammatory disease, and an increased risk of acquisition of sexually transmitted infections including human immunodeficiency virus (HIV). The epidemiology of BV supports sexual transmission. However, its etiology remains unknown. At the center of the debate is whether BV is caused by a primary pathogen or a polymicrobial consortium of microorganisms that are sexually transmitted. We previously published a conceptual model hypothesizing that BV is initiated by sexual transmission of Gardnerella vaginalis. Critics of this model have iterated that G. vaginalis is found in virginal women and in sexually active women with a normal vaginal microbiota. In addition, colonization does not always lead to BV. However, recent advances in BV pathogenesis research have determined the existence of 13 different species within the genus Gardnerella. It may be that healthy women are colonized by nonpathogenic Gardnerella species, whereas virulent strains are involved in BV development. Based on our results from a recent prospective study, in addition to an extensive literature review, we present an updated conceptual model for the pathogenesis of BV that centers on the roles of virulent strains of G. vaginalis, as well as Prevotella bivia and Atopobium vaginae.
Topics: Actinobacteria; Female; Gardnerella vaginalis; Humans; Models, Biological; Prevotella; Vagina; Vaginosis, Bacterial; Virulence
PubMed: 31369673
DOI: 10.1093/infdis/jiz342 -
Endocrinology May 2008The objective of this study was to determine whether stromal and/or epithelial relaxin receptor (LGR7) is required for relaxin to promote proliferation and inhibit...
The objective of this study was to determine whether stromal and/or epithelial relaxin receptor (LGR7) is required for relaxin to promote proliferation and inhibit apoptosis of stromal and epithelial cells in the mouse cervix and vagina. Tissue recombinants were prepared with stroma (St) and epithelium (Ep) from wild-type (wt) and LGR7 knockout (ko) mice: wt-St+wt-Ep, wt-St+ko-Ep, ko-St+wt-Ep, and ko-St+ko-Ep. Tissue recombinants were grafted under the renal capsule of intact syngeneic female mice. After 3 wk of transplant growth, hosts were ovariectomized and fitted with silicon implants containing progesterone and estradiol-17beta (designated d 1 of treatment). Animals were injected sc with relaxin or relaxin vehicle PBS at 6-h intervals from 0600 h on d 8 through 0600 h on d 10 of treatment. To evaluate cell proliferation, 5-bromo-2'-deoxyuridine was injected sc 10 h before cervices and vaginas were collected at 1000 h on d 10. Terminal deoxynucleotidyl transferase-mediated deoxyuridine 5'-triphosphate nick end labeling was used to quantify apoptosis. Relaxin markedly increased proliferation and decreased apoptosis of epithelial and stromal cells in tissue recombinants containing wt stroma (P < 0.01) but had no effect on tissue recombinants prepared with ko stroma, regardless of whether epithelium was derived from wt or ko mice. In conclusion, this study shows that LGR7-expressing cells in the stroma are both necessary and sufficient for relaxin to promote proliferation and inhibit apoptosis in both stromal and epithelial cells of cervix and vagina, whereas epithelial LGR7 does not affect these processes.
Topics: Algorithms; Animals; Animals, Newborn; Apoptosis; Cell Lineage; Cell Proliferation; Cervix Uteri; Epithelial Cells; Female; Green Fluorescent Proteins; Male; Mice; Mice, Inbred C57BL; Mice, Transgenic; Receptors, G-Protein-Coupled; Relaxin; Stromal Cells; Vagina
PubMed: 18218691
DOI: 10.1210/en.2007-1176 -
International Urogynecology Journal Jan 2023Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. Most recurrences seem to occur in the anterior...
Lateral extension and attachment of mesh to the lateral vagina during laparoscopic sacrocolpopexy: a modified technique aimed at lowering recurrences in the anterior vaginal compartment. A surgical video.
PURPOSE/OBJECTIVE
Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. Most recurrences seem to occur in the anterior compartment, especially if a paravaginal defect is present. To reduce the incidence of anterior recurrence after laparoscopic sacrocolpopexy we modified our previous published technique by placing the anterior mesh not only deep under the bladder but also laterally and fixing it to the lateral edge of the vagina. With this video article, we would like to show and explain our modified technique and demonstrate how lateral mesh placement can be easily and safely performed using laparoscopy.
METHODS
The video demonstrates our modified technique with lateral extension and fixation of the anterior mesh to the lateral vagina during laparoscopic sacrocolpopexy in a patient with severe uterine prolapse (grade III) and a large cystocele (grade III). Special emphasis is given to the topographical anatomy of the paravaginal space and the surgical technique of lateral fixation.
RESULTS
This modified new technique shows excellent perioperative results in more than 100 cases without any occurrences of lesions of the ureters. Our initial experience also shows very good anatomical results in all three compartments.
CONCLUSIONS
Paravaginal dissection and exposure of the ureters to extend the mesh placement and fixation to the lateral border of the vagina in the anterior compartment during laparoscopic sacrocolpopexy seem to be feasible and safe, helping to significantly reduce the risk of anterior recurrences. Prospective data are needed to evaluate this interesting technique.
Topics: Female; Humans; Pelvic Organ Prolapse; Gynecologic Surgical Procedures; Surgical Mesh; Prospective Studies; Vagina; Laparoscopy; Treatment Outcome
PubMed: 36085317
DOI: 10.1007/s00192-022-05338-8