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Sample records for dinoprostone vaginal insert

  1. Double-balloon catheter vs. dinoprostone vaginal insert for induction of labor with an unfavorable cervix.

    PubMed

    Du, Chuying; Liu, Yukun; Liu, Yinglin; Ding, Hong; Zhang, Rui; Tan, Jianping

    2015-06-01

    To compare a double-balloon catheter and dinoprostone vaginal insert for induction of labor with an unfavorable cervix. Patients with a Bishop score of ≤6 requiring labor induction at term received either a double-balloon catheter or a dinoprostone vaginal insert. The primary outcome was vaginal delivery rate within 24 h, and the secondary outcome was cesarean section rate. A total of 155 women were included; 76 received induction with a double-balloon catheter and 79 with the dinoprostone vaginal insert. The groups were similar with respect to maternal age, body mass index, gravidity, parity, baseline Bishop score, and indications for induction. Gestational age at induction was similar between the groups (double balloon 40.52 ± 0.86 weeks; dinoprostone 40.60 ± 0.79 weeks, P = 0.516). There was no difference in the vaginal delivery rate within 24 h (50 vs. 53.2 %, P = 0.694) or the cesarean section rate (39.5 vs. 31.6 %, P = 0.185) between the groups. More patients in the double-balloon catheter group required oxytocin administration than in the dinoprostone group (75 vs. 31.65 %, respectively, P < 0.001), but uterine hyperstimulation was less frequent in the double-balloon catheter group (0 vs. 10.1 %, respectively, P = 0.007). Neonatal outcomes were similar between the groups. Double-balloon catheter and dinoprostone vaginal insert are associated with similar vaginal delivery and cesarean section rates and neonatal outcomes.

  2. Reduction in resource use with the misoprostol vaginal insert vs the dinoprostone vaginal insert for labour induction: a model-based analysis from a United Kingdom healthcare perspective.

    PubMed

    Draycott, T; van der Nelson, H; Montouchet, C; Ruff, L; Andersson, F

    2016-02-10

    In view of the increasing pressure on the UK's maternity units, new methods of labour induction are required to alleviate the burden on the National Health Service, while maintaining the quality of care for women during delivery. A model was developed to evaluate the resource use associated with misoprostol vaginal inserts (MVIs) and dinoprostone vaginal inserts (DVIs) for the induction of labour at term. The one-year Markov model estimated clinical outcomes in a hypothetical cohort of 1397 pregnant women (parous and nulliparous) induced with either MVI or DVI at Southmead Hospital, Bristol, UK. Efficacy and safety data were based on published and unpublished results from a phase III, double-blind, multicentre, randomised controlled trial. Resource use was modelled using data from labour induction during antenatal admission to patient discharge from Southmead Hospital. The model's sensitivity to key parameters was explored in deterministic multi-way and scenario-based analyses. Over one year, the model results indicated MVI use could lead to a reduction of 10,201 h (28.9%) in the time to vaginal delivery, and an increase of 121% and 52% in the proportion of women achieving vaginal delivery at 12 and 24 h, respectively, compared with DVI use. Inducing women with the MVI could lead to a 25.2% reduction in the number of midwife shifts spent managing labour induction and 451 fewer hospital bed days. These resource utilisation reductions may equate to a potential 27.4% increase in birthing capacity at Southmead Hospital, when using the MVI instead of the DVI. Resource use, in addition to clinical considerations, should be considered when making decisions about labour induction methods. Our model analysis suggests the MVI is an effective method for labour induction, and could lead to a considerable reduction in resource use compared with the DVI, thereby alleviating the increasing burden of labour induction in UK hospitals.

  3. Vaginal Dinoprostone Versus Intravenous Oxytocin for Labor Induction in Patients Not Responsive to a First Dose of Dinoprostone: A Randomized Prospective Study.

    PubMed

    Antonazzo, Patrizio; Laoreti, Arianna; Personeni, Carlo; Grossi, Elena; Martinelli, Anna; Cetin, Irene

    2016-06-01

    To evaluate the efficacy of 2 different regimens for labor induction in patients with unfavorable cervix not responsive to a first dose of dinoprostone vaginal insert. Between November, 2011 and June, 2014, 338 patients underwent induction of labor. After standard 24 hours treatment, 94 singleton term pregnancies remained with a Bishop score ≤6 and were randomized into 2 different regimens: repeated vaginal dinoprostone (group A, n = 47) or intravenous oxytocin (group B, n = 47). Primary outcome was vaginal delivery, and the secondary outcomes were interval between labor induction and delivery and operative delivery rates. Vaginal deliveries were significantly higher (group A: 26/47 (55.3%) and group B 16/47 (34.0%), P < .05), and cesarean sections were significantly lower (group A 21/47 (44.7%) and group B 31/47 (66%), P < .05) in patients who received a double dose of dinoprostone. The intervals between labor induction and onset of labor and between labor induction and delivery were lower in the group treated with oxytocin. Neonatal outcomes were similar in the 2 groups. A second dinoprostone vaginal insert is an effective and safe choice for patients with unfavorable cervix not responsive to a first 24 hours administration of dinoprostone for cervical ripening, and its use is associated with lower cesarean section rates. © The Author(s) 2015.

  4. Comparative study of titrated oral misoprostol solution and vaginal dinoprostone for labor induction at term pregnancy.

    PubMed

    Wang, Xiu; Yang, Aijun; Ma, Qingyong; Li, Xuelan; Qin, Li; He, Tongqiang

    2016-09-01

    To evaluate effectiveness and safety of titrated oral misoprostol solution (OMS) in comparison with vaginal dinoprostone for cervix ripening and labor induction in term pregnant women. A multicenter randomized controlled trial of women with term singleton pregnancy with indications for labor induction; 481 participants were allocated to receive titrated OMS with different doses by hourly administration according to the procedure or insert vaginal dinoprostone for cervix ripening and labor induction to compare maternal outcomes including indication of labor induction, mode of outcome of delivery, maternal morbidity, and neonatal outcomes between two groups for evaluating the efficacy and safety of titrated oral misoprostol induction. Proportion of delivery within 12 h of titrated oral misoprostol is significantly less than vaginal dinoprostone (p = 0.03), but no difference of total vaginal delivery rate (p = 0.93); the mean time of first treatment to vaginal delivery was longer in OMS group (21.3 ± 14.5 h) compared with the vaginal dinoprostone group (15.7 ± 9.6 h). Although the proportion of cesarean section between the two groups showed no statistically significant difference, OMS group showed significantly lower frequency of uterine hyperstimulation, hypertonus, partus precipitatus and non-reassuring fetal heart rate than dinoprostone group. Neonatal outcomes were similar evaluating from Apgar score and NICU admission. Our study also showed that labor induction of women with cervix Bishop score ≤3 needed increased dosage of misoprostol solution. Titrated OMS is as effective as vaginal dinoprostone in labor induction for term pregnant women, with safer effect for its lower rate of adverse effect for women.

  5. Does vaginal pH affect the efficacy of dinoprostone in cervical ripening/labor duration?

    PubMed

    Basirat, Z; Barat, S H; Ghanbarpour, A; Golsorkhtabar-Amiri, M

    2012-01-01

    Prostaglandins are effective in the ripening of the cervix and facilitating labor induction. Vaginal pH is probably an important factor in the effectiveness of vaginal prostaglandins. The aim of this study was to evaluate the effect of vaginal pH on the function of prostaglandin vaginal tablet during labor. This is a double-blinded clinical trial study of 147 pregnant primigravid trated in the Yahyanejad Hospital of Babol (Iran) from January 2006 to December 2007. Initial pH was measured during vaginal examination with nitrazin paper and the Bishop score was determined. All women received vaginal dinoprostone inserted in the posterior fornix of the vagina for cervical ripening and the second dose was administered if the uterine contractions were inadequate. Reassessment of the Bishop score after 12 hours, duration of latent and active phases, and also the duration of the second stage of labor were compared between the two groups with low or high vaginal pH. The incidence of Cesarean section was lower in women with high vaginal pH but was not statistically significant. The Bishop score after 12 hours, latent phase, and second stage durations were not different in the two groups of high or low vaginal pH, but active phase duration in patients with high pH was significantly shorter than those with low pH (p = 0.019). High vaginal pH influences the function of prostaglandin tablet as a reduction in duration of the active phase of labor.

  6. Dinoprostone

    MedlinePlus

    ... the eye; cephalopelvic disproportion; previous difficult or traumatic deliveries; unexplained vaginal bleeding; or heart, liver, or kidney ... may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( ...

  7. Sustained-release dinoprostone vaginal pessary with concurrent high-dose oxytocin infusion compared to sustained-release dinoprostone vaginal pessary followed 6 h later by high-dose oxytocin infusion for labor induction in women at term with unfavorable cervix: a randomized controlled trial.

    PubMed

    Güngördük, Kemal; Yildirim, Gokhan; Güngördük, Ozgu; Ark, Cemal; Tekirdağ, Ismet

    2011-01-01

    To compare the efficacy and safety of sustained-release dinoprostone vaginal pessary and concurrent high-dose oxytocin infusion with sustained-release dinoprostone vaginal pessary followed 6 h later by high-dose oxytocin infusion for cervical ripening and labor induction. A total of 500 nulliparous or multiparous women with a singleton pregnancy, Bishop score ≤4 and admitted for labor induction. Women were randomly assigned to induction of labor using intravaginal dinoprostone with concurrent high-dose oxytocin (n = 250) or intravaginal dinoprostone pessary followed 6 h later by high-dose oxytocin (n = 250). The primary outcome was the number of vaginal deliveries achieved within 24 h of labor induction. Baseline characteristics of both groups were comparable. Vaginal delivery within 24 h of labor induction was significantly increased with sustained-release dinoprostone followed 6 h later by high-dose oxytocin infusion (92.8 vs. 82.0%, RR 2.82, 95% CI 1.58-5.04). There were more cesarean section deliveries in the dinoprostone with concurrent high-dose oxytocin group (16.8 vs. 6.8%, RR 0.36, 95% CI 0.20-0.65). Maternal outcomes did not differ significantly. An Apgar score of <7 at 5 min was found more often in the dinoprostone with concurrent high-dose oxytocin group (3.6%) in comparison to dinoprostone pessary followed 6 h later by high-dose oxytocin (0.8%), although this was not statistically different (RR 0.21, 95% CI 0.04-1.01). Sustained-release dinoprostone followed 6 h later by high-dose oxytocin infusion appears to be safer and more effective than sustained-release dinoprostone with concurrent high-dose oxytocin infusion in achieving cervical ripening and successful vaginal delivery. Copyright © 2010 S. Karger AG, Basel.

  8. Is Low Dose Vaginal Misoprostol Better Than Dinoprostone Gel For Induction of Labor: A Randomized Controlled Trial

    PubMed Central

    Agrawal, Swati; Puri, Manju; Nigam, Aruna; Kaur, Harvinder; Trivedi, Shubha Sagar

    2014-01-01

    Objective: To compare the efficacy and safety profile of low dose vaginal misoprostol with dinoprostone gel for induction of labor in term pregnancies. Methods: The study was conducted at Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital on 100 pregnant women with term pregnancy after application of inclusion and exclusion criteria. The women were randomized in 2 groups of 50 women each. Group I received misoprostol 25μg at every six hour vaginally for a maximum of five doses for induction of labor; while group II received dinoprostone gel 0.5 mg every six hourly for a maximum of three doses. Maternal outcomes such as mode of delivery and induction delivery interval; and fetal outcomes such as APGAR score and incidence of NICU admission were assessed in both the groups. Statistical analysis was done using student t-test and chi-square test. Results: There was no significant difference in the mean induction to delivery interval in both the groups (14.32±0.13 hours in Group I and 14.92±0.18 hours in Group II, p=0.75), mode of delivery, indication of cesarean section and perinatal outcome. However, significant difference was observed in requirement of oxytocin augmentation in both the groups (32% in Group I and 68% in Group II, p=0.005). Conclusion: Vaginal misoprostol in low doses is similar in efficacy and safety to dinoprostone gel for cervical ripening and labor induction in term pregnancy. PMID:25386492

  9. Randomized study of vaginal misoprostol (PGE(1)) and dinoprostone gel (PGE(2)) for induction of labor at term.

    PubMed

    Pandis, G K; Papageorghiou, A T; Otigbah, C M; Howard, R J; Nicolaides, K H

    2001-12-01

    To investigate the efficacy and safety of misoprostol in the induction of labor at term by comparing this agent with the commonly used dinoprostone gel. A randomized clinical trial of vaginal misoprostol, 50 microg 6-hourly, and dinoprostone gel, 1-2 mg 6-hourly, in 435 women undergoing induction of labor at term. The women, 210 in the misoprostol group and 225 in the dinoprostone group, were compared to determine whether there was a significant difference in achieving vaginal delivery within 24 h, the incidence of hyperstimulation syndrome, Cesarean section rate and adverse neonatal outcome. They were also offered the option of preinduction sonographic cervical assessment. Misoprostol, compared to dinoprostone gel, was associated with a significantly shorter median induction-to-delivery interval (14.6 h vs. 19.0 h; P = 0.0014), a higher incidence of vaginal delivery within 24 h of induction (65.7% vs. 54.2%; P = 0.019) and a reduced need for oxytocin augmentation during labor (20.5% vs. 29.8%; P = 0.034). The groups did not differ significantly in the rates of Cesarean section (18.1% vs. 19.1%; P = 0.88) and hyperstimulation syndrome (2.4% vs. 0.9%; P = 0.27). None of the cases of hyperstimulation required treatment with tocolysis. All nine cases of excessive uterine contractility occurred after the first dose of the drug. There were no significant differences in maternal and neonatal morbidity between the two groups. There was a significant association between preinduction cervical length and the induction-to-delivery interval in both those receiving misoprostol and those treated with dinoprostone. The use of misoprostol is associated with a shorter duration of labor and a higher rate of vaginal delivery within 24 h from induction without an increase in maternal and neonatal morbidity. Transvaginal sonographic measurement of cervical length is useful in the prediction of the likelihood of vaginal delivery within 24 h of induction and of the induction

  10. Effects of intravaginally inserted controlled-release dinoprostone and oxytocin for labor induction on umbilical cord blood gas parameters

    PubMed Central

    Keskin, Hüseyin Levent; Kabacaoğlu, Gökalp; Seçen, Elçin İşlek; Üstüner, Işık; Yeğin, Gülin; Avşar, Ayşe Filiz

    2012-01-01

    Objective: To compare the effects of oxytocin and dinoprostone used in labor induction on fetal blood gas parameters. Material and Methods: This prospective randomized trial involved 108 women who completed 37 gestational weeks and who required labor induction prior to normal vaginal birth. Labor was induced in 57 women with an intravenous low dose oxytocin regimen and in 51 with intravaginal dinoprostone (PGE2). Following childbirth, umbilical artery blood gas was analyzed, with pH, pCO2, pO2, HCO3 and base excess (BE) compared in the two groups. Results: Mean age and obstetrical data (gravidity, parity, gestational weeks and birthweight) were similar in the two groups (p>0.05). All infants had 1 and 5 minute APGAR scores ≥7. Umbilical artery blood pH was similar in the oxytocin and dinoprostone groups (7.31±0.07 vs. 7.31±0.05, p=0.780), as were the other blood gas parameters (pCO2, pO2, base excess and HCO3; p>0.05 each). Conclusion: Induction of labor with either oxytocin or dinoprostone in women with uncomplicated term pregnancies had no adverse effects on umbilical artery blood gas parameters. PMID:24592052

  11. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts.

    PubMed

    Miller, Hugh; Goetzl, Laura; Wing, Deborah A; Powers, Barbara; Rugarn, Olof

    2016-01-01

    To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts. Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment. Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively. When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used.

  12. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts

    PubMed Central

    Miller, Hugh; Goetzl, Laura; Wing, Deborah A.; Powers, Barbara; Rugarn, Olof

    2016-01-01

    Abstract Objective: To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts. Methods: Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment. Results: Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively. Conclusions: When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used. PMID:25758619

  13. Vaginal delivery rate in post-term pregnancies with one versus more than one dinoprostone gel administrations: an observational study.

    PubMed

    Farina, A; Bernabini, D; Rapacchia, G; Zanello, M; Curti, A; De Musso, F; Pula, G; Pedrazzi, A; Rizzo, N

    2013-10-01

    The study aims to calculate the probability of a successful vaginal delivery in post-term low-risk women by using a set of predictors (maternal, fetal, and ultrasonographic) according to the number of dinoprostone gel applications. This was an observational study of a cohort of 174 low-risk post-term singleton pregnancies. Parity, cervical status and length, and amniotic fluid volume (AFI) were evaluated immediately before prostaglandin gel induction at the Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy between January 2010 and October 2011. A consistent difference in vaginal delivery rates was observed for women who had one gel administration (Group 1) versus those who received either two or three gel administrations (Group 2): 77.5% at 24 hours and 97.4% at 48 hours vs. 27% at 24 hours and 54% at 48 hours (P <0.001 for both the comparisons) respectively. The predictors of a vaginal delivery were cervix dilatation and short cervix for Group 1, lower AFI for Group 2, and parity for both groups. Women who require more than one gel administration have a lower rate of vaginal delivery at 24 and 48 hours. Maternal, fetal, and ultrasonographic parameters can predict a successful vaginal delivery.

  14. Dinoprostone vaginal pessary for induction of labour: safety of use for up to 24 h.

    PubMed

    Tathem, Kellie; Harris, Lisa J; O'Rourke, Peter; Kimble, Rebecca M

    2012-12-01

    Cervidil(®) (dinoprostone) intravaginal pessaries are used for induction of labour and maintain serum prostaglandin levels for up to 24 h. The Therapeutic Goods Administration approves Cervidil(®) for 12-h use. However, twenty-four-hour use of Cervidil(®) is supported in Europe, New Zealand, America and some Australian hospitals. To assess the safety of Cervidil(®) use for up to 24 h for induction of labour in nulliparous women. A retrospective cohort study of 269 consecutive women receiving Cervidil(®) at the Royal Brisbane and Women's Hospital (RBWH) between July 2007 and December 2008 was performed. The primary outcome measures were frequency of, and time to, uterine tachysystole with or without fetal heart rate (FHR) changes. Secondary outcome measures included frequency of maternal (intrapartum temperature, postpartum haemorrhage) and neonatal (low Apgars, resuscitation, nursery admission) morbidity. Morbidity outcomes of those who received Cervidil(®) for less than or equal to 12 h were compared with those who received Cervidil(®) for more than 12 h. Uterine tachysystole occurred in 9.3% of patients receiving Cervidil(®) , with a mean time to tachysystole of 10 h. The majority of cases (68%) occurred within 12 h of use. There was no increase in maternal or neonatal morbidity for those who received Cervidil(®) for longer than 12 h. Twenty-four-hour use of Cervidil(®) is likely as safe as 12-h use for induction of labour in nulliparous women. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  15. Maternal serum progesterone, estradiol and estriol levels in successful dinoprostone-induced labor

    PubMed Central

    Konopka, C.K.; Morais, E.N.; Naidon, D.; Pereira, A.M.; Rubin, M.A.; Oliveira, J.F.; Mello, C.F.

    2013-01-01

    Hormone-mediated quiescence involves the maintenance of a decreased inflammatory responsiveness. However, no study has investigated whether labor induction with prostanoids is associated with changes in the levels of maternal serum hormones. The objective of this study was to determine whether labor induction with dinoprostone is associated with changes in maternal serum progesterone, estradiol, and estriol levels. Blood samples were obtained from 81 pregnant women at term. Sixteen patients had vaginal birth after spontaneous labor, 12 required cesarean section after spontaneous labor and 16 underwent elective cesarean. Thirty-seven patients had labor induction with dinoprostone. Eligible patients received a vaginal insert of dinoprostone (10 mg) and were followed until delivery. Serum progesterone (P4), estradiol (E2) and estriol (E3) levels and changes in P4/E2, P4/E3 and E3/E2 ratios were monitored from admission to immediately before birth, and the association of these measures with the resulting clinical classification outcome (route of delivery and induction responsiveness) was assessed. Progesterone levels decreased from admission to birth in patients who underwent successful labor induction with dinoprostone [vaginal and cesarean birth after induced labor: 23% (P < 0.001) and 18% (P < 0.025) decrease, respectively], but not in those whose induction failed (6.4% decrease, P > 0.05). Estriol and estradiol levels, P4/E2, P4/E3 and E3/E2 ratios did not differ between groups. Successful dinoprostone-induced labor was associated with reduced maternal progesterone levels from induction to birth. While a causal relationship between progesterone decrease and effective dinoprostone-induced labor cannot be established, it is tempting to propose that dinoprostone may contribute to progesterone withdrawal and favor labor induction in humans. PMID:23314338

  16. Characterisation of protein stability in rod-insert vaginal rings.

    PubMed

    Pattani, Aditya; Lowry, Deborah; Curran, Rhonda M; McGrath, Stephanie; Kett, Vicky L; Andrews, Gavin P; Malcolm, R Karl

    2012-07-01

    A major goal in vaccine development is elimination of the 'cold chain', the transport and storage system for maintenance and distribution of the vaccine product. This is particularly pertinent to liquid formulation of vaccines. We have previously described the rod-insert vaginal ring (RiR) device, comprising an elastomeric body into which are inserted lyophilised, rod-shaped, solid drug dosage forms, and having potential for sustained mucosal delivery of biomacromolecules, such as HIV envelope protein-based vaccine candidates. Given the solid, lyophilised nature of these insert dosage forms, we hypothesised that antigen stability may be significantly increased compared with more conventional solubilised vaginal gel format. In this study, we prepared and tested vaginal ring devices fitted with lyophilised rod inserts containing the model antigen bovine serum albumin (BSA). Both the RiRs and the gels that were freeze-dried to prepare the inserts were evaluated for BSA stability using PAGE, turbidimetry, microbial load, MALDI-TOF and qualitative precipitate solubility measurements. When stored at 4 °C, but not when stored at 40 °C/75% RH, the RiR formulation offered protection against structural and conformational changes to BSA. The insert also retained matrix integrity and release characteristics. The results demonstrate that lypophilised gels can provide relative protection against degradation at lower temperatures compared to semi-solid gels. The major mechanism of degradation at 40 °C/75% RH was shown to be protein aggregation. Finally, in a preliminary study, we found that addition of trehalose to the formulation significantly reduces the rate of BSA degradation compared to the original formulation when stored at 40 °C/75% RH. Establishing the mechanism of degradation, and finding that degradation is decelerated in the presence of trehalose, will help inform further development of RiRs specifically and polymer based freeze-dried systems in general.

  17. Concurrent oxytocin in women needing second dinoprostone.

    PubMed

    Sher, Zaiba; Ashraf, Mussaret; Irum, Nabila; Bashir, Shaheen; Khaliq, Nagina; Yaqub, Saima

    2015-05-01

    To reduce average induction delivery internal in patients with poor Bishop score without compromising fetomaternal outcome (in terms of birth weight, NICU admission, maternal complications and mode of delivery). A descriptive study. Department of Obstetrics and Gynaecology, Pakistan Atomic Energy Commission (PAEC) General Hospital, Islamabad, from February to December 2009. All patients needing 2nd dinoprostone pessary for induction of labour were included in the study. Patients with gestation below 37 weeks, those with intra-uterine growth restriction, bad obstetric history, previous uterine scar and patients in whom Bishop score improved for amniotomy after 1st dinoprostone pessary, were excluded. Data was collected on a special proforma where all variables were defined. Out of 90 patients, 44 (48.8%) had spontaneous vertex deliveries and 12 (13.3%) had instrumental deliveries so a total vaginal deliveries occurred in 56 (62.2%) patients. Thirty four patients (37.8%) had emergency caesarean sections. Main indication for cesarean was failure to progress in 1st stage of labour followed by fetal distress. There were 3 failed inductions. Only 2 patients had hyperstimulation. NICU admission were 8 and all babies were discharged healthy from nursery with no case of early neonatal death. Concurrent oxytocin with 2nd dinoprostone in patients with poor Bishop scores (initial scores 2 and 3) resulted in more vaginal birth and comparatively shorter induction delivery time with almost negligible fetomaternal complications.

  18. [Induction of labor in patients with premature rupture of membranes in term pregnancy using dinoprostone vs oxytocin. An aleatory study].

    PubMed

    Domínguez Salgado, C R; Gorostieta García, A; Vázquez Bretón, S

    1999-10-01

    It was accomplished a random comparative study to evaluate the effects of dinoprostone in the Hospital de Gineco Obstetricia No. 60 of the Mexican Institute of the Social Security, from June of 1997 to December of the same year, in relationship to the inducement cervical repening and vaginal delivery in patients with score less than or equal Bishop to 4. They were studied a total of 156 patients split into two groups: 78 patients who were administered by intracervical gel of Dinoprostone and to the remainders 78 were administered oxitocin with the same purpose, being this last the control group. We found that the duration time of induction with dinoprostone is 2 hours in average less than the inducement with oxitocin (p > 0.05). The were achieved 67 deliveries with dinoprostone and 65 deliveries with oxitocina, being not significantly. (p < 0.05) The percentage of inducement defect was considered in relationship to the absence of cervical modifications in 12 hours of administration of dinoprostone or oxitocin, being only 3 patients in each group in these conditions. The observed complications were the same in both groups and the conditions of the newborn were better in the Dinoprostone group. The septic complications of mothers were smaller in Dinoprostone group than Oxitocin group and were significantly (p > 0.05). We can conclude that the dinoprostone intracervical application reduce the induction and expulsion time, with better conditions of the new born, and less percent of infectious complications, in relationship to the Oxitocin control group.

  19. Controlled-release misoprostol vaginal insert in parous women for labor induction: a randomized controlled trial.

    PubMed

    Ewert, Karine; Powers, Barbara; Robertson, Steve; Alfirevic, Zarko

    2006-11-01

    To assess the ability of a controlled-release misoprostol vaginal insert to induce labor using dose reservoirs of 25, 50, 100, and 200 microg. This double-blind, dose ranging, randomized study was carried out in parous women requiring induction of labor at term. Each woman was randomly assigned to receive a single misoprostol vaginal insert that could remain in place for up to 24 hours and was removed for onset of active labor, an adverse event, or having reached 24 hours in situ. The primary outcome measure was time from insertion of the misoprostol vaginal insert to vaginal delivery of the neonate. A total of 124 women participated in the study. The median time to vaginal delivery was 27.5, 19.1, 13.1, and 10.6 hours for the 25-, 50-, 100-, and 200-microg doses, respectively. The percentage of women who delivered vaginally within 12 hours was 9%, 14%, 47%, and 53% (P<.001 using the 25-microg group as the comparator) and within 24 hours was 42%, 79%, 81%, and 70% (P=.003). Uterine hyperstimulation syndrome occurred in one woman who received the 25-mug, two women who received the 100-microg, and three women who received the 200-microg dose reservoirs. Misoprostol vaginal inserts effectively induced labor in pregnant parous women at term. I.

  20. Misoprostol vaginal insert for induction of labor: a delivery system with accurate dosing and rapid discontinuation.

    PubMed

    Stephenson, Megan L; Hawkins, J Seth; Powers, Barbara L; Wing, Deborah A

    2014-01-01

    Labor induction and cervical ripening are widely utilized and new methods are constantly being investigated. Prostaglandins have been shown to be effective labor induction agents and, in particular, were compared with other prostaglandin preparations; vaginal misoprostol used off-label was associated with reduced failure to achieve vaginal delivery. The challenge is to provide this medication with the correct dosing for this indication and with the ability to discontinue the medication if needed, all while ensuring essential maternal and neonatal safety. The misoprostol vaginal insert initiates cervical ripening using a delivery system that controls misoprostol release and can be rapidly removed. This article reviews the development, safety and efficacy of the misoprostol vaginal insert for induction of labor and cervical ripening, and will focus on vaginally administered prostaglandins.

  1. Association of Lactobacillus crispatus with fructo-oligosaccharides and ascorbic acid in hydroxypropyl methylcellulose vaginal insert.

    PubMed

    Vitali, Beatrice; Abruzzo, Angela; Parolin, Carola; Palomino, Rogers Alberto Ñahui; Dalena, Francesco; Bigucci, Federica; Cerchiara, Teresa; Luppi, Barbara

    2016-01-20

    The aim of this work was to develop a synbiotic vaginal insert containing the probiotic strain Lactobacillus crispatus BC5, the prebiotic substrate fructo-oligosaccharide and the antioxidant agent ascorbic acid, for the prophylaxis and therapy of vaginal infections. Mucoadhesive in situ gelling vaginal inserts based on hydroxypropyl methylcellulose were prepared by freeze-drying, stored at +2-8 °C for 90 days and characterized in terms of technological and functional properties. Complete survival of L. crispatus BC5 was found immediately after insert preparation (96.08%) as well as after 90 days of storage (95.82%) in the vaginal inserts containing fructo-oligosaccharide, ascorbic acid and skimmed milk. Synbiotic inserts showed improved mucoadhesion ability (from three- to five-fold) with respect to a standard formulation based on hydroxypropyl methylcellulose alone. Moreover, inserts allowed to modulate lactobacilli release in virtue of the different amounts of fructo-oligosaccharide. Finally, antimicrobial activity was exerted by L. crispatus BC5 released from the vaginal formulation.

  2. Comparison of low-dose oxytocin and dinoprostone for labor induction in postterm pregnancies: a randomized controlled prospective study.

    PubMed

    Akay, Nezahat Öztürk; Hızlı, Deniz; Yılmaz, Saynur Sarıcı; Yalvaç, Serdar; Kandemir, Omer

    2012-01-01

    The aim of this study was to compare the efficacy of oxytocin and dinoprostone in achieving successful labor induction and vaginal delivery in postterm women with an unfavorable cervix. Postterm women with an uncomplicated pregnancy and a Bishop score of ≤6 were randomized to receive either dinoprostone vaginal pessary (Propess®) or low-dose oxytocin. The primary outcomes were the length of the induction-to-delivery period and the incidence of vaginal delivery. A total of 144 women were available for the analysis. The overall vaginal delivery rates were 75% (54/72) for the dinoprostone group and 80.6% (58/72; p = 0.35) for the oxytocin group; the mean induction-to-vaginal delivery interval was 13.3 and 10.3 h in the dinoprostone and the oxytocin group, respectively (p = 0.003). Uterine hyperstimulation was 7.4% compared with 6.8% (p = 0.8), and abnormal fetal heart rate was 26.4% compared with 18% (p = 0.2), respectively. Both oxytocin and dinoprostone seem to have similar obstetric outcomes in postterm pregnancies with an unfavorable cervix, except for a significant superiority of oxytocin for delivery in a shorter period. Copyright © 2012 S. Karger AG, Basel.

  3. A randomized trial of vaginal prostaglandin E2 for induction of labor. Insert vs. tablet.

    PubMed

    Rabl, Michaela; Joura, Elmar A; Yücel, Yüksel; Egarter, Christian

    2002-02-01

    To compare the efficacy and safety of a prostaglandin E2 (PGE2) vaginal insert with PGE2 administered as a vaginal tablet. A randomized, observational study was performed. Women requiring induction of labor were randomly assigned to receive either a 10-mg PGE2 vaginal insert (group 1, n = 100) or 3-mg PGE2 tablets twice at six-hour intervals (group 2, n = 100). The primary efficacy outcome variable was vaginal delivery within 24 hours of insertion. The criteria for safety were the occurrence of uterine hyperstimulation, abnormal fetal heart rate patterns, use of beta 2-sympathomimetic drugs and fetal outcome. No differences in terms of vaginal delivery or cesarean section within 24 hours of induction were found. The cesarean section rate was 21% in group 1 and 22% in group 2. The interval from insertion of the induction agent to the onset of regular uterine contractions and the insertion-to-delivery interval were not different between the two cohorts. No difference in the frequency of uterine hyperstimulation, use of beta 2-sympathomimetic drugs, abnormal fetal heart rate patterns, fetal outcome, or oxytocin and analgesic requirements were found. In seven of eight patients in group 1 who experienced uterine hyperstimulation, removal of the insert was sufficient to stop it, whereas in group 2, of nine cases, eight needed medical interventions to end hyperstimulation (P = .003). The continuous release of PGE2 from the vaginal insert permits controlled induction of labor, and easy removal of the drug in cases of uterine hyperstimulation is possible.

  4. Absorption of oxybutynin from vaginal inserts: drug blood levels and the response of the rabbit bladder.

    PubMed

    Schröder, A; Levin, R M; Kogan, B A; Das, A K; Kay, F; Mahashabde, A

    2000-12-20

    Oxybutynin has been used for treatment of urge urinary incontinence for more than 20 years. However, one of the major problems with its use is uncomfortable anticholinergic side effects that can lead to discontinuation of treatment. Alternative forms of drug administration may reduce side effects and thus improve patient compliance. A cylinder-shaped, curved silicone elastomer insert containing oxybutynin was anchored in the vagina of female rabbits. The inserts were designed to release oxybutynin at rates of 0.5, 1.0, and 5.0 mg/day, respectively. Blood drug and metabolite levels were monitored for 1 to 7 days and cystometry was carried out after 7 days of treatment. There was a consistent dose-dependent absorption of the oxybutynin resulting in stable plasma concentrations by 3 days. Levels of N-desethyloxybutynin, the active metabolite that is thought to be responsible for side effects, were less than 1.0 ng/mL in all groups. The cystometrograms showed a decrease in the detrusor pressures for the higher oxybutynin groups and a dose-dependent decrease in micturition pressure. The vaginal wall in contact with the insert showed no irritation. The inserts produced stable blood levels and released sufficient amounts of oxybutynin to have measurable effects on the bladder. There was no irritating effect of the insert on the vaginal wall after a 1-week treatment. Vaginal inserts containing oxybutynin may be an interesting alternative method for the chronic delivery of oxybutynin.

  5. Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening.

    PubMed

    Asiedu, Mercy Nyamewaa; Agudogo, Júlia; Krieger, Marlee S; Miros, Robert; Proeschold-Bell, Rae Jean; Schmitt, John W; Ramanujam, Nimmi

    2017-01-01

    Cervical cancer screening usually requires use of a speculum to provide a clear view of the cervix. The speculum is one potential barrier to screening due to fear of pain, discomfort and embarrassment. The aim of this paper is to present and demonstrate the feasibility of a tampon-sized inserter and the POCkeT Colposcope, a miniature pen sized-colposcope, for comfortable, speculum-free and potentially self-colposcopy. We explored different designs using 3D computer-aided design (CAD) software and performed mechanical testing simulations on each. Designs were rapid prototyped and tested using a custom vaginal phantom across a range of vaginal pressures and uterine tilts to select an optimal design. Two final designs were tested with fifteen volunteers to assess cervix visualization, comfort and usability compared to the speculum and the optimal design, the curved-tip inserter, was selected for testing in volunteers. We present a vaginal inserter as an alternative to the standard speculum for use with the POCkeT Colposcope. The device has a slim tubular body with a funnel-like curved tip measuring approximately 2.5 cm in diameter. The inserter has a channel through which a 2 megapixel (MP) mini camera with LED illumination fits to enable image capture. Mechanical finite element testing simulations with an applied pressure of 15 cm H2O indicated a high factor of safety (90.9) for the inserter. Testing of the device with a custom vaginal phantom, across a range of supine vaginal pressures and uterine tilts (retroverted, anteverted and sideverted), demonstrated image capture with a visual area comparable to the speculum for a normal/axial positioned uteri and significantly better than the speculum for anteverted and sideverted uteri (p<0.00001). Volunteer studies with self-insertion and physician-assisted cervix image capture showed adequate cervix visualization for 83% of patients. In addition, questionnaire responses from volunteers indicated a 92.3% overall

  6. Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening

    PubMed Central

    Agudogo, Júlia; Krieger, Marlee S.; Miros, Robert; Proeschold-Bell, Rae Jean; Schmitt, John W.; Ramanujam, Nimmi

    2017-01-01

    Objective Cervical cancer screening usually requires use of a speculum to provide a clear view of the cervix. The speculum is one potential barrier to screening due to fear of pain, discomfort and embarrassment. The aim of this paper is to present and demonstrate the feasibility of a tampon-sized inserter and the POCkeT Colposcope, a miniature pen sized-colposcope, for comfortable, speculum-free and potentially self-colposcopy. Study design We explored different designs using 3D computer-aided design (CAD) software and performed mechanical testing simulations on each. Designs were rapid prototyped and tested using a custom vaginal phantom across a range of vaginal pressures and uterine tilts to select an optimal design. Two final designs were tested with fifteen volunteers to assess cervix visualization, comfort and usability compared to the speculum and the optimal design, the curved-tip inserter, was selected for testing in volunteers. Results We present a vaginal inserter as an alternative to the standard speculum for use with the POCkeT Colposcope. The device has a slim tubular body with a funnel-like curved tip measuring approximately 2.5 cm in diameter. The inserter has a channel through which a 2 megapixel (MP) mini camera with LED illumination fits to enable image capture. Mechanical finite element testing simulations with an applied pressure of 15 cm H2O indicated a high factor of safety (90.9) for the inserter. Testing of the device with a custom vaginal phantom, across a range of supine vaginal pressures and uterine tilts (retroverted, anteverted and sideverted), demonstrated image capture with a visual area comparable to the speculum for a normal/axial positioned uteri and significantly better than the speculum for anteverted and sideverted uteri (p<0.00001). Volunteer studies with self-insertion and physician-assisted cervix image capture showed adequate cervix visualization for 83% of patients. In addition, questionnaire responses from volunteers

  7. Vaginitis

    MedlinePlus

    What is vaginitis? Vaginitis, also called vulvovaginitis, is an inflammation or infection of the vagina. It can also affect the vulva, which is the external part of a woman's genitals. Vaginitis can cause itching, pain, discharge, and odor. Vaginitis ...

  8. Two methods of cervix ripening: intracervical Foley catether and dinoprostone - which one is actually more efficient?

    PubMed

    Kosinska-Kaczynska, Katarzyna; Ciechanowicz, Piotr; Saletra, Aleksandra; Szymusik, Iwona; Wielgos, Miroslaw

    2015-01-01

    The aim was to evaluate which of the two analyzed methods of preinduction: intracervical Foley catether and intracervical dinoprostone is related to higher rate of successful vaginal delivery in shorter time and to shorter hospitalization after the delivery. A retrospective analysis of 198 patients with unfavorable cervix for labor induction (Bishop score ≤ 6), hospitalized at 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, was carried out. In 105 patients labor preinduction was conducted with Foley catheter (study group) and in 93 with intracervical dinoprostone (control group). There were no significant differences regarding patients' age, body mass index (BMI), weight gain during the pregnancy, duration of pregnancy and parity between the groups. 68.6% of patients in the study group and 65.6% in the control group delivered vaginally (p=0.65). In the study group significantly less women developed spontaneous onset of labor (36.2% vs 66.7%; p<0.001). The time from preinduction to delivery onset and from preinduction to vaginal delivery were longer in the study group (780 min vs 489 min; 1682 min vs 920 min; p<0.001). The time of hospitalization after the delivery was significantly shorter in the study group (4.1 days vs 6.8; (p<0.001). Both Foley catheter and dinoprostone seem to be equally effective in achieving vaginal delivery. In terms of time effectiveness Foley catheter preinduction is related to longer time from preinduction to delivery, nevertheless shorter time of hospitalization.

  9. A prospective cohort study of pain with intrauterine device insertion among women with and without vaginal deliveries.

    PubMed

    Allen, R H; Carey, M S; Raker, C; Goyal, V; Matteson, K

    2014-04-01

    The purpose of this prospective cohort study was to compare pain during IUD insertion between women with a history of vaginal delivery and women without a history of vaginal delivery. First-time IUD users chose either the CuT380A or the levonorgestrel IUS. We enrolled 49 women with previous vaginal delivery and 49 women with no history of vaginal delivery (either only caesarean deliveries or nulliparous). The mean pain score on a 0-100 mm visual analog scale during insertion in the vaginal delivery group was 34.7 (SD 31.6) compared with 51.2 (SD 29.2) in the group without previous vaginal delivery (p = 0.009). In multivariable analysis controlling for age, breast-feeding, expected pain, baseline anxiety, insertion timing (6-12 weeks postpartum, 2-4 weeks post-abortion or interval), and insertion difficulty, history of vaginal delivery was associated with a 15.5 point reduction in pain (95% CI, -27.4, -3.7). Other significant predictors of pain were 'expected pain' and 'insertion difficulty'.

  10. Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: a systematic review and meta-analysis.

    PubMed

    Liu, Aihai; Lv, Jieqiang; Hu, Yue; Lang, Junzhe; Ma, Luhang; Chen, Wenbing

    2014-04-01

    Recent studies suggest that misoprostol may be more effective than dinoprostone in pregnant women with unfavorable cervix. The objective here is to investigate and compare the efficacy and safety of intravaginal misoprostol and intracervical dinoprostone for labor induction, including incidence of cesarean section, vaginal delivery rate within 24 h, uterine hyperstimulation, tachysystole, oxytocin augmentation, neonatal intensive care unit (NICU) admissions, and Apgar score of less than 7 at 1 and 5 min. Databases searched were MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, up to July 2013. Randomized controlled trials comparing intravaginal misoprostol with intracervical dinoprostone in women with singleton pregnancy, intact membranes and unfavorable cervix (Bishop's <6) were included. Pooled relative risk, mean difference and 95% confidence intervals were calculated. The use of misoprostol was significantly effective in increasing the rate of vaginal delivery within 24 h and less oxytocin augmentation when compared with dinoprostone. However, the incidents of uterine hyperstimulation and tachysystole were significantly higher under the misoprostol protocol than dinoprostone protocol. Furthermore, we found similar efficiency in the rate of cesarean delivery, NICU admission and Apgar score at 1 and 5 min among the study groups. Intravaginal misoprostol appears to be more efficient for labor induction than intracervical dinoprostone; however, dinoprostone has been demonstrated to be safer because of the lower incidence of uterine hyperstimulation and tachysystole. Further high-quality studies assessing the possible effectiveness of misoprostol and dinoprostone in selected groups of patients are warranted. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  11. Effect of vaginal administration of misoprostol before intrauterine contraceptive insertion following previous insertion failure: a double blind RCT.

    PubMed

    Bahamondes, M Valeria; Espejo-Arce, Ximena; Bahamondes, Luis

    2015-08-01

    Is pretreatment with misoprostol useful in insertion of intrauterine contraceptives (IUCs) after insertion failure at the first attempt? Pretreatment with intravaginal administration of 200 mcg of misoprostol after IUC insertion failure 10 and 4 h before the second attempt of IUC placement was significantly better than placebo at facilitating the insertion of an IUC. One of the reasons for low use of IUCs is the concept that insertion is difficult. Misoprostol was used in several randomized clinical trials (RCT) before IUC insertion to facilitate the insertion. In general, the results showed no significant differences when compared with placebo. However, most previous studies have been carried out among unselected women whereas the present study is among women with previous insertion failure. This was a double blind RCT conducted between February 2013 and October 2014. Participants were 104 women who requested an insertion of an IUC and the insertion failed at the first attempt. After insertion failure, the women received a sealed envelope with misoprostol or placebo. The randomization system (1: 1) in one block size was computer-generated. The study was conducted at a tertiary care centre. The women were instructed to insert vaginally one tablet of misoprostol 200 µg (Prostokos, Hebron, Cariacica, PE, Brazil) or placebo 10 and 4 h before the woman returned to the clinic for a new insertion attempt. The outcomes were successful IUC insertion and the use of a cervical dilator immediately prior to the insertion procedure. A total of 2639 women requested the insertion of an IUC during the study period. The IUC was inserted at the first attempt in 2535 women (96%) and 104 women in whom we were unable to insert the device were eligible to participate in the RCT. Four women declined and 100 women were randomized (55 for the misoprostol group and 45 for the placebo group). From the 100 participating women, the levonorgestrel-releasing intrauterine system (LNG-IUS) was

  12. Immediate Postpartum Intrauterine Contraceptive Device Insertions in Caesarean and Vaginal Deliveries: A Comparative Study of Follow-Up Outcomes

    PubMed Central

    Nanda, Smiti; Gupta, Anjali; More, Hemant

    2016-01-01

    Background. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim was to study the clinical outcomes of IPPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean). Methods. This is a retrospective analytical study done in a tertiary care teaching institute. A Cohort of 593 vaginal and caesarean deliveries with IPPIUCD insertions, over a two-year period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings. Descriptives were calculated for various outcomes and chi square tests were used for comparison in between categorical variables. Results. Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 5.3% cases and were significantly higher in vaginal insertions (p = 0.042). The incidence of undescended strings was high (38%), with highly significant difference between both groups (p = 0.000). Conclusion. IPPIUCD is a strong weapon in the family planning armoury and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems. PMID:27631023

  13. Vaginitis.

    PubMed

    Hainer, Barry L; Gibson, Maria V

    2011-04-01

    Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.

  14. An evaluation of conscious sedation using propofol and remifentanil for tension-free vaginal tape insertion.

    PubMed

    Winton, A L; Eastwood, J; Powell, M C; Norris, A M

    2008-09-01

    Tension-free vaginal tape insertion is a recommended treatment for stress incontinence. There is evidence that intra-operative testing of continence by asking patients to cough may improve outcomes, but an optimal sedation regimen has not been determined. We prospectively evaluated the effectiveness of propofol and remifentanil infusions in 25 patients using pre- and post-sedation peak cough pressures and pain scores. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Score (ISAS). Post-sedation cough pressures were improved compared to baseline, with a mean peak pressure increase of 24 mmHg (95% CI 15.5-32.5; p < 0.001). Pain scores (median, IQR [range]) were low for local anaesthetic infiltration (0, [0-1]) and first (0, [0-1]) and second (0, [0-3.5]) needle insertions. Of the 19 patients completing the ISAS, all felt safe and satisfied. Sedation using propofol and remifentanil provides acceptable analgesia, satisfaction and effective continence testing.

  15. [Cervical ripening at term. A randomized and prospective study: Misoprotol versus dinoprostone].

    PubMed

    Trabelsi, Haikel; Mathlouthi, Nabil; Zayen, Sonia; Dhouib, Mohamed; Chaabene, Kaies; Trabelsi, Khaled; Amouri, Habib; Ben Ayed, Belhassen; Guermazi, Mohamed

    2012-05-01

    To compare the efficacy and safety of cervical ripening at term by vaginal Misoprostol and Dinoprostone. We performed a prospective randomized study on cervical ripening with misoprostol and dinoprostone in the third trimester of pregnancy. 300 patients have been divided into two groups: one consisted by 150 patients who received Misoprostol (Cytotec ®) and the second consisted by 150 patients who received Dinoprostone (Prépidil ®). Analysis of our results allowed to reveal: a significant decrease in the time of entry into work for the Misoprostol group (9.08 hours versus 12.51 hours, p = 0.007), a significant reduction delivery time (14.48 hours versus 19.30 hours, p = 0.001). Moreover, the birth rate in the first 24 hours after the first dose was significantly higher in the Misoprostol group (86.7% versus 72.7%, p = 0.003). The use of oxytocin was significantly reduced with Misoprostol (44% versus 58.7%, p = 0.01). The mode of delivery was not influenced by membership in one or other of the two groups. Misoprostol seems an interesting molecule for cervical ripening and labor induction.

  16. Vaginal inserts based on chitosan and carboxymethylcellulose complexes for local delivery of chlorhexidine: preparation, characterization and antimicrobial activity.

    PubMed

    Bigucci, Federica; Abruzzo, Angela; Vitali, Beatrice; Saladini, Bruno; Cerchiara, Teresa; Gallucci, Maria Caterina; Luppi, Barbara

    2015-01-30

    The aim of this work was to prepare vaginal inserts based on chitosan/carboxymethylcellulose polyelectrolyte complexes for local delivery of chlorhexidine digluconate. Complexes were prepared with different chitosan/carboxymethylcellulose molar ratios at a pH value close to pKa interval of the polymers and were characterized in terms of physico-chemical properties, complexation yield and drug loading. Then complexes were used to prepare inserts as vaginal dosage forms and their physical handling, morphology, water-uptake ability and drug release properties as well as antimicrobial activity toward Candida albicans and Escherichia coli were evaluated. Results confirmed the ionic interaction between chitosan and carboxymethylcellulose and the influence of the charge amount on the complexation yield. Complexes were characterized by high values of drug loading and showed increasing water-uptake ability with the increase of carboxymethylcellulose amount. The selection of appropriate chitosan/carboxymethylcellulose molar ratios allowed to obtain cone-like shaped solid inserts, easy to handle and able to hydrate releasing the drug over time. Finally, the formulated inserts showed antimicrobial activity against common pathogens responsible for vaginal infections.

  17. Postplacental or Delayed Insertion of the Levonorgestrel Intrauterine Device After Vaginal Delivery

    PubMed Central

    Chen, Beatrice A.; Reeves, Matthew F.; Hayes, Jennifer L.; Hohmann, Heather L.; Perriera, Lisa K.; Creinin, Mitchell D.

    2011-01-01

    OBJECTIVE To estimate whether 6-month use of the levonorgestrel-releasing intrauterine device (IUD) would be higher when insertion occurred within 10 minutes of placental delivery compared with 6–8 weeks postpartum. METHODS We enrolled pregnant women planning vaginal deliveries and desiring a postpartum levonorgestrel-releasing IUD. Patients were randomly assigned when admitted in labor to postplacental or delayed IUD insertion. The women followed up in person at 6–8 weeks and 6 months and were contacted by telephone at 3 months. Women were ineligible for a study IUD postenrollment for intrapartum events including infection, hemorrhage, and cesarean delivery; these women were contacted by phone at 3 and 6 months. Expelled IUDs were replaced per patient preference. RESULTS Successful IUD placement occurred in 50 of 51 participants (98.0%) and 46 of 51 participants (90.2%) in the postplacental and delayed groups, respectively (P=.2). Expulsion within 6 months occurred in 12 of 50 (24.0%; 95% confidence interval [CI], 13.1–38.2) and two of 46 (4.4%; 95% CI 0.5–14.8) participants, respectively (P=.008). Intrauterine device use at 6 months was 43 of 51 (84.3%; 95% CI 71.4–93.0) and 39 of 51 (76.5%; 95% CI 62.5–87.2), respectively (P=.32). For ineligible patients, only 11 of 41 (26.8%) women were using IUDs at 6 months and two (4.9%) had become pregnant. CONCLUSION Intrauterine device use 6 months after delivery is similar in women who have postpartum or scheduled delayed IUD placement through a study after replacement of expelled IUDs. Expulsions are significantly higher with postplacental compared with delayed IUD placement. Women asked to follow up with their own health care providers for delayed insertion are significantly less likely to receive an IUD. CLINICALTRIALREGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00476021. LEVEL OF EVIDENCE I PMID:20966692

  18. [Tethered tape or the fourth factor. A new cause of recurrent stress incontinence after midurethral tape procedures vaginal tape insertion].

    PubMed

    Kociszewski, J; Fabian, G; Grothey, S; Viereck, V; Füsgen, I; Wiedemann, A

    2014-01-01

    This is the first report of a newly identified cause of recurrent stress urinary incontinence (SUI) after midurethral tape insertion. This article reports a series of cases with primary or secondary tape failure including clinical presentation and findings, the results of pelvic floor (PF) ultrasound, and the (surgical) correction of malpositioned vaginal tapes. A vaginal tape for treating SUI must be accurately placed under the mid-third of the urethra and at a distance of 3-5 mm from the urethra. Alignment parallel to the urethra in the urethrovaginal septum is also essential for adequate function. A tethered tape refers to the adhesion of a tape edge to the anterior vaginal wall either during primary wound closure or due to secondary ingrowths and is typically associated with recurrent SUI during activities or changes in posture. Less common is SUI through an increase in pressure from cranially, which occurs when coughing or laughing. "Vaginal polyps" may point to imminent vaginal erosion of the tape. In the sagittal plane, the PF examination will identify an oblique orientation of the tape at rest, an abnormal closeness of the tape to the transducer, and changes in tape shape upon manipulation of the vaginal probe. Once the diagnosis has been established, a tethered tape is easy to correct by realignment or tightening to accomplish correct positioning parallel to the urethra. This measure restores tape function and continence. Primary or secondary failure of a tension-free vaginal tape may be caused by a tethered tape. This complication can be diagnosed on the basis of characteristic findings at PF ultrasound. In most women, the tape position can be corrected and there is no need for tape removal.

  19. Sustained release of the candidate antiretroviral peptides T-1249 and JNJ54310516-AFP from a rod insert vaginal ring.

    PubMed

    Murphy, Diarmaid J; Amssoms, Katie; Pille, Geert; Clarke, Aileen; O'Hara, Marc; van Roey, Jens; Malcolm, R Karl

    2016-06-01

    Administration of biomacromolecular drugs in effective quantities from conventional vaginal rings is hampered by poor drug permeability in the polymers from which rings are commonly constructed. Here, we report the formulation development and testing of rod insert rings for sustained release of the candidate antiretroviral peptides T-1249 and JNJ54310516-AFP (JNJ peptide), both of which have potential as HIV microbicides. Rod inserts were prepared comprising antiviral peptides T-1249 or JNJ peptide in combination with a hydrophilic excipient (sodium chloride, sodium glutamate, lactose or zinc acetate) dispersed at different loadings within a medical grade silicone elastomer. The inserts were tested for weight change and swelling when immersed in simulated vaginal fluid (SVF). Dye migration into the inserts was also assessed visually over 28 days. In vitro release of T-1249 and JNJ peptide from rings containing various insert types was tested. Weight change and degree of swelling of rods immersed in SVF was dependent on the type and concentration of excipient present. The rods displayed the following rank order in terms of weight change: sodium glutamate > zinc acetate ≈ sodium chloride > lactose. The weight change and degree of swelling of the inserts did not correlate with the level of dye uptake observed. In vitro release of T-1249 was improved through addition of lactose, sodium chloride and sodium glutamate, while release of JNJ peptide was improved through addition of sodium chloride or sodium glutamate. Sustained release of hydrophobic peptides can be achieved using a rod insert ring design formulated to include a hydrophilic excipient. Release rates were dependent upon the type of excipient used. The degree of release improvement with different inserts partially reflects their ability to imbibe surrounding fluid and swell in aqueous environments.

  20. Plasma prostaglandin E(2) metabolite levels during labor induction with a sustained-release prostaglandin E(2) vaginal insert.

    PubMed

    Goharkhay, N; Stanczyk, F Z; Gentzschein, E; Wing, D A

    2000-01-01

    To measure prostaglandin E(2) levels during labor induction with a sustained-release vaginal polymer insert (prostaglandin E(2) insert) and to determine whether Bishop score change correlated with tachysystole. Twelve primiparas and 12 multiparas were treated with a 0.3 mg per hour sustained-release polymer vaginal prostaglandin E(2) insert for up to 24 hours. Bishop score was assessed at start and end of therapy, and serum samples were collected at 4-hour intervals. Prostaglandin E(2) metabolite (PGEM) levels were measured by specific enzyme immunoassay. Exposure averaged 13.5 +/- 7.2 hours. Four patients (16.7%, three nulliparas) had tachysystole. Mean PGEM levels increased from 187 +/- 42 pg/mL at baseline to 548 +/- 110 pg/mL at 12 hours (P <.05) and remained relatively stable thereafter. Nulliparas with Bishop score changes of four points or more had the highest increase, with average peak levels of 985 +/- 109 pg/mL, compared with 452 +/- 58 pg/mL for all others (P <.001). Patients with tachysystole had higher 4-hour (P <.01) and overall (P <.04) increases in PGEM level. Removal of the insert led to an average decrease of 335 pg/mL in PGEM levels (P <.01). The decrease correlated with the PGEM level measured before removal (r =.94, P <.0001) and the maximum PGEM increase from baseline (r =.94, P <.0001). The mean mixed venous cord PGEM level was 409 +/- 375 pg/mL. Administration of the prostaglandin E(2) insert led to a sustained increase in circulating PGEM levels in women who had labor induction. Peak PGEM levels correlated with Bishop score improvement. Rapid increases in prostaglandin E(2) levels might cause tachysystole.

  1. Patients' administration preferences: progesterone vaginal insert (Endometrin®) compared to intramuscular progesterone for Luteal phase support.

    PubMed

    Beltsos, Angeline N; Sanchez, Mark D; Doody, Kevin J; Bush, Mark R; Domar, Alice D; Collins, Michael G

    2014-11-11

    Administration of exogenous progesterone for luteal phase support has become a standard of practice. Intramuscular (IM) injections of progesterone in oil (PIO) and vaginal administration of progesterone are the primary routes of administration. This report describes the administration preferences expressed by women with infertility that were given progesterone vaginal insert (PVI) or progesterone in oil injections (PIO) for luteal phase support during fresh IVF cycles. A questionnaire to assess the tolerability, convenience, and ease of administration of PVI and PIO given for luteal phase support was completed by infertile women diagnosed with PCOS and planning to undergo IVF. The women participated in an open-label study of highly purified human menopausal gonadotropins (HP-hMG) compared with recombinant FSH (rFSH) given for stimulation of ovulation. Most women commented on the convenience and ease of administration of PVI, while a majority of women who administered IM PIO described experiencing pain. In addition, their partners often indicated that they had experienced at least some anxiety regarding the administration of PIO. The most distinguishing difference between PVI and PIO in this study was the overall patient preference for PVI. Despite the need to administer PVI either twice a day or three times a day, 82.6% of the patients in the PVI group found it "very" or "somewhat convenient" compared with 44.9% of women in the PIO group. The results of this comprehensive, prospective patient survey, along with findings from other similar reports, suggest that PVI provides an easy-to-use and convenient method for providing the necessary luteal phase support for IVF cycles without the pain and inconvenience of daily IM PIO. Moreover, ongoing pregnancy rates with the well-tolerated PVI were as good as the pregnancy rates with PIO. ClinicalTrial.gov, NCT00805935.

  2. Progesterone pharmacokinetics and pharmacodynamics with 3 dosages and 2 regimens of an effervescent micronized progesterone vaginal insert.

    PubMed

    Paulson, Richard J; Collins, Michael G; Yankov, Vladimir I

    2014-11-01

    Progesterone vaginal insert (PVI), an effervescent delivery system, dissolves rapidly, is absorbed through the vaginal epithelium, and achieves higher endometrial tissue concentrations than those achieved with progesterone in oil (PIO) given im. Our objective was to examine the pharmacokinetics and pharmacodynamics of PVI compared with PIO. Fifty-eight healthy premenopausal women were randomized to 50, 100, or 200 mg PVI once daily; 100 or 200 mg PVI twice daily; or 50 to 100 mg PIO via im injection once daily for 10 days. Serum samples were obtained after the first dose; serum and endometrial tissue were obtained after the last dose. Maximum observed serum concentration (Cmax), time to Cmax, and area under the serum-concentration time curve over the dosing interval were calculated after correcting for baseline progesterone concentrations. ANOVA and paired t test were used to compare results across and within groups. A higher Cmax was observed after PIO than PVI administration. Endometrial tissue progesterone concentrations were higher for PVI regimens. Time to Cmax was 7.3 hours after PIO and 3.3 to 5.9 hours after PVI. Steady state was achieved within 24 and 48 hours for PVI and PIO regimens, respectively. The area under the curve increased with increasing PVI dosage; however, the increase was not proportional to the increase in dosage. Downregulation of estrogen and progesterone receptors was observed in secretory biopsy specimens. The PVI system consistently allowed for rapid progesterone absorption and achieved higher endometrial tissue concentrations and lower systemic exposures than observed after im PIO.

  3. Induction of Labor in Post-Term Nulliparous and Parous Women – Potential Advantages of Misoprostol over Dinoprostone

    PubMed Central

    Tsikouras, P.; Koukouli, Z.; Manav, B.; Soilemetzidis, M.; Liberis, A.; Csorba, R.; Trypsianis, G.; Galazios, G.

    2016-01-01

    Introduction: We undertook a prospective cohort study to compare the effectiveness and safety of 50 µg misoprostol versus 3 mg dinoprostone in two vaginal doses 6 hours apart, followed if necessary by oxytocin for labor induction in low-risk post-term (> 40 weeks) pregnancies with unfavorable cervix (Bishop score ≤ 6). Methods: Labor induction and subsequent management were conducted using a standardized protocol. The primary outcome of the study was labor induction rate. Secondary outcomes included mode of delivery, time interval from induction to delivery, maternal complications and neonatal outcome. Results: 107 patients received misoprostol (Group A) and 99 patients received dinoprostone (Group B). Compared with group A, more women in Group B needed a second vaginal dose of prostaglandin or oxytocin infusion in order to proceed to labor (21.5 vs. 43.4 %; p = 0.01). Misoprostol alone as a single or double vaginal dose was more effective than dinoprostone alone in inducing labor without oxytocin administration (85.0 vs. 50.4 %; p = 0.04). Overall, the rate of successful induction of labor did not differ between groups (91.6 vs. 85.8 %; p = 0.75). Vaginal delivery, operative vaginal delivery and Caesarean section rates were not significantly different. Time interval from induction to delivery however, was shorter for Group A (median 11 hours vs. 14.1 hours; p < 0.001). Though emergency Caesarean section due to fetal distress was more frequent in Group A (16.8 vs. 4.0 %; p = 0.007), low Apgar scores < 7 and NICU admissions did not differ significantly. Maternal complications, mostly not serious, were higher in Group A (31.8 vs. 2.0, p < 0.001). Conclusion: Misoprostol is a more effective agent than dinoprost in post-term pregnancy for labor induction with few maternal adverse effects. PMID:27582576

  4. A randomized trial of levonorgestrel intrauterine system insertion 6 to 48 h compared to 6 weeks after vaginal delivery; lessons learned.

    PubMed

    Stuart, Gretchen S; Lesko, Catherine R; Stuebe, Alison M; Bryant, Amy G; Levi, Erika E; Danvers, Antoinette I

    2015-04-01

    The objective of this randomized trial was to compare breastfeeding among women who received a levonorgestrel-releasing intrauterine system within 6-48 h (early) or 4-6 weeks (standard) after an uncomplicated vaginal birth. Analysis groups of 86 women in each arm were needed to demonstrate a 20% difference in any breastfeeding. Thirty-five women were randomized to the early (N=17) and standard (N=18) arms. The combination of unsuccessful placement (2/17; 12%), expulsions (7/17; 41%) and removals (3/17; 18%) reached 71% (12/17) in the early arm, so the study was stopped. In our small study cohort, levonorgestrel-releasing intrauterine system insertion between 6 and 48 h after vaginal birth was associated with a high rate of expulsion or removal soon after insertion. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Use of the Dye Stain Assay and Ultraviolet Light Test for Assessing Vaginal Insertion of Placebo-filled Applicators Before and After Sex

    PubMed Central

    Keller, Marla J.; Buckley, Niall; Katzen, Lauren L.; Walsh, Jennifer; Friedland, Barbara; Littlefield, Sarah; Lin, Juan; Xue, Xiaonan; Cornelison, Terri; Herold, Betsy C.; Einstein, Mark H.

    2014-01-01

    Background Applicator dye staining and ultraviolet (UV) light have been used in trials to measure adherence, but not in the setting of before and after sex gel dosing (BAT-24). This study was designed to determine if semen or pre-sex gel dosing impacts the sensitivity and specificity of a dye stain assay (DSA) for measuring vaginal insertion of placebo-filled applicators with BAT-24 dosing. Methods Healthy monogamous couples received Microlax®-type applicators filled with hydroxyethylcelluose placebo gel. Women were instructed to vaginally insert one dose of gel before and a second dose after sex and to return applicators within 48 hours after sex. Applicators were stained to detect semen followed by UV then DSA and scored by two readers. Positive and negative controls were randomly included in applicator batches. Results Fifteen couples completed the study. Each female returned at least six applicators over a 30-day period. The sensitivity for insertion of post-sex applicators was higher for UV (97%) compared to DSA (90%) and the specificity was similar (≥96%). For pre-sex applicators, the sensitivity and specificity were higher for DSA (100%) compared to UV testing (87% sensitivity, 96% specificity). Among returned post-sex applicators, 95% tested positive by UV compared to 87% by DSA. Agreement between readers was significantly better on the pre-sex applicators for DSA than for UV and for post-sex readings agreement was less than half that for UV, although the results were not statistically significant. Conclusions Applicator tests are feasible for measuring adherence in trials with gel dosing before and after sex. PMID:24220355

  6. Use of the dye stain assay and ultraviolet light test for assessing vaginal insertion of placebo-filled applicators before and after sex.

    PubMed

    Keller, Marla J; Buckley, Niall; Katzen, Lauren L; Walsh, Jennifer; Friedland, Barbara; Littlefield, Sarah; Lin, Juan; Xue, Xiaonan; Cornelison, Terri; Herold, Betsy C; Einstein, Mark H

    2013-12-01

    Applicator dye staining and ultraviolet (UV) light have been used in trials to measure adherence, but not in the setting of before and after sex gel dosing (BAT-24). This study was designed to determine if semen or presex gel dosing impacts the sensitivity and specificity of a dye stain assay (DSA) for measuring vaginal insertion of placebo-filled applicators with BAT-24 dosing. Healthy monogamous couples received Microlax-type applicators (Tectubes, Åstorp, Sweden) filled with hydroxyethylcelluose placebo gel. Women were instructed to vaginally insert 1 dose of gel before and a second dose after sex and to return applicators within 48 hours after sex. Applicators were stained to detect semen, followed by UV then DSA, and scored by 2 readers. Positive and negative controls were randomly included in applicator batches. Fifteen couples completed the study. Each woman returned at least 6 applicators over a 30-day period. The sensitivity for insertion of postsex applicators was higher for UV (97%) compared with DSA (90%), and the specificity was similar (≥96%). For presex applicators, the sensitivity and specificity were higher for DSA (100%) compared with UV testing (87% sensitivity, 96% specificity). Among returned postsex applicators, 95% tested positive by UV compared with 87% by DSA. Agreement between readers was significantly better on the presex applicators for DSA than for UV, and for postsex readings, agreement was less than half that for UV, although the results were not statistically significant. Applicator tests are feasible for measuring adherence in trials with gel dosing before and after sex.

  7. Outcome of the laparoscopic two-team sling procedure, tension-free vaginal tape insertion, and transobturator tape insertion in women with recurrent stress urinary incontinence.

    PubMed

    Hassonah, Seham; Medel, Sebastian; Lovatsis, Danny; Drutz, Harold P; Alarab, May

    2013-11-01

    Objectif : Bien que la prise en charge chirurgicale de l’incontinence urinaire à l’effort primaire (IUE) ait été bien étudiée, la prise en charge optimale de l’IUE persistante ou récurrente constitue un défi considérable pour le chirurgien et les données publiées pertinentes sont limitées. Cette étude avait pour but de documenter les données quant aux issues de diverses techniques chirurgicales utilisées dans notre centre pour la prise en charge de l’IUE récurrente, ainsi que d’évaluer les complications immédiates et à long terme étant associées à ces interventions. Méthodes : Cette étude rétrospective a évalué l’issue de l’intervention laparoscopique de fronde à deux équipes, de l’insertion d’une bandelette vaginale sans tension (TVT) et de l’insertion d’une bandelette transobturatrice (TOT) dans la prise en charge de l’IUE récurrente chez des femmes. Parmi les données recueillies, on trouvait les caractéristiques démographiques des patientes, les données urodynamiques, la guérison postopératoire subjective et la guérison objective (test à la toux négatif), ainsi que les complications peropératoires et postopératoires. Résultats : Quarante-six femmes présentant une IUE récurrente ont été admises à l’étude : 24 d’entre elles ont subi une intervention laparoscopique de fronde à deux équipes, 15 ont subi une insertion de TVT et 7 ont subi une insertion de TOT. Les taux de guérison objective ont été de 91,7 %, de 73,3 % et de 85,7 %, respectivement, tandis que les taux de guérison subjective ont été de 79,2 %, de 60 % et de 57,1 %, respectivement. Au sein du groupe « intervention laparoscopique de fronde à deux équipes », une des participantes en est venue à présenter un hématome infecté, tandis qu’une autre a nécessité une chirurgie en raison d’une occlusion de l’intestin grêle. Conclusion : L’intervention laparoscopique de fronde à deux

  8. Cervical ripening agent dinoprostone for delivery induction in late pregnancy mothers: experiences of 685 cases.

    PubMed

    Liang, C; Xu, D; He, J

    2015-01-01

    The failure of labor induction often requires following cesarean section and suffering of patients. Cervical ripening is therefore critical in clinical care of pregnant mothers. The present study demonstrated the use of dinoprostone in cervical ripening for delivery induction in 685 cases of pregnancy mothers. The authors conclude that dinoprostone is a very useful and safe drug for delivery induction. The combined use of oxytocin and careful monitoring of all body symptoms are important for the clinical safety.

  9. Vaginal cancer

    MedlinePlus

    Vaginal cancer; Cancer - vagina; Tumor - vaginal ... Most vaginal cancers occur when another cancer, such as cervical or endometrial cancer , spreads. This is called secondary vaginal cancer. Cancer ...

  10. Vaginal dryness

    MedlinePlus

    Vaginitis - atrophic; Vaginitis due to reduced estrogen; Atrophic vaginitis; Menopause vaginal dryness ... Atrophic vaginitis is caused by a decrease in estrogen. Estrogen keeps the tissues of the vagina lubricated and healthy. ...

  11. Vaginal Atrophy

    MedlinePlus

    Vaginal atrophy Overview Vaginal atrophy (atrophic vaginitis) is thinning, drying and inflammation of the vaginal walls due to your body having less estrogen. Vaginal atrophy occurs most often after ...

  12. Misoprostol Vaginal Insert in Labor Induction: A Cost-Consequences Model for 5 European Countries-An Economic Evaluation Supported with Literature Review and Retrospective Data Collection.

    PubMed

    Bierut, Adam; Dowgiałło-Smolarczyk, Jadwiga; Pieniążek, Izabela; Stelmachowski, Jarosław; Pacocha, Kinga; Sobkowski, Maciej; Baev, Oleg R; Walczak, Jacek

    2016-10-01

    The present study aimed to assess the costs and consequences of using an innovative medical technology, misoprostol vaginal insert (MVI), for the induction of labor (IOL), in place of alternative technologies used as a standard of care. This was a retrospective study on cost and resource utilization connected with economic model development. Target population were women with an unfavorable cervix, from 36 weeks of gestation, for whom IOL is clinically indicated. Data on costs and resources was gathered via a dedicated questionnaire, delivered to clinical experts in five EU countries. The five countries participating in the project and providing completed questionnaires were Austria, Poland, Romania, Russia and Slovakia. A targeted literature review in Medline and Cochrane was conducted to identify randomized clinical trials meeting inclusion criteria and to obtain relative effectiveness data on MVI and the alternative technologies. A hospital perspective was considered as most relevant for the study. The economic model was developed to connect data on clinical effectiveness and safety from randomized clinical trials with real life data from local clinical practice. The use of MVI in most scenarios was related to a reduced consumption of hospital staff time and reduced length of patients' stay in hospital wards, leading to lower total costs with MVI when compared to local comparators. IOL with the use of MVI generated savings from a hospital perspective in most countries and scenarios, in comparison to alternative technologies. Sponsorship, article processing charges, and the open access charge for this study were funded by Ferring Pharmaceuticals Poland.

  13. Induction of labor in patients with an unfavorable cervix after a cesarean using an osmotic dilator versus vaginal prostaglandin.

    PubMed

    Maier, Josefine T; Metz, Melanie; Watermann, Nina; Li, Linna; Schalinski, Elisabeth; Gauger, Ulrich; Rath, Werner; Hellmeyer, Lars

    2017-06-26

    Trial of labor after cesarean (TOLAC) is a viable option for safe delivery. In some cases cervical ripening and subsequent labor induction is necessary. However, the commonly used prostaglandins are not licensed in this subgroup of patients and are associated with an increased risk of uterine rupture. This cohort study compares maternal and neonatal outcomes of TOLAC in women (n=82) requiring cervical ripening agents (osmotic dilator vs. prostaglandins). The initial Bishop scores (BSs) were 2 (0-5) and 3 (0-5) (osmotic dilator and prostaglandin group, respectively). In this retrospective analysis, Fisher's exact test, the Kruskal-Wallis rank sum test and Pearson's chi-squared test were utilized. Vaginal birth rate (including operative delivery) was 55% (18/33) in the osmotic dilator group vs. 51% (25/49) in the dinoprostone group (P 0.886). Between 97% and 92% (32/33 and 45/49) (100%, 100%) of neonates had an Apgar score of >8 after 1 min (5, 10 min, respectively). The time between administration of the agent and onset of labor was 36 and 17.1 h (mean, Dilapan-S® group, dinoprostone group, respectively). Time from onset of labor to delivery was similar in both groups with 4.4 and 4.9 h (mean, Dilapan-S® group, dinoprostone group, respectively). Patients receiving cervical ripening with Dilapan-S® required oxytocin in 97% (32/33) of cases. Some patients presented with spontaneous onset of labor, mostly in the dinoprostone group (24/49, 49%). Amniotomy was performed in 64% and 49% (21/33 and 24/49) of cases (Dilapan-S® group and dinoprostone group, respectively). This pilot study examines the application of an osmotic dilator for cervical ripening to promote vaginal delivery in women who previously delivered via cesarean section. In our experience, the osmotic dilator gives obstetricians a chance to perform induction of labor in these women.

  14. Vaginal Fistula

    MedlinePlus

    Vaginal fistula Overview By Mayo Clinic Staff A vaginal fistula is an abnormal opening that connects your vagina to ... or urine to pass through your vagina. Vaginal fistulas can develop as a result of an injury, ...

  15. Vaginal Fistula

    MedlinePlus

    Diseases and Conditions Vaginal fistula By Mayo Clinic Staff A vaginal fistula is an abnormal opening that connects your vagina to another organ, ... stool or urine to pass through your vagina. Vaginal fistulas can develop as a result of an ...

  16. Vaginal Diseases

    MedlinePlus

    Vaginal problems are some of the most common reasons women go to the doctor. They may have ... that affect the vagina include sexually transmitted diseases, vaginal cancer, and vulvar cancer. Treatment of vaginal problems ...

  17. Vaginal disorders.

    PubMed

    Soderberg, S F

    1986-05-01

    Chronic vaginitis is the most common vaginal disorder. Dogs with vaginitis show no signs of systemic illness but often lick at the vulva and have purulent or hemorrhagic vaginal discharges. Vaginitis is most commonly secondary to a noninfectious inciting factor such as congenital vaginal anomalies, clitoral hypertrophy, foreign bodies, trauma to the vaginal mucosa, or vaginal tumors. Inspection of the caudal vagina and vestibule both visually and digitally will often reveal the source of vaginal irritation. Vaginal cytology is used to establish the stage of the estrous cycle as well as distinguish uterine from vaginal sources of discharge. Vaginal cultures are used to establish the predominant offending organism associated with vaginal discharges and may be used as a guide for selection of a therapeutic agent. Vaginitis is best managed by removing the inciting cause and treating the area locally with antiseptic douches. Congenital malformations at the vestibulovaginal or vestibulovulvar junction may prevent normal intromission. Affected bitches may be reluctant to breed naturally because of pain. Such defects are detected best by digital examination. Congenital vaginal defects may be corrected by digital or surgical means. Prolapse of tissue through the lips of the vulva may be caused by clitoral hypertrophy, vaginal hyperplasia, or vaginal tumors. Enlargement of clitoral tissue is the result of endogenous or exogenous sources of androgens. Treatment of this condition includes removal of the androgen source and/or surgical removal of clitoral tissue. Vaginal hyperplasia is detected during proestrus or estrus of young bitches. Hyperplastic tissue will regress during diestrus. Tissue that is excessively traumatized and/or prolapse of the entire vaginal circumference may be removed surgically. Ovariohysterectomy may be used to prevent recurrence. Vaginal tumors are detected most often in older intact bitches. Such tumors are generally of smooth muscle or fibrous

  18. Dinoprostone versus misoprostol: a randomized study of nulliparous women undergoing induction of labor.

    PubMed

    Lokugamage, Amali U; Forsyth, Sophie F; Sullivan, Keith R; El Refaey, Hazem; Rodeck, Charles H

    2003-02-01

    The objectives of the study were to compare the efficacy and safety of intravaginal misoprostol and intravaginal dinoprostone for induction of labor and to quantify the clinical response to suspicious cardiotocographic (CTG) readings. One hundred and ninety-one patients were randomized to receive either 50 micro g misoprostol initially then a further identical dose 6 h later or 2 mg dinoprostone initially followed by 1 mg 6 h later, over a period of 24 h. If not in labor after 24 h, then both arms of the study would thereafter receive dinoprostone alone as per hospital protocol. The induction to delivery interval (1047 vs. 1355 min, p = 0.01), delivery within 12 h (35.4% vs. 18.9%, p = 0.02) and delivery within 24 h (83.3% vs. 63.3%, p = 0.01) were all shorter in the misoprostol arm. There were no differences in rates of oxytocin augmentation (p = 0.47), tachysystole (p = 0.32) and hyperstimulation syndrome (p = 0.82). There was an increase in the median number of times a doctor was called to advise on a suspicious CTG in the misoprostol group (1 vs. 2 occasions, p = 0.052), but there was no difference in neonatal outcome. Intravaginal misoprostol led to a shorter, more efficient labor, and although there was more anxiety related to the CTG, there was no increase in neonatal adverse effects.

  19. Estrogen Vaginal

    MedlinePlus

    ... life; the end of monthly menstrual periods). Femring® brand estradiol vaginal ring is also used to treat ... sweating) in women who are experiencing menopause. Premarin® brand vaginal cream is also used to treat kraurosis ...

  20. Vaginal Odor

    MedlinePlus

    ... usually don't cause vaginal odors. Neither do yeast infections. Generally, if you have vaginal odor without ... Avoid douching. All healthy vaginas contain bacteria and yeast. The normal acidity of your vagina keeps bacteria ...

  1. Clindamycin Vaginal

    MedlinePlus

    ... an infection caused by an overgrowth of harmful bacteria in the vagina). Clindamycin is in a class ... works by slowing or stopping the growth of bacteria. Vaginal clindamycin cannot be used to treat vaginal ...

  2. Vaginal Infections

    PubMed Central

    Nicolle, Lindsay E.

    1989-01-01

    Vaginal infections are among the most common complaints for which women see their physicians. The patient complains primarily of vaginal discharge or pruritus. Optimal management of these infections requires a careful history, physical examination, and laboratory assessment to determine the pathogen. Specific therapy is available for the three important causes of vaginal infection: yeast vulvovaginitis, trichomoniasis, and bacterial vaginosis. Concomitant sexually transmitted diseases should be excluded in women with complaints suggestive of vaginal infection. PMID:21248968

  3. Atrophic vaginitis.

    PubMed

    Stika, Catherine S

    2010-01-01

    With the loss of estrogen that occurs with menopause, physiologic and structural changes occur within the vulvovaginal mucosa that lead to a condition commonly called atrophic vaginitis. Although mild genital changes occur in most women, 10-47% of postmenopausal women will develop one or more debilitating symptoms that include vulvovaginal dryness, dyspareunia, vulvar itching or pain, recurrent urinary tract infections, as well as abnormal vaginal discharge. Topical estrogen replacement therapies reverse these mucosal changes and are effective treatments for the symptoms of atrophic vaginitis. Vaginal moisturizers and lubricants also provide symptomatic relief for vaginal dryness and dyspareunia, respectively. © 2010 Wiley Periodicals, Inc.

  4. Vaginal Cancer

    MedlinePlus

    Vaginal cancer is a rare type of cancer. It is more common in women 60 and older. You are also more likely to get it if you have had a human ... test can find abnormal cells that may be cancer. Vaginal cancer can often be cured in its ...

  5. Emphysematous vaginitis.

    PubMed

    Lima-Silva, Joana; Vieira-Baptista, Pedro; Cavaco-Gomes, João; Maia, Tiago; Beires, Jorge

    2015-04-01

    Emphysematous vaginitis is a rare condition, characterized by the presence of multiple gas-filled cysts in the vaginal and/or exocervical mucosa. Although its etiology is not completely understood, it is self-limited, with a benign clinical course. Vaginal discharge, sometimes bloody, and pruritus are the most common symptoms. Chronic and acute inflammation can be found, and diseases that impair the immune system and pregnancy have been associated with this condition. A 48-year-old postmenopausal woman, with a history of hysterectomy with several comorbidities, presented with a 4-month history of bloody discharge and vulvar pruritus. Examination showed multiple cystic lesions, 1 to 5 mm, occupying the posterior and right lateral vaginal walls. Speculum examination produced crepitus. Vaginal wet mount was normal, except for diminished lactobacilli; results of Trichomonas vaginalis DNA test and vaginal cultures were negative. Lugol's iodine applied to the vagina was taken up by the intact lesions. Biopsy result showed typical features of emphysematous vaginitis. This is an unusual entity, presenting with common gynecological complaints, and both physicians and pathologists should be aware to prevent misdiagnosis and overtreatment.

  6. Terconazole Vaginal Cream, Vaginal Suppositories

    MedlinePlus

    ... pregnant, insert the applicator gently. If you feel resistance (hard to insert), do not try to insert ... prescription and nonprescription drugs you are taking, especially antibiotic medications and vitamins.tell your doctor if you ...

  7. The effect of type of vaginal insert and dose of pLH on embryo production, following fixed-time AI in a progestin-based superstimulatory protocol in Nelore cattle.

    PubMed

    Nogueira, Marcelo F Gouveia; Fragnito, Paulo S; Trinca, Luzia A; Barros, Ciro M

    2007-02-01

    The objective was to analyze and report field data focusing on the effect of type of progesterone-releasing vaginal insert and dose of pLH on embryo production, following a superstimulatory protocol involving fixed-time artificial insemination (FTAI) in Nelore cattle (Bos taurus indicus). Donor heifers and cows (n = 68; 136 superstimulations over 2 years) received an intravaginal, progesterone-releasing insert (CIDR or DIB, with 1.9 or 1.0 g progesterone, respectively) and 3-4 mg of estradiol benzoate (EB) i.m. at random stages of the estrous cycle. Five days later (designated Day 0), cattle were superstimulated with a total of 120-200 mg of pFSH (Folltropin-V), given twice daily in decreasing doses from Days 0 to 3. All cattle received two luteolytic doses of PGF2alpha at 08:00 and 20:00 h on Day 2 and progesterone inserts were removed at 20:00 h on Day 3 (36 h after the first PGF2alpha injection). Ovulation was induced with pLH (Lutropin-V, 12.5 or 25 mg, i.m.) at 08:00 h on Day 4 with FTAI 12, 24 and in several cases, 36 h later. Embryos were recovered on Days 11 or 12, graded and transferred to synchronous recipients. Overall, the mean (+/-S.E.M.) number of total ova/embryos (13.3 +/- 0.8) and viable embryos (9.4 +/- 0.6) and pregnancy rate (43.5%; 528/1213) did not differ among groups, but embryo viability rate (overall, 70.8%) was higher in donors with a DIB (72.3%) than a CIDR (68.3%, P = 0.007). In conclusion, the administration of pLH 12 h after progesterone removal in a progestin-based superstimulatory protocol facilitated fixed-time AI in Nelore donors, with embryo production, embryo viability and pregnancy rates after embryo transfer, comparable to published results where estrus detection and AI was done. Results suggested a possible alternative, which would eliminate the need for estrus detection in donors.

  8. Vaginal parasitosis.

    PubMed

    Garud, M A; Saraiya, U; Paraskar, M; Khokhawalla, J

    1980-01-01

    In two cases the ova of parasitic worms, Ascaris lumbricoides and Enterobius vermicularis, were observed in Papanicolaou-stained vaginal smears. The characteristics of each type of ovum are described.

  9. Treating vaginitis.

    PubMed

    Cullins, V A; Dominguez, L; Guberski, T; Secor, R M; Wysocki, S J

    1999-10-01

    Vaginitis resulting from bacterial, fungal, or protozoal infections can be associated with altered vaginal discharge, odor, pruritus, vulvovaginal irritation, dysuria, or dyspareunia, depending on the type of infection. Bacterial vaginosis, which is primarily characterized by a malodorous discharge, is common in women with multiple sex partners and is caused by the overgrowth of several facultative and anaerobic bacterial species. Vulvovaginal candidiasis is characterized by pruritus and a cottage cheese-like discharge. Vaginal trichomoniasis, a sexually transmitted disease caused by an anaerobic protozoan parasite, is associated with a copious yellow or green, sometimes frothy, discharge. Differential diagnosis of these infections requires a thorough history, vulvovaginal examination, and simple laboratory tests, including microscopy of the vaginal discharge. The information obtained from this workup should enable an accurate diagnosis. Topical or oral metronidazole is the treatment of choice for bacterial vaginosis; terconazole, or other antifungals, for vulvovaginal candidiasis; and oral metronidazole for trichomoniasis.

  10. Vaginal Discharge

    MedlinePlus

    ... also be on the lookout for symptoms of yeast infections, bacterial vaginosis and trichomoniasis, 3 infections that ... cause changes in your vaginal discharge.Signs of yeast infectionsWhite, cottage cheese-like dischargeSwelling and pain around ...

  11. Vaginal Microbiota.

    PubMed

    Mendling, Werner

    2016-01-01

    The knowledge about the normal and abnormal vaginal microbiome has changed over the last years. Culturing techniques are not suitable any more for determination of a normal or abnormal vaginal microbiota. Non culture-based modern technologies revealed a complex and dynamic system mainly dominated by lactobacilli.The normal and the abnormal vaginal microbiota are complex ecosystems of more than 200 bacterial species influenced by genes, ethnic background and environmental and behavioral factors. Several species of lactobacilli per individuum dominate the healthy vagina. They support a defense system together with antibacterial substances, cytokines, defensins and others against dysbiosis, infections and care for an normal pregnancy without preterm birth.The numbers of Lactobacillus (L.) iners increase in the case of dysbiosis.Bacterial vaginosis (BV) - associated bacteria (BVAB), Atopobium vaginae and Clostridiales and one or two of four Gardnerella vaginalis - strains develop in different mixtures and numbers polymicrobial biofilms on the vaginal epithelium, which are not dissolved by antibiotic therapies according to guidelines and, thus, provoke recurrences.Aerobic vaginitis seems to be an immunological disorder of the vagina with influence on the microbiota, which is here dominated by aerobic bacteria (Streptococcus agalactiae, Escherichia coli). Their role in AV is unknown.Vaginal or oral application of lactobacilli is obviously able to improve therapeutic results of BV and dysbiosis.

  12. Hysterectomy - vaginal - discharge

    MedlinePlus

    Vaginal hysterectomy - discharge; Laparoscopically assisted vaginal hysterectomy - discharge; LAVH - discharge ... were in the hospital, you had a vaginal hysterectomy. Your surgeon made a cut in your vagina. ...

  13. Mucoadhesive vaginal drug delivery systems.

    PubMed

    Acartürk, Füsun

    2009-11-01

    Vaginal delivery is an important route of drug administration for both local and systemic diseases. The vaginal route has some advantages due to its large surface area, rich blood supply, avoidance of the first-pass effect, relatively high permeability to many drugs and self-insertion. The traditional commercial preparations, such as creams, foams, gels, irrigations and tablets, are known to reside in the vaginal cavity for a relatively short period of time owing to the self-cleaning action of the vaginal tract, and often require multiple daily doses to ensure the desired therapeutic effect. The vaginal route appears to be highly appropriate for bioadhesive drug delivery systems in order to retain drugs for treating largely local conditions, or for use in contraception. In particular, protection against sexually-transmitted diseases is critical. To prolong the residence time in the vaginal cavity, bioadhesive therapeutic systems have been developed in the form of semi-solid and solid dosage forms. The most commonly used mucoadhesive polymers that are capable of forming hydrogels are synthetic polyacrylates, polycarbophil, chitosan, cellulose derivatives (hydroxyethycellulose, hydroxy-propylcellulose and hydroxypropylmethylcellulose), hyaluronic acid derivatives, pectin, tragacanth, carrageenan and sodium alginate. The present article is a comprehensive review of the patents related to mucoadhesive vaginal drug delivery systems.

  14. Vaginal cysts

    MedlinePlus

    ... You may need a biopsy to rule out vaginal cancer, especially if the mass appears to be solid. If the cyst is located under the bladder or urethra, x-rays may be needed to see if the cyst extends into these organs.

  15. Steroidal contraceptive vaginal rings.

    PubMed

    Sarkar, N N

    2003-06-01

    The development of steroid-releasing vaginal rings over the past three decades is reviewed to illustrate the role of this device as an effective hormonal contraceptive for women. Vaginal rings are made of polysiloxane rubber or ethylene-vinyl-acetate copolymer with an outer diameter of 54-60 mm and a cross-sectional diameter of 4-9.5 mm and contain progestogen only or a combination of progestogen and oestrogen. The soft flexible combined ring is inserted in the vagina for three weeks and removed for seven days to allow withdrawal bleeding. Progesterone/progestogen-only rings are kept in for varying periods and replaced without a ring-free period. Rings are in various stages of research and development but a few, such as NuvaRing, have reached the market in some countries. Women find this method easy to use, effective, well tolerated and acceptable with no serious side-effects. Though the contraceptive efficacy of these vaginal rings is high, acceptability is yet to be established.

  16. Vaginal contraceptives still evolving.

    PubMed

    Pearson, R M

    1986-01-01

    The effort to develop vaginal contraceptives began in the distant past and is still underway today. 1000 years ago, South American Indians inserted into the vagina bark strips impregnated with quinine. In medieval times women used vaginal inserts of cloth soaked in honey or vinegar. Quinine pessaries were introduced into Europe in the late 1800s, and in the early 1900s investigators began to study the effects of various chemicals on sperm motility. Following World War II, surfactant spermicides which disrupt the sperm membrane were developed and marketed. Many of these preparations contained nonoxynol-9. Currently, the D-isomer of propranolol is being examined as a spermicidal contraceptive, and several bacteriocides, e.g., benzalkonium and chlorhexidine, are being developed as spermicides which reduce the penetrability of cervical mucus. Other chemicals being investigated act by inhibiting the acrosome reaction. Advantages of vaginal contraceptives are that they are inexpensive, reversible, and relatively safe and easy to use. Generally they require no medical intervention or supervision. In addition, spermicides may kill or inhibit the growth of organisms responsible for sexually transmitted diseases. Disadvantages of spermicides are that they are generally less effective than many other methods, some interfere with sexual spontaneity, they may cause local irritations, and some women find them messy to use. Recently, concerns were expressed about the possible teratogenic effects of sperimicides. Most of these concerns proved to be unfounded. Given the many new avenues of research, the major disadvantage of sperimicides, i.e., their high failure rates, may be minimized in the near future.

  17. Vaginal itching and discharge - child

    MedlinePlus

    Pruritus vulvae; Itching - vaginal area; Vulvar itching; Yeast infection - child ... vagina or the skin around the vagina. Vaginal yeast infection . Vaginitis . Vaginitis in girls before puberty is ...

  18. Contraceptive vaginal rings: a review.

    PubMed

    Brache, Vivian; Faundes, Anibal

    2010-11-01

    Development efforts on contraceptive vaginal rings were initiated over 40 years ago based on two principles: the capacity of the vaginal epithelium to absorb steroids and the capacity of elastomers to release these hormones at a nearly constant rate. Numerous models of contraceptive vaginal rings (CVRs) have been studied, but only two have reached the market: NuvaRing, a combined ring that releases etonogestrel (ENG) and ethinylestradiol (EE), and Progering, a progesterone-releasing ring for use in lactating women. The main advantages of CVRs are their effectiveness (similar to or slightly better than the pill), ease of use without the need of remembering a daily routine, user's ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring. The main disadvantages are related to the mode of delivery; CVRs may cause vaginal discharge and complaints, ring expulsion is not uncommon, the ring may be felt during coitus and vaginal insertion may be unpleasant for some women. The studies reviewed in this article provide evidence that CVRs are safe, effective and highly acceptable to women. There is no doubt that CVRs offer a new, effective contraceptive option to women, expanding their available choices of hormonal contraception. Copyright © 2010 Elsevier Inc. All rights reserved.

  19. Vaginal yeast infection

    MedlinePlus

    Yeast infection - vagina; Vaginal candidiasis; Monilial vaginitis ... Most women have a vaginal yeast infection at some time. Candida albicans is a common type of fungus. It is often found in small amounts in the ...

  20. Vaginitis test - wet mount

    MedlinePlus

    ... after intercourse. Trichomoniasis , a sexually transmitted disease Vaginal yeast infection Risks There are no risks with this ... Vaginal itching and discharge - adult and adolescent Vaginal yeast infection Review Date 8/14/2015 Updated by: ...

  1. Intrauterine device insertion during the postpartum period: a systematic review.

    PubMed

    Kapp, Nathalie; Curtis, Kathryn M

    2009-10-01

    Insertion of an intrauterine device (IUD) at different times or by different routes during the postpartum period may increase the risk of complications. We searched Medline, Lilacs and Cochrane Collaboration databases for articles in any language, between database inception until December 2008, which compared outcomes of postpartum IUD insertion time intervals. Search terms included postpartum, puerperium, postcesarean delivery, cesarean section, IUD(s), IUCD(s), intrauterine device(s) and insertion. From 297 articles, we identified 15 for inclusion in this review: all studies examined the outcomes from copper IUD insertions within the postpartum time period compared to other time intervals or compared routes (vaginal or via hysterotomy) of postpartum insertion. No studies of levonorgestrel IUDs were identified. Immediate IUD insertion (within 10 min of placental delivery) was safe when compared with later postpartum time periods and interval insertion. Immediate postpartum IUD insertion demonstrated lower expulsion rates when compared with delayed postpartum insertion but with higher rates than interval insertion. Immediate insertion following cesarean delivery demonstrated lower expulsion rates than immediate insertion following vaginal delivery. Poor to fair quality evidence from 15 articles demonstrated no increase in risk of complications among women who had an IUD inserted during the postpartum period; however, some increase in expulsion rates occurred with delayed postpartum insertion when compared to immediate insertion and with immediate insertion when compared to interval insertion. Postplacental placements during cesarean delivery are associated with lower expulsion rates than postplacental vaginal insertions, without increasing rates of postoperative complications.

  2. Vaginal Cancer Overview

    MedlinePlus

    ... are here Home > Types of Cancer > Vaginal Cancer Vaginal Cancer This is Cancer.Net’s Guide to Vaginal Cancer. Use the menu below to choose the Overview/ ... social workers, and patient advocates. Cancer.Net Guide Vaginal Cancer Introduction Statistics Medical Illustrations Risk Factors and Prevention ...

  3. 21 CFR 529.1003 - Flurogestone acetate-impregnated vaginal sponge.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 6 2011-04-01 2011-04-01 false Flurogestone acetate-impregnated vaginal sponge... § 529.1003 Flurogestone acetate-impregnated vaginal sponge. (a) Specifications. Each vaginal sponge... ewes during their normal breeding season. (2) Limitations. Using applicator provided, insert sponge...

  4. 21 CFR 529.1003 - Flurogestone acetate-impregnated vaginal sponge.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Flurogestone acetate-impregnated vaginal sponge... § 529.1003 Flurogestone acetate-impregnated vaginal sponge. (a) Specifications. Each vaginal sponge... ewes during their normal breeding season. (2) Limitations. Using applicator provided, insert sponge...

  5. 21 CFR 529.1003 - Flurogestone acetate-impregnated vaginal sponge.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 6 2012-04-01 2012-04-01 false Flurogestone acetate-impregnated vaginal sponge... § 529.1003 Flurogestone acetate-impregnated vaginal sponge. (a) Specifications. Each vaginal sponge... ewes during their normal breeding season. (2) Limitations. Using applicator provided, insert sponge...

  6. Desquamative inflammatory vaginitis.

    PubMed

    Reichman, Orna; Sobel, Jack

    2014-10-01

    Desquamative inflammatory vaginitis (DIV) is an uncommon form of chronic purulent vaginitis. It occurs mainly in Caucasians with a peak occurrence in the perimenopause. Symptoms and signs are nonspecific; DIV is a diagnosis of exclusion, and other causes of purulent vaginitis should be excluded. The main symptoms include purulent discharge, vestibulo-vaginal irritation, and dyspareunia. Examination of vaginal walls shows signs of inflammation with increased erythema and petechiae. Through microscopy (wet mount) of the vaginal secretions, DIV is defined by an increase in inflammatory cells and parabasal epithelial cells (immature squamous cells). Vaginal flora is abnormal and pH is always elevated above 4.5. Although etiology and pathogenesis remain unknown, the favorable response to anti-inflammatory agents suggests that the etiology is immune mediated. Either local vaginal clindamycin or vaginal corticosteroids are adequate treatment. As a chronic condition, maintenance treatment should be considered as relapse is common. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Postpartum Vaginal Stenosis Due to Chemical Vaginitis

    PubMed Central

    Kaur, Gurcharan; Gupta, Ridhima

    2016-01-01

    Acquired vaginal stenosis is a rare obstructing anomaly, which can be caused by use of chemicals in the vagina. A 21-year-old gravida 1 para 1, presented with secondary amenorrhea and inability to have sexual intercourse, after normal spontaneous vaginal delivery complicated by post partum bleeding. The delivery was conducted by untrained traditional birth attendant at home. The wash cloth soaked with caustic soda was packed in the patient’s vagina and was left in situ for 10 days, which ultimately led to the severe scarring and stenosis of the vagina. Patient underwent surgical management and the extensive vaginal adhesions were excised and a patent vagina was reconstructed. Patient then reported successful vaginal intercourse without dyspareunia. Post partum vaginal stenosis due to chemical vaginitis is rare. These cases can be prevented by adequate training of untrained health care workers. PMID:27437311

  8. Effects of intrauterine contraception on the vaginal microbiota.

    PubMed

    Bassis, Christine M; Allsworth, Jenifer E; Wahl, Heather N; Sack, Daniel E; Young, Vincent B; Bell, Jason D

    2017-09-01

    There have been conflicting reports of altered vaginal microbiota and infection susceptibility associated with contraception use. The objectives of this study were to determine if intrauterine contraception altered the vaginal microbiota and to compare the effects of a copper intrauterine device (Cu-IUD) and a levonorgestrel intrauterine system (LNG-IUS) on the vaginal microbiota. DNA was isolated from the vaginal swab samples of 76 women using Cu-IUD (n=36) or LNG-IUS (n=40) collected prior to insertion of intrauterine contraception (baseline) and at 6 months. A third swab from approximately 12 months following insertion was available for 69 (Cu-IUD, n=33; LNG-IUS, n=36) of these women. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced. The 16S rRNA gene sequences were processed and analyzed using the software package mothur to compare the structure and dynamics of the vaginal bacterial communities. The vaginal microbiota from individuals in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one community type that was not dominated by a single Lactobacillus species. Changes in the vaginal bacterial community composition were not associated with the use of Cu-IUD or LNG-IUS. Additionally, we did not observe a clear difference in vaginal microbiota stability with Cu-IUD versus LNG-IUS use. Although the vaginal microbiota can be highly dynamic, alterations in the community associated with the use of intrauterine contraception (Cu-IUD or LNG-IUS) were not detected over 12 months. We found no evidence that intrauterine contraception (Cu-IUD or LNG-IUS) altered the vaginal microbiota composition. Therefore, the use of intrauterine contraception is unlikely to shift the composition of the vaginal microbiota such that infection susceptibility is altered. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. The vaginal contraceptive sponge.

    PubMed

    Edelman, D A

    1984-06-01

    The vaginal contraceptive sponge, approved on April 1, 1983 by the US Food Administration (FDA) for sale in the US as a single use, disposable, over-the-counter contraceptive, is made of polyurethane and designed to be biocompatible with the vaginal environment. The sponge is available in a single size, is round, and about 5.5 cm in diameter and 2.5 cm thick. An indentation on 1 side helps to ensure the sponge's correct placement against the cervix. A polyester retrieval loop attached to the sponge facilitates removal. Postcoital tests of the sponge without the spermicide indicated that it was ineffective in preventing sperm from entering the cervical canal. Before insertion, the contraceptive sponge is moistened with tap water to activate the spermicide and is inserted into the vagina with the indentation placed against the cervis. The sponge has been designed to provide continuous protection against pregnancy for at least 24 hours after insertion. Following a successful phase ii clinical trail of the sponge, in 1979 comparative phase iii clinical trials were initiated by Family Health International. The following trials were conducted: sponge versus the diaphragm (arcing-spring) used with a spermicide (nonoxynol-9) at 13 clinics in the US (1439 subjects) and at 2 clinics in Canada and the UK (502 subjects); sponge versus a foaming spermicidal (menfegol) suppository at 5 clinics in Yugoslavia, Taiwan, and Bangladesh (1386) subjects); and sponge versus spermicidal (nonoxynol-9) foam at 2 clinics in Israel and Thailand (366 subjects). In all trials the contraceptive methods were raondomly assigned. Clinics were required to follow up subjects for 1 year. Only the US study has been completed. In the comparative trials of the sponge and diaphragm (both US based and overseas) the pregnancy rates were significantly higher for the sponge. In the comparative trials of the sponge and foaming suppositories or spermicidal foam there were no significant differences between the

  10. Vaginal "fisting" as a cause of death.

    PubMed

    Fain, D B; McCormick, G M

    1989-03-01

    We describe the death of a young girl that resulted from the insertion of a clenched hand and forearm into her vagina during heterosexual activity. (The male homosexual practice of rectal fist insertion has been described previously.) We believe this death to be the first reported case of a "fisting" death due to vaginal fist insertion during heterosexual activity. This death is reported to alert forensic pathologists, medicolegal death investigators, and coroners aware of the role of aberrant sexual activity and its potential to cause death.

  11. Vaginal birth - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100198.htm Vaginal birth - series—Normal anatomy To use the sharing features ... vaginal delivery. Please keep in mind that every birth is unique, and your labor and delivery may ...

  12. Diagnosis of vaginitis.

    PubMed

    Egan, M E; Lipsky, M S

    2000-09-01

    Vaginitis is the most common gynecologic diagnosis in the primary care setting. In approximately 90 percent of affected women, this condition occurs secondary to bacterial vaginosis, vulvovaginal candidiasis or trichomoniasis. Vaginitis develops when the vaginal flora has been altered by introduction of a pathogen or by changes in the vaginal environment that allow pathogens to proliferate. The evaluation of vaginitis requires a directed history and physical examination, with focus on the site of involvement and the characteristics of the vaginal discharge. The laboratory evaluation includes microscopic examination of a saline wet-mount preparation and a potassium hydroxide preparation, a litmus test for the pH of vaginal secretions and a "whiff" test. Metronidazole is the primary treatment for bacterial vaginosis and trichomoniasis. Topical antifungal agents are the first-line treatments for candidal vaginitis.

  13. Vaginal sponge and spermicides

    MedlinePlus

    Birth control - over the counter; Contraceptives - over the counter; Family planning - vaginal sponge; Contraception - vaginal sponge ... at preventing pregnancy as some other forms of birth control. However, using a spermicide or sponge is much ...

  14. Vaginal Yeast Infections

    MedlinePlus

    ... Surgery? A Week of Healthy Breakfasts Shyness Vaginal Yeast Infections KidsHealth > For Teens > Vaginal Yeast Infections Print ... side effect of taking antibiotics. What Is a Yeast Infection? A yeast infection is a common infection ...

  15. Vaginitis: diagnosis and management.

    PubMed

    Quan, Martin

    2010-11-01

    Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. The medical history and examination are an important source of clues to the underlying diagnosis. However, making a definitive diagnosis requires skillful performance of office laboratory procedures, including the vaginal pool wet mount examination, determination of the vaginal pH, and the whiff test. Vaginal and cervical cultures, nucleic acid tests, and point-of-care tests are available and may be required in selected patients. Once a specific diagnosis is made, effective therapy can be prescribed. Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.

  16. Outpatient vaginal cuff brachytherapy for endometrial cancer.

    PubMed

    Petereit, D. G.; Tannehill, S. P.; Grosen, E. A.; Hartenbach, E. M.; Schink, J. C.

    1999-11-01

    Petereit DG, Tannehill SP, Grosen EA, Hartenbach EM, Schink JC. Outpatient vaginal cuff brachytherapy for endometrial cancer. The objective of this study was to determine the efficacy and complications of postoperative high-dose-rate (HDR) vaginal-cuff brachytherapy (VCB) in patients with endometrial carcinoma. Between August 1989 to September 1997, 191 patients were treated postoperatively after a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) with outpatient adjuvant HDR VCB for low-risk endometrial cancer (IB-84%, grade 1 or 2-96%). Patients were treated with 2 HDR fractions, delivered one week apart while under conscious sedation (16.2 Gy X 2 to the vaginal surface). All clinical endpoints were calculated using the Kaplan Meier method. The median time in the brachytherapy suite was 60 min in which no acute complications were observed. The 30-day morbidity and mortality rates were both 0%. With a median follow-up of 38 months (12-82 months), the 4-year survival, relapse-free survival, and vaginal-control rates were 95%, 98%, and 100%, respectively. One patient developed a colo-vaginal fistula at 5 years. Adjuvant HDR VCB in 2 outpatient insertions produced 100% vaginal control rates with minimal morbidity. The advantages of high dose-rate compared to low dose-rate vaginal brachytherapy include patient convenience, markedly shorter treatment times (1 h per insertion), and reduction in the cost and potential morbidity of hospitalization. HDR brachytherapy approach is a cost-effective alternative to either low-dose-rate brachytherapy or whole pelvic radiotherapy in carefully selected patients.

  17. Efficacy and safety of vaginal estriol and progesterone in postmenopausal women with atrophic vaginitis.

    PubMed

    Chollet, Janet A; Carter, Gloria; Meyn, Leslie A; Mermelstein, Fred; Balk, Judith L

    2009-01-01

    The aim of this study was to assess the efficacy and safety of intravaginal estriol and progesterone on atrophic vaginitis in postmenopausal women. Under a physician-sponsored Investigational New Drug application, 19 healthy postmenopausal women with atrophic vaginitis received vaginal suppositories containing estriol (1 mg) and progesterone (30 mg). The participants were instructed to insert one suppository intravaginally once daily for 2 weeks and thrice weekly for a total of 6 months. Vaginal pH, Vaginal Maturation Index, urinalysis, self-reported vaginal dryness, menopausal quality of life, and serum estriol and progesterone levels were measured at enrollment and after 3 and 6 months of suppository use. Endometrial biopsies were obtained at enrollment and at 6 months. After 2 weeks of therapy, six participants had serum estriol and progesterone measured. The Vaginal Maturation Index, vaginal pH, and vaginal dryness rating improved significantly at 3 and 6 months compared with baseline. Menopausal quality of life scores improved significantly in all domains, with the sexual subscale showing the most improvement. There were no cases of endometrial hyperplasia after 6 months of suppository use. Serum preinsertion estriol at week 2 and months 3 and 6 were similar to baseline levels. Serum preinsertion progesterone increased but returned to baseline preinsertion levels at month 6, and preinsertion levels were significantly less at month 6 compared with month 3. Intravaginal administration of a combination estriol and progesterone agent to women with atrophic vaginitis may represent a safe and effective alternative to systemic hormone replacement, although this study was not adequate to provide proof of efficacy given that it was uncontrolled.

  18. Fever and leukocytosis related to terconazole vaginal suppository.

    PubMed

    Hyder, S S; Manjon, J E; Gantz, N M

    1994-07-01

    We describe a 22-year-old woman who developed fever, shaking chills, and leukocytosis after insertion of a terconazole (80 mg) vaginal suppository for mild vaginal candidiasis. The patient became afebrile and asymptomatic 24 hours after hospital admission without antibiotic therapy. More experience with terconazole is needed before it can be considered as safe as other imidazole derivatives that have been available for more than 15 years.

  19. Feeding tube insertion - gastrostomy

    MedlinePlus

    ... tube insertion; G-tube insertion; PEG tube insertion; Stomach tube insertion; Percutaneous endoscopic gastrostomy tube insertion ... and down the esophagus, which leads to the stomach. After the endoscopy tube is inserted, the skin ...

  20. Nonprescription vaginal contraception.

    PubMed

    Edelman, D A

    1980-01-01

    Data on the efficacy of vaginal contraceptive suppositories and foams available in the United States are reviewed, and data on a new vaginal contraceptive, the Collatex sponge, is presented. The efficacy of this device appears to be similar to that of the diaphragm.

  1. Vaginal mechanical contraceptive devices.

    PubMed

    Smith, M; Barwin, B N

    1983-10-01

    The alleged adverse effects of oral contraceptives and intrauterine devices have led to increased consumer and physician demand for vaginal contraceptive devices. The efficacy and the advantages and disadvantages of vaginal sponges, cervical caps and diaphragms are discussed and compared in this article.

  2. Management of persistent vaginitis.

    PubMed

    Nyirjesy, Paul

    2014-12-01

    With vaginitis remaining a common condition that leads women to seek care, it is not surprising that some women develop chronic vulvovaginal problems that are difficult to diagnose and treat. With a differential diagnosis that encompasses vulvar disorders and infectious and noninfectious causes of vaginitis, accurate diagnosis is the cornerstone of choosing effective therapy. Evaluation should include a symptom-specific history, careful vulvar and vaginal examination, and office-based tests (vaginal pH, amine test, saline and 10% potassium hydroxide microscopy). Ancillary tests, especially yeast culture with speciation, are frequently crucial to obtaining a correct diagnosis. A heavy but normal physiologic discharge can be determined by excluding other causes. With vulvovaginal candidiasis, differentiating between Candida albicans and non-albicans Candida infection has important treatment ramifications. Most patients with C albicans infections can be successfully treated with maintenance antifungal therapy, usually with fluconazole. Although many non-albicans Candida, particularly Candida glabrata, may at times be innocent bystanders, vaginal boric acid therapy is an effective first choice for many true non-albicans Candida infections. Recurrent bacterial vaginosis, a difficult therapeutic challenge, can often be controlled with maintenance therapy. Multiple options, especially high-dose tinidazole, have been used for metronidazole-resistant trichomoniasis. With the aging of the U.S. population, atrophic vaginitis and desquamative inflammatory vaginitis, both associated with hypoestrogenism, are encountered frequently in women with persistent vaginitis.

  3. Vaginal infections update.

    PubMed

    Mashburn, Jane

    2012-01-01

    Vaginal symptoms are one of the leading reasons that women visit their health care providers. Women often self-diagnose and may treat themselves inappropriately. This article describes the etiology, risk factors, symptoms, diagnosis, and treatment of the 3 most common vaginal infections: bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

  4. Vaginal contraception--an update.

    PubMed

    Edelman, D A; Thompson, S

    1982-04-01

    A number of new and innovative methods of vaginal contraceptive have been developed in recent years and are currently being evaluated. Some of these methods are described briefly and the available data on their safety and efficacy are presented. 3 types of contraceptive sponges have been developed--collagen sponge, intravaginal insert, and Secure sponge--and are now being evaluated. The collagen sponge, a cylindrical-shaped disk, exerts its contraceptive effect by acting as a physical barrier to the sperm and through its ability to absorb semen much in excess of its own weight. Preliminary data confirm the effectiveness of the sponge obtained from post-coital tests. The intravaginal insert (IVI) is made of a polyester material incorporating the spermicide nonoxynol-9. In a small clinical evaluation of the IVI, 49 women were followed up for 1 month. No pregnancies or unexpected adverse reactions were reported. The Secure sponge is made of polyurethane and incorporates 1 g of the spermicide nonoxynol-9. Its primary mode of action in preventing pregnancy is through the release of nonoxynol-9. In a multiclinic phase 2 evaluation of the Secure, which included 382 women, the 6-month gross life-table pregnancy rate was 3.8 +or- 1.3/100 women; the 6-month gross discontinuation rate for all reasons was 26.2 +or- 3.4/100 women. Sufficient data from the comparative trials of the Secure and Neo Sampoon foaming suppository studies conducted in Yugoslavia, Taiwan, and Bangladesh have been reported to the International Fertility Research Program (IFRP). The 12-month life-table rates for reasons leading to discontinuation of the contraceptive methods were not significantly different except for the category of "other personal reasons." The advantages Secure provides over other vaginal contraceptives are identified. Foaming vaginal suppositories similar to Neo Sampoon but containing 100 mg nonoxynol-9 are being developed and evaluated in the U.S. Clinical data on these products are

  5. Butoconazole Vaginal Cream

    MedlinePlus

    ... pregnant, insert the applicator gently. If you feel resistance (hard to insert), do not try to insert ... prescription and nonprescription drugs you are taking, especially antibiotic medications and vitamins.tell your doctor if you ...

  6. Management of Vaginal Cancer.

    PubMed

    Shrivastava, S B L; Agrawal, Gaurav; Mittal, Megha; Mishra, Priyanshi

    2015-01-01

    Vaginal cancer is a rare gynecologic cancer with very little documentation. Literature search to have useful information for the management of vaginal cancer and share. We have searched the PUBMED database, Google search engine and other database. A total of 26 references were taken into account. Once spread from primary other cancers or vulva is ruled out, vaginal cancer is designated to be primary in origin. It was revealed that majority of vaginal cancers reported are squamous cell carcinomas. The most common risk factors implicated are Human Papiloma Virus, age. Most common presenting symptoms were abnormal vaginal bleeding,. Diagnosis requires pathological confirmation. Management depends on staging work-up. Vaginal cancer is staged by FIGO system of staging and TNM staging. There are many prognostic factors influencing the choice of treatment. Lymph node metastasis is one of the important prognostic factors, others to mention are histology, size, age. In a recent SEER analysis of over 2000 patients, the 5 year disease specific survival was 84% for stage 1, 75% for stage II and 57% for advanced tumors. Early carcinomas are generally treated with either surgery or radiation therapy. Advanced cancers are treated with radiation therapy with simultaneous administration of combined chemotherapy. Preventive strategies include safe sex and HPV vaccination. Primary vaginal cancer is a rare entity, if there is no history of cancer cervix or vulva in past or absence of cervical squamous cell carcinoma or vulvar carcinoma within 5 years is usually considered as primary vaginal cancer. Though early stage vaginal cancers have better outcome treated with surgery or radiotherapy or surgery followed by radiotherapy, radiotherapy alone is preferred mode of treatment in vaginal cancers.

  7. Vaginal toxic shock reaction triggering desquamative inflammatory vaginitis.

    PubMed

    Pereira, Nigel; Edlind, Thomas D; Schlievert, Patrick M; Nyirjesy, Paul

    2013-01-01

    The study aimed to report 2 cases of desquamative inflammatory vaginitis associated with toxic shock syndrome toxin 1 (TSST-1)-producing Staphylococcus aureus strains. Case report of 2 patients, 1 with an acute and 1 with a chronic presentation, diagnosed with desquamative inflammatory vaginitis on the basis of clinical findings and wet mount microscopy. Pretreatment and posttreatment vaginal bacterial and yeast cultures were obtained. Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial culture results after oral antibiotic therapy were negative. Desquamative inflammatory vaginitis may be triggered through TSST-1-mediated vaginal toxic shock reaction.

  8. Use of a vaginal tampon in the diagnosis of vesicovaginal fistulae.

    PubMed

    Wesolowski, D P; Meaney, T F

    1977-01-01

    A technique for the demonstration of vesicovaginal fistula during excretory urography is described. The method consists of inserting a vaginal tampon prior to the administration of contrast material for excretory urography.

  9. Vaginal rejuvenation: current perspectives

    PubMed Central

    Barbara, Giussy; Facchin, Federica; Buggio, Laura; Alberico, Daniela; Frattaruolo, Maria Pina; Kustermann, Alessandra

    2017-01-01

    Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed. PMID:28860864

  10. The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach.

    PubMed

    Bakker, Ronan; Pierce, Stephanie; Myers, Dean

    2017-08-01

    Prostaglandins play a critical role in cervical ripening by increasing inflammatory mediators in the cervix and inducing cervical remodeling. Prostaglandin E1 (PGE1) and prostaglandin E2 (PGE2) exert different effects on these processes and on myometrial contractility. These mechanistic differences may affect outcomes in women treated with dinoprostone, a formulation identical to endogenous PGE2, compared with misoprostol, a PGE1 analog. The objective of this review is to evaluate existing evidence regarding mechanistic differences between PGE1 and PGE2, and consider the clinical implications of these differences in patients requiring cervical ripening for labor induction. We conducted a critical narrative review of peer-reviewed articles identified using PubMed and other online databases. While both dinoprostone and misoprostol are effective in cervical ripening and labor induction, they differ in their clinical and pharmacological profiles. PGE2 has been shown to stimulate interleukin-8, an inflammatory cytokine that promotes the influx of neutrophils and induces remodeling of the cervical extracellular matrix, and to induce functional progesterone withdrawal. Misoprostol has been shown to elicit a dose-dependent effect on myometrial contractility, which may affect rates of uterine tachysystole in clinical practice. Differences in the mechanism of action between misoprostol and PGE2 may contribute to their variable effects in the cervix and myometrium, and should be considered to optimize outcomes.

  11. Forgotten Vaginal Foreign Body Presenting as Cervical Dystocia.

    PubMed

    Chawla, Sonia; Singla, Anshuja; Chandra, Charu; Falodia, Swati

    2016-02-01

    Generally encountered in paediatrics age group, vaginal foreign body is a rare presentation in gynaecological clinics. Inserted as a part of sexual abuse, gratification or psychiatric disorder, these foreign bodies can present with a varied symptomatology. We report a case of 22-year-old female, a victim of domestic violence, who had a foreign body inserted in the vagina which was forgotten. Later it was discovered when she presented at term with cervical dystocia.

  12. Vaginal delivery - discharge

    MedlinePlus

    Skip navigation U.S. National Library of Medicine The navigation menu has been collapsed. ... //medlineplus.gov/ency/patientinstructions/000628.htm Vaginal delivery - discharge To use the sharing features on this page, ...

  13. Yeast Infection (Vaginal)

    MedlinePlus

    ... Your infection is caused by a type of candida other than Candida albicans You're pregnant You have uncontrolled diabetes ... or suppositories You develop other symptoms The fungus candida causes a vaginal yeast infection. Your vagina naturally ...

  14. What Is Vaginal Cancer?

    MedlinePlus

    ... There are several types of vaginal cancer. Squamous cell carcinoma About 70 of every 100 cases of ... Our Volunteers More ACS Sites Bookstore Shop Cancer Atlas Press Room Cancer Statistics Center Volunteer Learning Center ...

  15. Review of Vaginitis

    PubMed Central

    1993-01-01

    Adisruption of the dynamic equilibrium of the healthy vagina may have significant sequelae, leading to chronic or serious conditions. Therefore, all cases of vaginitis should be accurately diagnosed and appropriately treated. PMID:18475337

  16. Vaginitis - self-care

    MedlinePlus

    ... be caused by: Yeast , bacteria, viruses, and parasites Bubble baths, soaps, vaginal contraceptives, feminine sprays, and perfumes ... your blood sugar levels under control. Allow more air to reach your genital area. Wear loose-fitting ...

  17. Baboon vaginal microbial flora.

    PubMed

    Obiero, Jael A; Waititu, Kenneth K; Mulei, Isaac; Omar, Farah I; Jaoko, Walter; Mwethera, Peter G

    2016-06-01

    Knowledge of the composition of vaginal microbial ecosystem is essential for understanding the etiology, prevention, and treatment of vaginal diseases. A baboon model has been used to provide detailed understanding of reproductive physiology and immunology applicable to women. However, little is known about the composition of its vaginal microbial ecosystem. Gram stain and Nugent scores were used for assessment of baboon vaginal microbial flora. Biochemical identification and analysis of isolates were performed using the api(®) kits and identification software. Species of Lactobacilli, Staphylococci, Clostridia, Bacilli, Corynebacteria, Gram-negative rods, other Gram-positive rods, cocci and Candida, were isolated. Healthy vaginal microbiota consisted mainly of lactobacillus morphotypes. Animals with high Nugent scores had increased number of Gram-positive cocci and variable rods, with increased number of Gram-negative morphotypes. The baboon vaginal microbiota is heterogeneous in terms of species composition and is typified by a scarcity of lactobacilli. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Moniliasis—The Use of Candicidin Vaginal Ointment for Treatment

    PubMed Central

    Roberts, Chester L.; Sullivan, John J.

    1965-01-01

    Candicidin vaginal ointment, 0.14 mg per gm of petrolatum base, was used in the treatment of 25 patients with monilial vaginitis. Ten of these patients were pregnant. All 15 of the non-gravid patients were cured, as proved by repeated cultures, after a maximum of three weeks of therapy. Eight of the 10 gravid patients were cured. Of the two patients with resistant cases, one had severe diabetes and the other had endocervicitis. Of 50 patients treated by insertion of Candeptin vaginal tablets, 42 became free of vaginal moniliasis after one or two 14-day courses of home treatment. All 42 remained free of infection for one month following treatment, as proven by culture. There were no instances of sensitivity to the preparation. PMID:14347973

  19. Sustained release of proteins from a modified vaginal ring device

    PubMed Central

    Morrow, Ryan J.; Woolfson, A. David; Donnelly, Louise; Curran, Rhonda; Andrews, Gavin; Katinger, Dietmar; Malcolm, R. Karl

    2013-01-01

    A new vaginal ring technology, the insert vaginal ring (InVR), is presented. The InVR overcomes the current shortfall of conventional vaginal rings (VRs) that are generally ineffectual for the delivery of hydrophilic and/or macromolecular actives, including peptides, proteins and antibodies, due to their poor permeation characteristics in the hydrophobic polymeric elastomers from which VRs are usually fabricated. Release of the model protein BSA from a variety of insert matrices for the InVR is demonstrated, including modified silicone rods, directly compressed tablets and lyophilised gels, which collectively provided controlled release profiles from several hours to beyond 4 weeks. Furthermore, the InVR was shown to deliver over 1 mg of the monoclonal antibody 2F5 from a single device, offering a potential means of protecting women against the transmission of HIV. PMID:21055465

  20. A Temperature-Monitoring Vaginal Ring for Measuring Adherence

    PubMed Central

    Boyd, Peter; Desjardins, Delphine; Kumar, Sandeep; Fetherston, Susan M.; Le-Grand, Roger; Dereuddre-Bosquet, Nathalie; Helgadóttir, Berglind; Bjarnason, Ásgeir; Narasimhan, Manjula; Malcolm, R. Karl

    2015-01-01

    Background Product adherence is a pivotal issue in the development of effective vaginal microbicides to reduce sexual transmission of HIV. To date, the six Phase III studies of vaginal gel products have relied primarily on self-reporting of adherence. Accurate and reliable methods for monitoring user adherence to microbicide-releasing vaginal rings have yet to be established. Methods A silicone elastomer vaginal ring prototype containing an embedded, miniature temperature logger has been developed and tested in vitro and in cynomolgus macaques for its potential to continuously monitor environmental temperature and accurately determine episodes of ring insertion and removal. Results In vitro studies demonstrated that DST nano-T temperature loggers encapsulated in medical grade silicone elastomer were able to accurately and continuously measure environmental temperature. The devices responded quickly to temperature changes despite being embedded in different thickness of silicone elastomer. Prototype vaginal rings measured higher temperatures compared with a subcutaneously implanted device, showed high sensitivity to diurnal fluctuations in vaginal temperature, and accurately detected periods of ring removal when tested in macaques. Conclusions Vaginal rings containing embedded temperature loggers may be useful in the assessment of product adherence in late-stage clinical trials. PMID:25965956

  1. Insertion Sequences

    PubMed Central

    Mahillon, Jacques; Chandler, Michael

    1998-01-01

    Insertion sequences (ISs) constitute an important component of most bacterial genomes. Over 500 individual ISs have been described in the literature to date, and many more are being discovered in the ongoing prokaryotic and eukaryotic genome-sequencing projects. The last 10 years have also seen some striking advances in our understanding of the transposition process itself. Not least of these has been the development of various in vitro transposition systems for both prokaryotic and eukaryotic elements and, for several of these, a detailed understanding of the transposition process at the chemical level. This review presents a general overview of the organization and function of insertion sequences of eubacterial, archaebacterial, and eukaryotic origins with particular emphasis on bacterial elements and on different aspects of the transposition mechanism. It also attempts to provide a framework for classification of these elements by assigning them to various families or groups. A total of 443 members of the collection have been grouped in 17 families based on combinations of the following criteria: (i) similarities in genetic organization (arrangement of open reading frames); (ii) marked identities or similarities in the enzymes which mediate the transposition reactions, the recombinases/transposases (Tpases); (iii) similar features of their ends (terminal IRs); and (iv) fate of the nucleotide sequence of their target sites (generation of a direct target duplication of determined length). A brief description of the mechanism(s) involved in the mobility of individual ISs in each family and of the structure-function relationships of the individual Tpases is included where available. PMID:9729608

  2. Severe atrophic vaginitis causing vaginal synechiae and hematocolpos at menopause.

    PubMed

    Segal, Saya; Harvie, Heidi S; Siegelman, Evan; Arya, Lily A

    2011-03-01

    Vaginal atrophy caused by decreased levels of ovarian estrogen production is common at menopause. Atrophic vaginitis severe enough to result in vaginal stricture of the upper two thirds of the vagina and subsequent hematocolpos is unusual. A 53-year-old woman presented with nonvisualization of the cervix at the time of her annual examination. Pelvic ultrasound reported a "vaginal cyst," and the final diagnosis of hematocolpos was made by magnetic resonance imaging. The woman was managed with surgical excision of vaginal synechiae followed by local vaginal estrogen therapy and dilators, with satisfactory results. Untreated severe atrophic vaginitis at menopause can result in a shortened vagina and hematocolpos. Magnetic resonance imaging is useful to characterize vaginal pathology in postmenopausal women.

  3. Disc Battery - An Unusual Vaginal Foreign Body in a Child.

    PubMed

    Khan, Yousuf Aziz; Mahmood, Mansoor; Taqi, Esmaeel

    2016-01-01

    Disc battery ingestion and esophageal injury is well-known in children. Insertion of a disc/lithium battery into body's natural orifices is rarely reported. We present a case of self-insertion of a lithium battery into the vagina by a 2 ½ year old female. Vaginoscopy was performed and the battery was retrieved which had corroded and caused vaginal ulceration. Post-operative outcome was favorable. Treating physicians must be aware of the hazardous effects of insertion of lithium batteries as it may cause significant damage in a short period.

  4. Disc Battery - An Unusual Vaginal Foreign Body in a Child

    PubMed Central

    Mahmood, Mansoor; Taqi, Esmaeel

    2016-01-01

    Disc battery ingestion and esophageal injury is well-known in children. Insertion of a disc/lithium battery into body’s natural orifices is rarely reported. We present a case of self-insertion of a lithium battery into the vagina by a 2 ½ year old female. Vaginoscopy was performed and the battery was retrieved which had corroded and caused vaginal ulceration. Post-operative outcome was favorable. Treating physicians must be aware of the hazardous effects of insertion of lithium batteries as it may cause significant damage in a short period. PMID:27672579

  5. Can Vaginal Cancer Be Prevented?

    MedlinePlus

    ... kidneys, and several other organs. Find and treat pre-cancerous conditions Most vaginal squamous cell cancers are believed to start out as pre-cancerous changes, called vaginal intraepithelial neoplasia or VAIN . ...

  6. Vaginal metastasis of pancreatic cancer.

    PubMed

    Benhayoune, Khadija; El Fatemi, Hinde; El Ghaouti, Meryem; Bannani, Abdelaziz; Melhouf, Abdelilah; Harmouch, Taoufik

    2015-01-01

    Vaginal metastasis from pancreatic cancer is an extreme case and often indicates a poor prognosis. We present a case of pancreatic carcinoma with metastasis to the vagina that was discovered by vaginal bleeding. To our knowledge, this is the third case in the world of a primary pancreatic adenocarcinoma discovered of symptoms from a vaginal metastasis.

  7. Vaginal Toxic Shock Reaction Triggering Desquamative Inflammatory Vaginitis

    PubMed Central

    Pereira, Nigel; Edlind, Thomas D.; Schlievert, Patrick M.; Nyirjesy, Paul

    2012-01-01

    Objective To report two cases of desquamative inflammatory vaginitis (DIV) associated with toxic shock syndrome toxin-1 (TSST-1)-producing Staphylococcus aureus strains. Materials and Methods Case report of two patients, one with an acute and one with a chronic presentation, diagnosed with DIV on the basis of clinical findings and wet mount microscopy. Pre- and posttreatment vaginal bacterial and yeast cultures were obtained. Results Pretreatment vaginal bacterial cultures from both patients grew TSST-1-producing S. aureus. Subsequent vaginal bacterial cultures following oral antibiotic therapy were negative. Conclusions DIV may be triggered through TSST-1-mediated vaginal toxic shock reaction. PMID:23222054

  8. Vaginal microbiome changes with levonorgestrel intrauterine system placement.

    PubMed

    Jacobson, Janet C; Turok, David K; Dermish, Amna I; Nygaard, Ingrid E; Settles, Matthew L

    2014-08-01

    To investigate changes in female genital tract bacterial ecology associated with levonorgestrel intrauterine system (LNG IUS) use. Study participants were regularly cycling Caucasian women without recent history of pregnancy or exogenous hormone use. Vaginal, cervical and uterine samples were obtained at nine time intervals, from 1 week before to 12 weeks after LNG IUS placement. Replicate paired vaginal and cervical specimens were collected to determine the consistency of specimen collection and processing. A total of 406 samples from 11 women were available for analysis after DNA extraction, amplification and species identification. Of the 355 bacterial species or genera detected, Lactobacillus crispatus was most prevalent representing 48.9% of over 6 million total reads. L. crispatus reads of replicate vaginal samples were not significantly different [odds ratio (OR) 0.79, 0.36-1.73]. In addition, L. crispatus reads of vaginal and cervical samples from the same visit were not significantly different (OR 0.69, 0.31-1.51). Compared to sampling visits prior to LNG IUS placement, sampling visits after LNG IUS insertion were more likely to have L. crispatus reads greater than 50% of total reads (OR 2.13, 1.01-4.48). Of the 63 uterine samples demonstrating bacteria, Burkholderia genus proteobacteria, a common environmental contaminant, were most prevalent both before and after LNG IUS insertion accounting for 48.0% of all uterine sample reads. The vaginal microbiome changes very little in response to LNG IUS placement. Further study is needed to place this finding in context with clinical outcomes. There do not appear to be any clinically important differences in the vaginal microbiome in response to insertion of the LNG IUS. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. A detachable porous vaginal mold facilitates reconstruction of a modified McIndoe neovagina.

    PubMed

    Yu, Ken-Jen; Lin, Yu-Shiou; Chao, Koun-Chung; Chang, Sheng-Ping; Lin, Long-Yau; Bell, William

    2004-02-01

    To release a new design for a detachable porous vaginal mold to facilitate reconstruction of a modified McIndoe vaginal mold. We constructed a detachable, porous vaginal mold with a plastic laboratory centrifuge tube with multiple holes throughout the entire tube. Patients in a national tertiary medical center. Four patients of congenital vaginal agenesis received the modified McIndoe procedure. Two full-thickness skin grafts removed from the inguinal region were used to cover the detachable porous plastic vaginal mold; the mold was then inserted into the neovaginal cavity and kept in place by sutures between the mold and labia majora. The vaginal mold was removed on day 12 after the operation. All patients adhered to the follow-up instructions. Description of the accessibility of a neovaginal mold. The vaginal mold is helpful in taking care of the vaginal wound in that it allows easy removal of wound secretion and local cleansing douches. All grafts took completely and recovered well. No detachment of the graft occurred. The advantages of the detachable porous vaginal mold made from a plastic centrifuge tube are that it is readily available, allows for easy wound care, and, as a fixed point, prevents graft detachment or inversion and thus may lead to a promising result for a modified McIndoe vaginal reconstruction.

  10. Staging for vaginal cancer.

    PubMed

    Rajaram, Shalini; Maheshwari, Amita; Srivastava, Astha

    2015-08-01

    Vaginal cancer is a rare cancer comprising about 3% of all gynecologic cancers. Primary vaginal cancer should be carefully assigned as spread from cervix, vulva, and other metastatic tumors to vagina can occur. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Squamous cell carcinoma is still the most common histopathologic type followed by adenocarcinoma. With decreasing use of diethylstilbestrol in pregnancy, non-diethylstilbestrol-associated cancers are described. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) staging of vaginal cancer (2009) follows the same rules as cervical cancer; it is clinically staged and allows the use of routine investigative modalities for staging. Although FIGO encourages the use of advanced imaging modalities, such as computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET), to guide therapy, the imaging findings may not be used to change or reassign the stage. TNM staging is the pathologic staging system proposed by the American Joint Committee on Cancer, and information available from examination of the resected specimen, including pelvic and inguinal lymph nodes, may be used for staging. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Influence of contraceptive choice on vaginal bacterial and fungal microflora.

    PubMed

    Donders, G; Bellen, G; Janssens, D; Van Bulck, B; Hinoul, P; Verguts, J

    2017-01-01

    The influence of contraception on vaginal microflora can have a major impact on the risk of developing acute or recurrent vaginal infections, but also may influence the risk of acquiring sexually transmissible infections (STI) such as HIV. A cohort of 248 women presenting for levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or reinsertion were stratified according to their current contraceptive method. Information concerning their menstrual pattern and data about the medical history were collected. The composition of their vaginal microflora was studied by detailed phase contrast microscopy of fresh vaginal fluid, and aerobic cultures were taken to detect enteric bacterial growth and fungal colonisation. LNG-IUS and progesterone-only-pill (POP) users had significantly lower blood loss (p < 0.001) than other women. Regardless of the type of contraception used, all women reported similar rates of symptomatic lower genital tract infection during the preceding year. Women using combined oral contraception (COC) and long-term LNG-IUS had the same bacterial composition of vaginal microflora as non-contraceptive users, even when infections were combined. Both hormonal and non-hormonal intrauterine device users had an increased tendency to have more vaginal colonisation with Candida. Women on POPs or subcutaneous implants had a tendency towards increased vaginal atrophy, but had a lower Candida carriage rate compared to IUCD users (LNG-IUS and Copper-IUCD, p = 0.037). Women with an increased risk of acquiring STIs or recurrent BV could benefit from LNG-IUS or COC due to a well-preserved vaginal bacterial flora. Women with a susceptibility for RVVC should prefer POPs, and avoid intrauterine contraception.

  12. Menopause and the vaginal microbiome.

    PubMed

    Muhleisen, Alicia L; Herbst-Kralovetz, Melissa M

    2016-09-01

    For over a century it has been well documented that bacteria in the vagina maintain vaginal homeostasis, and that an imbalance or dysbiosis may be associated with poor reproductive and gynecologic health outcomes. Vaginal microbiota are of particular significance to postmenopausal women and may have a profound effect on vulvovaginal atrophy, vaginal dryness, sexual health and overall quality of life. As molecular-based techniques have evolved, our understanding of the diversity and complexity of this bacterial community has expanded. The objective of this review is to compare the changes that have been identified in the vaginal microbiota of menopausal women, outline alterations in the microbiome associated with specific menopausal symptoms, and define how hormone replacement therapy impacts the vaginal microbiome and menopausal symptoms; it concludes by considering the potential of probiotics to reinstate vaginal homeostasis following menopause. This review details the studies that support the role of Lactobacillus species in maintaining vaginal homeostasis and how the vaginal microbiome structure in postmenopausal women changes with decreasing levels of circulating estrogen. In addition, the associated transformations in the microanatomical features of the vaginal epithelium that can lead to vaginal symptoms associated with menopause are described. Furthermore, hormone replacement therapy directly influences the dominance of Lactobacillus in the microbiota and can resolve vaginal symptoms. Oral and vaginal probiotics hold great promise and initial studies complement the findings of previous research efforts concerning menopause and the vaginal microbiome; however, additional trials are required to determine the efficacy of bacterial therapeutics to modulate or restore vaginal homeostasis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Chest tube insertion

    MedlinePlus

    Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head. Sometimes, ...

  14. Dihalocarbene Insertion Experiment

    ERIC Educational Resources Information Center

    Goh, S. H.

    1975-01-01

    Describes the insertion reaction using the insertion of carbenes into carbon-hydrogen bonds as an example. Outlines an experiment that will illustrate dihalocarbene insertions into diisopropyl ether. (GS)

  15. Pyomyositis after vaginal delivery.

    PubMed

    Gaughan, Eve; Eogan, Maeve; Holohan, Mary

    2011-07-07

    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  16. MIV-150-containing intravaginal rings protect macaque vaginal explants against SHIV-RT infection.

    PubMed

    Ouattara, Louise A; Barnable, Patrick; Mawson, Paul; Seidor, Samantha; Zydowsky, Thomas M; Kizima, Larisa; Rodriguez, Aixa; Fernández-Romero, José A; Cooney, Michael L; Roberts, Kevin D; Gettie, Agegnehu; Blanchard, James; Robbiani, Melissa; Teleshova, Natalia

    2014-05-01

    Recent studies demonstrated that intravaginal rings (IVRs) containing 100 mg of the nonnucleoside reverse transcriptase inhibitor (NNRTI) MIV-150 significantly protect macaques against a chimeric simian-human immunodeficiency virus that expresses the HIV-1 HxB2 reverse transcriptase (SHIV-RT) when present before and after vaginal challenge. The objectives of this study were to (i) evaluate the pharmacodynamics (PD) of MIV-150 in vaginal fluids (VF) and in ectocervical and vaginal tissues following 100-mg MIV-150 IVR exposure and to (ii) gain more insight whether pharmacokinetics (PK) of MIV-150 can predict PD. MIV-150 in VF collected at 1 day and 14 days post-MIV-150 IVR insertion inhibited ex vivo SHIV-RT infection in vaginal biopsy specimens from untreated animals (not carrying IVRs) in a dose-dependent manner. Previous PK studies demonstrated a significant increase of ectocervical and vaginal tissue MIV-150 concentrations 14 days versus 1 day post-IVR insertion, with the highest increase in vaginal tissue. Therefore, we tested PD of MIV-150 in tissues 14 days post-MIV-150 IVR insertion. Ex vivo SHIV-RT infection of vaginal, but not ectocervical, tissues collected 14 days post-MIV-150 IVR insertion was significantly inhibited compared to infection at the baseline (prior to MIV-150 IVR exposure). No changes in vaginal and ectocervical tissue infection were observed after placebo IVR exposure. Overall, these data underscore the use of the ex vivo macaque explant challenge models to evaluate tissue and VF PK/PD of candidate microbicides before in vivo animal efficacy studies. The data support further development of MIV-150-containing IVRs.

  17. Streptococcal toxic shock syndrome secondary to group A Streptococcus vaginitis.

    PubMed

    Hikone, Mayu; Kobayashi, Ken-Ichiro; Washino, Takuya; Ota, Masayuki; Sakamoto, Naoya; Iwabuchi, Sentaro; Ohnishi, Kenji

    2015-12-01

    Streptococcal toxic shock syndrome (TSS) is a systemic illness usually caused in the setting of infection by group A Streptococcus (GAS). The primary infections are often invasive infections of the respiratory tract or necrotizing infections of the skin and soft tissue, but some infections occur without relevant focus. GAS vaginitis is a rare condition among adult women and is accordingly thought to be uncommon as a cause of streptococcal TSS. Here we report the cases of two postmenopausal women with streptococcal TSS secondary to GAS vaginitis, one aged 55 and one aged 60. Both came to our emergency department with complaints or symptoms of abdominal pain, fever, hypotension, and multi-organ failure. In both cases, the relevant factor associated with streptococcal infection was a recent episode of GAS vaginitis. Both underwent fluid management and 14 days of antibiotic treatment and fully recovered without complications. Vaginitis was likely to be the primary infectious trigger of TSS in these two cases. Intrauterine device insertion, endometrial biopsy, and post-partum state have all been previously reported in TSS patients, and the female genital tract has been described as a portal of entry. GAS vaginitis warrants appropriate treatment as it may progress to severe systemic infection as described. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  18. Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients.

    PubMed

    Briere, Tina Marie; Crane, Christopher H; Beddar, Sam; Bhosale, Priya; Mok, Henry; Delclos, Marc E; Krishnan, Sunil; Das, Prajnan

    2012-08-01

    Acute vulvitis, acute urethritis, and permanent sexual dysfunction are common among patients treated with chemoradiation for squamous cell carcinoma of the anal canal. Avoidance of the genitalia may reduce sexual dysfunction. A vaginal dilator may help delineate and displace the vulva and lower vagina away from the primary tumor. The goal of this study was to evaluate the positional reproducibility and vaginal sparing with the use of a vaginal dilator. Ten female patients treated with IMRT for anal cancer were included in this study. A silicone vaginal dilator measuring 29 mm in diameter and 114 mm in length was inserted into the vagina before simulation and each treatment. The reproducibility of dilator placement was investigated with antero-posterior and lateral images acquired daily. Weekly cone beam CT (CBCT) imaging was used to confirm coverage of the GTV, which was typically posterior and inferior to the dilator apex. Finally, a planning study was performed to compare the vaginal doses for these 10 patients to a comparable group of 10 female patients who were treated for anal cancer with IMRT without vaginal dilators. The absolute values of the location of the dilator apex were 7.0 ± 7.8mm in the supero-inferior direction, 7.5 ± 5.5 mm in the antero-posterior, and 3.8 ± 3.1mm in the lateral direction. Coverage of the GTV and CTV was confirmed from CBCT images. The mean dose to the vagina was lower by 5.5 Gy, on average, for the vaginal dilator patients, compared to patients treated without vaginal dilators. The vaginal dilator tended to be inserted more inferiorly during treatment than during simulation. For these ten patients, this did not compromise tumor coverage. Combined with IMRT treatment planning, use of a vaginal dilator could allow for maximum sparing of female genitalia for patients undergoing radiation therapy for anal cancer. Published by Elsevier Ireland Ltd.

  19. [Surgical technique of saphenous vein harvesting using a Cusco vaginal speculum].

    PubMed

    Kikuchi, Keita; Suzuki, Kotaro; Endo, Yoshiki; Matsuyama, Takayoshi; Osaka, Shin-ichi; Kurata, Atsushi

    2014-11-01

    We used Cusco vaginal speculum in harvesting saphenous vein graft (SVG) as an assist device for making a skin tunnel. After making 2 incisions of 3 to 4 cm, the SVG was dissected in a usual procedure. Then Cusco vaginal speculum was inserted into the skin tunnel between the 2 incisions. The SVG was dissected in a usual fashion under direct vision with the speculum. This procedure requires only small incisions, short learning curve and low cost. The new technique using Cusco vaginal speculum can be a reliable option for harvesting SVG.

  20. After vaginal delivery - in the hospital

    MedlinePlus

    After vaginal birth; Pregnancy - after vaginal delivery; Postpartum care - after vaginal delivery ... Isley MM, Katz VL. Postpartum care and long-term health considerations. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem ...

  1. Vaginal itching and discharge - adult and adolescent

    MedlinePlus

    ... lead to vaginal dryness and other symptoms ( atrophic vaginitis ). Forgotten tampon or foreign body, which may cause ... or fallopian tubes Skin conditions, such as desquamative vaginitis and lichen planus

  2. Oral ketoconazole and miconazole vaginal pessary treatment for vaginal candidosis.

    PubMed

    Sharma, J B; Buckshee, K; Gulati, N

    1991-08-01

    This prospective study was carried out on 250 patients having clinical and mycological evidence of vaginal candidosis. One hundred patients received ketoconazole orally (400 mg/day for 5 days), another 100 patients received miconazole vaginal pessary treatment (one 100 mg tablet locally for 14 days), while the other 50 patients received combination therapy of oral ketoconazole and miconazole vaginal tablets. Although all 3 regimens were significantly effective in relieving patients symptoms and physical signs, the combination therapy gave the best results. There was 98% symptomatic relief with the combination therapy in contrast to 82% and 78% in the oral ketocanozole and vaginal micronazole groups respectively (p less than 0.001). Mycological cure rates were also significantly higher in the combination therapy group (94% versus 80% and 76%). The relapse rate was least in the combination group 2% versus 8% and 12%. The combination therapy is recommended for the best results in vaginal candidosis.

  3. Treatment of vaginal atrophy.

    PubMed

    Domoney, Claudine

    2014-03-01

    Vaginal or vulvovaginal atrophy is a widespread but poorly recognized condition of peri- and post-menopausal women. It causes urogenital symptoms of dryness, reduced lubrication, itching, burning, irritable bladder symptoms and painful intercourse. This impacts quality of life and sexual health, but increases with time rather than reduces, as with most other menopausal symptoms. With early identification, treatments can improve these symptoms and reverse the physical changes. However, when embedded, bladder and sexual changes have occurred and these may be more difficult to remedy. Therefore, it is important to educate both healthcare professionals and women about these symptoms and advise on the range of interventions available.

  4. Newly developed vaginal atrophy symptoms II and vaginal pH: a better correlation in vaginal atrophy?

    PubMed

    Tuntiviriyapun, P; Panyakhamlerd, K; Triratanachat, S; Chatsuwan, T; Chaikittisilpa, S; Jaisamrarn, U; Taechakraichana, N

    2015-04-01

    The primary objective of this study was to evaluate the correlation among symptoms, signs, and the number of lactobacilli in postmenopausal vaginal atrophy. The secondary objective was to develop a new parameter to improve the correlation. A cross-sectional descriptive study. Naturally postmenopausal women aged 45-70 years with at least one clinical symptom of vaginal atrophy of moderate to severe intensity were included in this study. All of the objective parameters (vaginal atrophy score, vaginal pH, the number of lactobacilli, vaginal maturation index, and vaginal maturation value) were evaluated and correlated with vaginal atrophy symptoms. A new parameter of vaginal atrophy, vaginal atrophy symptoms II, was developed and consists of the two most bothersome symptoms (vaginal dryness and dyspareunia). Vaginal atrophy symptoms II was analyzed for correlation with the objective parameters. A total of 132 naturally postmenopausal women were recruited for analysis. Vaginal pH was the only objective parameter found to have a weak correlation with vaginal atrophy symptoms (r = 0.273, p = 0.002). The newly developed vaginal atrophy symptoms II parameter showed moderate correlation with vaginal pH (r = 0.356, p < 0.001) and a weak correlation with the vaginal atrophy score (r = 0.230, p < 0.001). History of sexual intercourse within 3 months was associated with a better correlation between vaginal atrophy symptoms and the objective parameters. Vaginal pH was significantly correlated with vaginal atrophy symptoms. The newly developed vaginal atrophy symptoms II was associated with a better correlation. The vaginal atrophy symptoms II and vaginal pH may be better tools for clinical evaluation and future study of the vaginal ecosystem.

  5. [Comparison of dinoprostone gel and gemeprost suppositories for induction of abortion in the second and third trimester].

    PubMed

    Mink, D; Heiss, C; Rothbrust, S; Schmidt, W

    1995-01-01

    The results of the cervical priming with a Dinoprost-containing gel and a Gemeprost-containing vaginal suppository were compared in 68 patients, who required termination of pregnancy beyond 14 weeks because of a severe maternal disease or a fetal abnormality. The priming consisted of either an intracervical application of Dinoprost (500 micrograms) in a tylose-gel in 6-8 hour intervals or a retrocervical application of Gemeprost (1 mg) as a vaginal suppository in 12 hour intervals. Although no significant parameter variances were found in the selected patient groups, abortion was induced in 75% of cases within 24 hours, in 89% within 36 hours using Gemeprost. Mean induction time for Gemeprost was 19.5 hours. Using Dinoprost only 19% of patients had an abortion within 24 hours (44% within 36 hours, respectively), mean induction time was significantly longer (38.8 hours, p < 0.005). These differences remained unchanged, when patients who had a prior caesarean section were not evaluated. Using Gemeprost the additional systemic administration of Sulprost was necessary in 21% of cases, using Dinoprost, in 50% of cases. Severe complications did not occur and minor side effects such as nausea or vomiting were observed in single cases. These results demonstrate that Gemeprost can be used in cervical priming even after 14 weeks of pregnancy and that the longer application interval of 12 hours results in a reduction of side effects without a decrease in efficacy.

  6. Vaginal wind: A literature review.

    PubMed

    Neels, Hedwig; Mortiers, Xavier; de Graaf, Sybrich; Tjalma, Wiebren A A; De Wachter, Stefan; Vermandel, Alexandra

    2017-07-01

    In the medical literature, there is little known about vaginal wind, though from clinical expertise, it turns out to be a consistent and underreported problem. The aim of this review was to collect the available literature about the different aspects of vaginal wind. A systematic literature search was conducted using three databases until December 2015. The search strategy was built using relevant synonyms of vaginal wind. Study characteristics were extracted. Risk of bias, the quality of the relevant studies and the level of evidence was judged. Eleven studies met the inclusion criteria. Vaginal wind occurs on random movements and during or after coitus. The prevalence ranges from one to 69%. The pathophysiology is unclear and the incidence unknown. Known risk factors are vaginal delivery and urinary incontinence. Provoking factors are coitus, digital stimulation, cunnilingus and exercising. Female sexual function is decreased. The sexual function of male partners with vaginal wind is not influenced. Overall vaginal wind leads to a decrease in the quality of live and can have cause social isolation. The treatment is related to the cause and mainly not successful. Tampons can be used for treatment as well as prevention. Vaginal wind is an underestimated health issue with a severe impact on sexual functioning. Adequate research is needed regarding the influence of sexual activity, weight, age, parity, the underlying pathophysiological mechanisms, prevention and treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Vaginal Mucormycosis: A Case Report

    PubMed Central

    2001-01-01

    Although Zygomycetes cause life-threatening, opportunistic infections in immunocompromised hosts, the first case of vaginitis caused by Mucor species in a healthy woman is reported. Mucor vaginitis, which caused mild symptoms only, was refractory to conventional azole therapy and resistant to flucytosine. Cure was achieved with topical amphotericin B. PMID:11495552

  8. Preventing vaginal stenosis after brachytherapy for gynaecological cancer: an overview of Australian practices.

    PubMed

    Lancaster, Letitia

    2004-03-01

    Despite advances in brachytherapy techniques in recent years, patients still experience a variety of treatment-related complications. Vaginal stenosis is a recognised toxicity of brachytherapy for the treatment of gynaecological cancer. It can result in long-term sexual dysfunction and painful vaginal examinations; however, it is generally accepted that it may be prevented by regular sexual intercourse or the use of vaginal dilators. The incidence of vaginal stenosis is variably reported in the literature, while preventative strategies and compliance are infrequently described and rarely evaluated. A telephone survey of radiation oncology centres in Australia was undertaken as a quality improvement activity to determine best practice for the use of vaginal dilators for the prevention of vaginal stenosis, by way of identifying similarities of practice. The results revealed a lack of consistency for all variables, including which patients are advised to use vaginal dilators, the time to initiate use, frequency of use, insertion time and duration of use. These findings suggest that current methods for preventing radiation-induced vaginal stenosis warrant formal evaluation in order to establish an evidence base for practice.

  9. Chair Inserts for Preschoolers.

    ERIC Educational Resources Information Center

    Horn, Eva; And Others

    1987-01-01

    The article provides detailed procedures (with diagrams) for constructing cardboard chair inserts to meet the needs of preschool children with minimal to severe physical limitations. The inserts offer reduced expense and increased flexibility allowing a customized fit. (DB)

  10. In vivo assessment of human vaginal oxygen and carbon dioxide levels during and post menses.

    PubMed

    Hill, Donna R; Brunner, Marianne E; Schmitz, Deborah C; Davis, Catherine C; Flood, Janine A; Schlievert, Patrick M; Wang-Weigand, Sherry Z; Osborn, Thomas W

    2005-10-01

    Previous in vitro and in vivo animal studies showed that O(2) and CO(2) concentrations can affect virulence of pathogenic bacteria such as Staphylococcus aureus. The objective of this work was to measure O(2) and CO(2) levels in the vaginal environment during tampon wear using newly available sensor technology. Measurements by two vaginal sensors showed a decrease in vaginal O(2) levels after tampon insertion. These decreases were independent of the type of tampons used and the time of measurement (mid-cycle or during menstruation). These results are not in agreement with a previous study that concluded that oxygenation of the vaginal environment during tampon use occurred via delivery of a bolus of O(2) during the insertion process. Our measurements of gas levels in menses showed the presence of both O(2) and CO(2) in menses. The tampons inserted into the vagina contained O(2) and CO(2) levels consistent with atmospheric conditions. Over time during tampon use, levels of O(2) in the tampon decreased and levels of CO(2) increased. Tampon absorbent capacity, menses loading, and wear time influenced the kinetics of these changes. Colonization with S. aureus had no effect on the gas profiles during menstruation. Taken collectively, these findings have important implications on the current understanding of gaseous changes in the vaginal environment during menstruation and the potential role(s) they may play in affecting bacterial virulence factor production.

  11. Desquamative inflammatory vaginitis. A review.

    PubMed Central

    Oates, J K; Rowen, D

    1990-01-01

    Desquamative inflammatory vaginitis is an uncommon cause of an intractable vaginitis often accompanied by serious dyspareunia, which can occur at any stage of reproductive life and after the menopause. The cytological changes are identical with those seen in atrophic vaginitis yet the disorder often occurs in the presence of apparently normal ovarian function. Vaginal synechiae and stenosis develop in an appreciable number of patients. Treatment is unsatisfactory though there is some response to either local or systemic steroid therapy. The literature is reviewed and the association of some cases with lichen planus of the mouth and genitals discussed. Its causation and natural history remain largely unknown and there is as yet, insufficient evidence to regard it as a single entity. It is likely that the incidence of the disorder is underestimated. PMID:2202657

  12. Drugs Approved for Vaginal Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) to prevent vaginal cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  13. Humoral immunity in vaginal candidiasis.

    PubMed Central

    Mathur, S; Koistinen, G V; Horger, E O; Mahvi, T A; Fudenberg, H H

    1977-01-01

    Serum antibody titers to Candida albicans were estimated in 37 women with recurrent vaginal candidiasis and in 148 normal American and Finnish subjects, using the passive-hemagglutination technique. The antibody titers ranged from 0 to 16 in normal individuals and 4 to 256 in vaginal candidiasis patients. Antibodies to C. albicans in the sera of vaginal candidiasis patients were found to be the secretory immunoglobulin A type, as determined by gel filtration and double-diffusion tests. The results were confirmed by the indir-ct fluorescent-antibody technique. Our findings suggest that, in vaginal candidiasis, the antibody response is mainly local, consisting of secretory immunoglobulin A, some of which finds its way into systemic circulation. Images PMID:319061

  14. Advances in microbicide vaginal rings.

    PubMed

    Malcolm, R Karl; Edwards, Karen-Leigh; Kiser, Patrick; Romano, Joseph; Smith, Thomas J

    2010-12-01

    Vaginal ring devices capable of providing sustained/controlled release of incorporated actives are already marketed for steroidal contraception and estrogen replacement therapy. In recent years, there has been considerable interest in developing similar ring devices for the administration of microbicidal compounds to prevent vaginal HIV transmission. Intended to be worn continuously, such coitally independent microbicide rings are being developed to maintain effective vaginal microbicide concentrations over many weeks or months, thereby overcoming issues around timing of product application, user compliance and acceptability associated with more conventional semi-solid formulations. In this article, an overview of vaginal ring technologies is presented, followed by a review of recent advances and issues pertaining to their application for the delivery of HIV microbicides. This article forms part of a special supplement on presentations covering intravaginal rings, based on the symposium "Trends in Microbicide Formulations", held on 25 and 26 January 2010, Arlington, VA. Copyright © 2010 Elsevier B.V. All rights reserved.

  15. Cross-linked xenogenic collagen implantation in the sheep model for vaginal surgery.

    PubMed

    Endo, Masayuki; Urbankova, Iva; Vlacil, Jaromir; Sengupta, Siddarth; Deprest, Thomas; Klosterhalfen, Bernd; Feola, Andrew; Deprest, Jan

    The properties of meshes used in reconstructive surgery affect the host response and biomechanical characteristics of the grafted tissue. Whereas durable synthetics induce a chronic inflammation, biological grafts are usually considered as more biocompatible. The location of implantation is another determinant of the host response: the vagina is a different environment with specific function and anatomy. Herein, we evaluated a cross-linked acellular collagen matrix (ACM), pretreated by the anti-calcification procedure ADAPT® in a sheep model for vaginal surgery. Ten sheep were implanted with a cross-linked ACM, and six controls were implanted with a polypropylene (PP; 56 g/m(2)) control. One implant was inserted in the lower rectovaginal septum, and one was used for abdominal wall defect reconstruction. Grafts were removed after 180 days; all graft-related complications were recorded, and explants underwent bi-axial tensiometry and contractility testing. Half of ACM-implanted animals had palpable induration in the vaginal implantation area, two of these also on the abdominal implant. One animal had a vaginal exposure. Vaginal ACMs were 63 % less stiff compared to abdominal ACM explants (p = 0.01) but comparable to vaginal PP explants. Seven anterior vaginal ACM explants showed areas of graft degradation on histology. There was no overall difference in vaginal contractility. Considering histologic degradation in the anterior vaginal implant as representative for the host, posterior ACM explants of animals with degradation had a 60 % reduced contractility as compared to PP (p = 0.048). Three abdominal implants showed histologic degradation; those were more compliant than non-degraded implants. Vaginal implantation with ACM was associated with graft-related complications (GRCs) and biomechanical properties comparable to PP. Partially degraded ACM had a decreased vaginal contractility.

  16. The use of prostaglandin pessaries prior to vaginal termination.

    PubMed

    Craft, I

    1973-03-01

    Prosaglandin F2alpha 100 mg pessaries were inserted on 2 occasions within 24 hours of vaginal termination of pregnancy in an attempt to facilitate the subsequent operative procedure. Some degree of cervical dilatation occurred in 8 out of the 10 subjects studied but in only multiparous patients was it of sufficient degree to make evacuation easier. Side effects of uterine cramps, a flushed sensation; and the presence of diarrhea were relatively common. Disadvantages of prostaglandin F2a pessaries for use in vaginal termination of pre.g.nancy (e.g., large amounts are needed to induce cervical dilatation; cervical trauma is affected by parity status, no local specific ccervical softening action) preclude its clinical use.

  17. Trypan blue staining to determine vaginal exposure in two types of plastic vaginal applicators containing two different microbicide formulations.

    PubMed

    Hemmerling, Anke; Harrison, William G; Brown, Joelle Morgan; Moscicki, Barbara; Oziemkowska, Maria; Bukusi, Elizabeth A; Cohen, Craig R

    2012-09-01

    Dye staining of applicators has been shown to be a reliable and objective method to test vaginal insertion in clinical microbicide trials, but different plastics, dyes, and product formulations may impact the accuracy of this method. Reportedly used applicators returned from 3 clinical trials were stained with 1% trypan blue. In a phase 1 study (VivaGel), using gel-filled HTI polypropylene applicators, 1271 (97%) of applicators stained positive. In a phase 1 and a phase 2a study (LACTIN-V) using linear low-density polyethylene applicators to deliver a dry powder formulation, 57 (95%) and 135 (86%) tested positive, respectively. Dye staining of vaginal applicators is an objective low-cost measure suitable for low-resource settings.

  18. Trypan Blue Staining to Determine Vaginal Exposure in Two Types of Plastic Vaginal Applicators Containing Two Different Microbicide Formulations

    PubMed Central

    Hemmerling, A; Harrison, WG; Brown, JM; Moscicki, AB; Oziemkowska, M; Bukusi, EA; Cohen, CR

    2013-01-01

    Dye staining of applicators has been shown to be a reliable and objective method to test vaginal insertion in clinical microbicide trials, but different plastics, dyes and product formulations may impact the accuracy of this method. Reportedly used applicators returned from three clinical trials were stained with 1% Trypan Blue. In a phase 1 study (VivaGel®), using gel-filled HTI polypropylene applicators, 1271 (97%) of applicators stained positive. In two phase 1 and 2a studies (LACTIN-V) using linear low-density polyethylene applicators to deliver a dry powder formulation, 57 (95%) and 135 (86%) tested positive, respectively. Dye staining of vaginal applicators is an objective, low cost measure suitable for low resource settings. PMID:22902667

  19. Chitosan/alginate complexes for vaginal delivery of chlorhexidine digluconate.

    PubMed

    Abruzzo, A; Bigucci, F; Cerchiara, T; Saladini, B; Gallucci, M C; Cruciani, F; Vitali, B; Luppi, B

    2013-01-16

    Chitosan/alginate complexes were prepared at different polycation/polyanion molar ratios and freeze-dried vaginal inserts were obtained for chlorhexidine digluconate local delivery in genital infections. Complex yield, FT-IR spectra, and TGA thermograms were studied to confirm the interaction between the two polyions. The influence of different complexes on physical handling, morphology, and drug distribution in the samples were evaluated by friability test, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS), respectively. In vitro water-uptake, mucoadhesion and release tests were performed as well as microbiological tests toward pathogenic vaginal microorganisms. The results showed that the selection of suitable chitosan/alginate molar ratio and drug loading allowed modulate insert ability to hydrate, adhere to the mucosa, and release chlorhexidine digluconate. The insert containing an excess of alginate was found to be the best performing formulation and showed good antimicrobial activity toward the pathogens Candida albicans and Escherichia coli. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Vaginal hormone therapy for urogenital and menopausal symptoms.

    PubMed

    Ballagh, Susan A

    2005-05-01

    Reduction of ovarian steroids at menopause leads to significant changes in the urogenital tract. These changes often worsen with time, particularly in nonsmokers, affecting up to 38% of menopausal women. Urogenital symptoms that clearly respond to estrogen therapy include atrophic vaginitis, dryness, and accompanying dyspareunia. Estrogen reduces urinary tract infections in women plagued by frequent recurrence. The sensation of urgency improves with estrogen but urge incontinence improvement is similar to that with placebo. Stress incontinence does not improve with estrogen. Until recently, vaginal therapy was reserved for local symptoms. Rings make systemic vaginal therapy acceptable and even preferred by some users. Vaginal delivery, like other parenteral therapies, bypasses the gastrointestinal tract, with less anticipated impact on lipids, globulins, clotting, and fibrinolytic factors. Evidence of a lowered risk of venous thromboembolism is reviewed. Options for estrogen therapy include native, synthetic, or biologically derived estrogens delivered by cream, gel, insert (pessary), ring, or tablet. Even the lowest dose estradiol (7.5 mug daily or 25 mug twice per week) shows evidence of systemic absorption. In long-term placebo-controlled studies, bone density was better preserved and lipid profiles were more favorable. Therefore, even these low dose therapies should be opposed by occasional progestogen to prevent endometrial carcinoma. Intermittent therapy is best given for a minimum of 12 days based on laboratory data. Less frequent dosing, although preferred by patients, likely confers a slightly increased risk of hyperplasia. No combination estrogen/progestogen vaginal product is currently available. The best dose to reduce risk of endometrial pathology adequately in the lower dose therapies will be defined not only by the dose and potency of the exogenous estrogen but by the individual is body habitus and lifestyle choices.

  1. [Multipurpose treatment of vaginal infections].

    PubMed

    Nikolov, A; Masseva, A; Shopova, E; Georgiev, S

    2012-01-01

    Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone.

  2. [The etiologic diversity of vaginitis].

    PubMed

    Bohbot, J-M; Sednaoui, P; Verriere, F; Achhammer, I

    2012-10-01

    To establish the different etiologies of vaginitis and, especially, assess the distribution of responsible pathogens through a prospective study. One hundred and sixty-nine women aged between 18 and 65 years (average age: 33.7 years old), consulting a physician for symptoms of vaginitis, were examined in 21 centers of gynaecology or infectious diseases. The clinical evaluation was completed by bacteriological sample that was tested for infections (including sexually transmitted infections (STIs)). One hundred and eighteen patients (69.8%) had one or several infectious etiologies distributed as follows: 79 (46.7%) candidiasis (3 of which were caused by non albicans Candida), 37 (21.9%) bacterial vaginitis and 16 (9.5%) bacterial vaginosis. To be noticed that there were 38 cases of mixed etiologies out of the 118 infectious etiologies (32.2%), 3 of them were STIs. Although candidiasis was the most common etiology in this study, it only represented less than 1 out of every two patients. Among the infectious etiologies, 1 out of 3 women presented a bacterial or mixed vaginitis. The etiological diversity of vaginitis leads to consider broad-spectrum treatment as first-line therapy and to prescribe a microbiological analysis in case of failure. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  3. Vaginitis: current microbiologic and clinical concepts.

    PubMed Central

    Hill, L V; Embil, J A

    1986-01-01

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a sufficient supply of glycogen, and the alteration in bacterial flora, normally dominated by Lactobacillus spp., and its metabolites that is characteristic of "nonspecific vaginitis". The authors review microbiologic and clinical aspects of the fungal, protozoal and bacterial infections, including the interactions of bacteria thought to produce nonspecific vaginitis, that are now recognized as causing vaginitis. Other causes of vaginitis are also discussed. PMID:3510698

  4. Paecilomyces lilacinus Vaginitis in an Immunocompetent Patient

    PubMed Central

    D’Amico, Ron; Sutton, Deanna A.; Rinaldi, Michael G.

    2003-01-01

    Paecilomyces lilacinus, an environmental mold found in soil and vegetation, rarely causes human infection. We report the first case of P. lilacinus isolated from a vaginal culture in a patient with vaginitis. PMID:14519255

  5. The effect of vaginal cream containing ginger in users of clotrimazole vaginal cream on vaginal candidiasis.

    PubMed

    Shabanian, Sheida; Khalili, Sima; Lorigooini, Zahra; Malekpour, Afsaneh; Heidari-Soureshjani, Saeid

    2017-01-01

    Vulvovaginal candidiasis is one of the most common infections of the genital tract in women that causes many complications. Therefore, we examined the clinical effect of ginger cream along with clotrimazole compared to vaginal clotrimazole alone in this study. This double-blind clinical trial was conducted on 67 women admitted to the Gynecology Clinic of Hajar Hospital with vaginal candidiasis. The patients were divided randomly into two groups of 33 and 34 people. The diagnosis was made according to clinical symptoms, wet smear, and culture. Ginger-clotrimazole vaginal cream 1% and clotrimazole vaginal cream 1% were administered to groups 1 and 2, respectively, once a day for 7 days and therapeutic effects and symptoms were evaluated in readmission. Data analysis was performed using SPSS version 22, t-test and Chi-square. The mean value of variables itching (P > 0.05), burning (P > 0.05), and cheesy secretion (P < 0.05) in users of ginger-clotrimazole was less than the other group after the treatment. Recurrence in clotrimazole group was 48.5% and in ginger-clotrimazole group 51.2% during the 1-month follow-up with no significant difference. Study results showed that cream containing ginger and clotrimazole 1% was more effective and may be more useful than the clotrimazole to treat vaginal candidiasis.

  6. Complication of a 2-mg estradiol vaginal ring: fibrotic vaginal adhesion.

    PubMed

    Pratts, Meghan E; Shen, Wen

    2014-11-01

    This work aims to review a novel case of a retained 2-mg estradiol vaginal ring used to treat postmenopausal urogenital atrophy. The ring was found adhered to the posterior fornix by a fibrotic band. This is the first reported case in the medical literature. We describe the case of a postmenopausal woman experiencing symptoms of urogenital atrophy. Factors predisposing her to this complication (such as inconsistent use of other forms of vaginal estradiol, initial incorrect use of the ring with two rings in place, and subsequent vaginal stenosis and irritation requiring vaginal dilator therapy at one point in her treatment course) were analyzed. A review of the medical literature was performed to examine the safety profile of estradiol vaginal rings used to treat urogenital atrophy and to investigate the incidence of complications. Two-milligram estradiol vaginal rings treat symptoms of urogenital atrophy by delivering a constant supply of estradiol to the vaginal epithelium. The ring has been shown to be as safe and effective as other forms of vaginal estrogen. Vaginal irritation is a known complication of 2-mg estradiol vaginal rings and other vaginal implants; however, none of the randomized controlled trials that have compared the ring to other vaginal estrogen forms have reported adherence of the ring to the vaginal epithelium. Providers should be aware of the possibility of ring adherence to the vaginal epithelium and should exercise caution in using the 2-mg estradiol vaginal ring in women with significant vaginal stenosis or irritation.

  7. Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor(®)) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study.

    PubMed

    Donders, Gilbert; Neven, Patrick; Moegele, Maximilian; Lintermans, Anneleen; Bellen, Gert; Prasauskas, Valdas; Grob, Philipp; Ortmann, Olaf; Buchholz, Stefan

    2014-06-01

    Phase I pharmacokinetic (PK) study assessed circulating estrogens in breast cancer (BC) patients on a non-steroidal aromatase inhibitor (NSAI) with vaginal atrophy using vaginal ultra-low-dose 0.03 mg estriol (E3) and Lactobacillus combination vaginal tablets (Gynoflor(®)). 16 women on NSAI with severe vaginal atrophy applied a daily vaginal tablet of Gynoflor(®) for 28 days followed by a maintenance therapy of 3 tablets weekly for 8 weeks. Primary outcomes were serum concentrations and PK of E3, estradiol (E2), and estrone (E1) using highly sensitive gas chromatography-mass spectrometry. Secondary outcomes were clinical measures for efficacy and side effects; microscopic changes in vaginal epithelium and microflora; and changes in serum FSH, LH, and sex hormone-binding globulin. Compared with baseline, serum E1 and E2 did not increase in any of the women at any time following vaginal application. Serum E3 transiently increased after the first application in 15 of 16 women, with a maximum of 168 pg/ml 2-3 h post-insertion. After 4 weeks, serum E3 was slightly increased in 8 women with a maximum of 44 pg/ml. The vaginal atrophy resolved or improved in all women. The product was well tolerated, and discontinuation of therapy was not observed. The low-dose 0.03 mg E3 and Lactobacillus acidophilus vaginal tablets application in postmenopausal BC patients during AI treatment suffering from vaginal atrophy lead to small and transient increases in serum E3, but not E1 or E2, and therefore can be considered as safe and efficacious for treatment of atrophic vaginitis in BC patients taking NSAIs.

  8. Grommet Having Metal Insert

    DTIC Science & Technology

    1998-09-28

    axially with respect to the body. The 1 means for releasably securing a tool to the insert comprises 2 female threads formed on an inner surface of the...below 10 the flange 32. These surfaces 34, 36 are threaded ( female 11 threads) so that the end of a tool 38 having male threads can 12 engage the...further includes a rigid insert secured to the body in the 12 centrally located aperture. The insert has female threads formed 13 therein for releasably

  9. Immediate post-partum insertion of intrauterine devices.

    PubMed

    Grimes, David A; Lopez, Laureen M; Schulz, Kenneth F; Van Vliet, Huib Aam; Stanwood, Nancy L

    2010-05-12

    Insertion of an intrauterine device (IUD) immediately after delivery is appealing for several reasons. The woman is known not to be pregnant, her motivation for contraception may be high, and the setting may be convenient for both the woman and her provider. However, the risk of spontaneous expulsion may be unacceptably high. To assess the efficacy and feasibility of IUD insertion immediately after expulsion of the placenta. Our a priori hypothesis was that this practice is safe but associated with higher expulsion rates than interval IUD insertion. We searched MEDLINE, CENTRAL, POPLINE, EMBASE, ClinicalTrials.gov, and ICTRP. We also contacted investigators to identify other trials. We sought all randomized controlled trials (RCTs) with at least one treatment arm that involved immediate post-partum (within 10 minutes of placental expulsion) insertion of an IUD. Comparisons could include different IUDs, different insertion techniques, immediate versus delayed post-partum insertion, or immediate versus interval insertion (unrelated to pregnancy). Studies could include either vaginal or cesarean deliveries. We evaluated the methodological quality of each report and sought to identify duplicate reporting of data from multicenter trials. Two authors abstracted the data. Principal outcome measures were pregnancy, expulsion, and continuation rates. Because the trials did not have uniform interventions, we were unable to aggregate them in a meta-analysis. We found nine RCTs; one directly compared immediate post-partum insertion with delayed insertion. Expulsion by six months was more likely for the immediate group than the delayed insertion group (OR 6.77; 95% CI 1.43 to 32.14). In trials of immediate insertion alone, modifications of existing devices, such as adding absorbable sutures or additional appendages, did not appear beneficial. Most studies showed no important differences between insertions done by hand or by instruments. Lippes Loop and Progestasert devices did

  10. Atrophic vaginitis: signs, symptoms, and better outcomes.

    PubMed

    Reimer, Annabelle; Johnson, Laura

    2011-01-01

    Atrophic vaginitis is a common finding in women with low estrogen states. Many women believe their symptoms are expected signs of aging. NPs can provide therapeutic options to improve vaginal health and quality of life. This article reviews physiology, clinical manifestations, signs, symptoms, and treatment methods for atrophic vaginitis.

  11. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and... OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Prosthetic Devices § 884.3900 Vaginal stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina by stretching, or...

  12. 21 CFR 884.3575 - Vaginal pessary.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vaginal pessary. 884.3575 Section 884.3575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... Vaginal pessary. (a) Identification. A vaginal pessary is a removable structure placed in the vagina...

  13. 21 CFR 884.5920 - Vaginal insufflator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Vaginal insufflator. 884.5920 Section 884.5920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5920 Vaginal insufflator. (a) Identification. A vaginal insufflator is a device used to...

  14. 21 CFR 884.3575 - Vaginal pessary.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Vaginal pessary. 884.3575 Section 884.3575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... Vaginal pessary. (a) Identification. A vaginal pessary is a removable structure placed in the vagina...

  15. 21 CFR 884.5920 - Vaginal insufflator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Vaginal insufflator. 884.5920 Section 884.5920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5920 Vaginal insufflator. (a) Identification. A vaginal insufflator is a device used to...

  16. 21 CFR 884.3575 - Vaginal pessary.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Vaginal pessary. 884.3575 Section 884.3575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... Vaginal pessary. (a) Identification. A vaginal pessary is a removable structure placed in the vagina...

  17. 21 CFR 884.5920 - Vaginal insufflator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vaginal insufflator. 884.5920 Section 884.5920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5920 Vaginal insufflator. (a) Identification. A vaginal insufflator is a device used to...

  18. 21 CFR 884.5920 - Vaginal insufflator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vaginal insufflator. 884.5920 Section 884.5920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5920 Vaginal insufflator. (a) Identification. A vaginal insufflator is a device used to...

  19. 21 CFR 884.5920 - Vaginal insufflator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Vaginal insufflator. 884.5920 Section 884.5920 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5920 Vaginal insufflator. (a) Identification. A vaginal insufflator is a device used to...

  20. 21 CFR 884.3575 - Vaginal pessary.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Vaginal pessary. 884.3575 Section 884.3575 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... Vaginal pessary. (a) Identification. A vaginal pessary is a removable structure placed in the vagina...

  1. Plastic pipe insertion

    SciTech Connect

    Diskin, J.

    1987-05-01

    In March 1987 KPL changed all that when the utility inserted 1,000 ft of 16-in. SDR 15.5 Phillips Driscopipe 8000 pipe with a wall thickness of 1.032-in., into an abandoned 24-in. cast-iron line in downtown Kansas City. This is believed to be the largest diameter insert removal job ever done for gas distribution in the U.S. For KPL it was a natural progression from the smaller sizes used earlier. The procedure is the same, and the operation was quick and comparatively simple. Lower construction costs were the bottom line because with insert renewal there is no need to cut up the streets, a major expense in any urban pipeline work. There are other significant costs savings as well because the insert renewal construction process is faster than other techniques.

  2. Ear tube insertion - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100045.htm Ear tube insertion - series—Normal anatomy To use the ... 4 Overview The eardrum (tympanic membrane) separates the ear canal from the middle ear. Review Date 8/ ...

  3. Impact of a Hormone-Releasing Intrauterine System on the Vaginal Microbiome: A Prospective Baboon Model

    PubMed Central

    Hashway, Sara A.; Bergin, Ingrid L.; Bassis, Christine M.; Uchihashi, Mayu; Schmidt, Kelsey C.; Young, Vincent B.; Aronoff, David M.; Patton, Dorothy L.; Bell, Jason D.

    2014-01-01

    Background Use of a levonorgestrel-releasing intrauterine system (LNG-IUS) in humans may alter vaginal microbial populations and susceptibility to pathogens. This study evaluated the time-dependent effects of an LNG-IUS on the vaginal microbiome of the baboon, a useful animal model for reproductive studies. Methods LNG-IUS were inserted into three reproductively mature, female baboons. The animals were evaluated for six months by physical examination and Gram-stained cytology. The vaginal microbiota was characterized at each timepoint by culture-independent analysis of the16S rRNA-encoding gene. Results Each baboon harbored a diverse vaginal microbiome. Inter-individual variation exceeded intra-individual variation. Diversity declined over time in one baboon and showed mild fluctuations in the other two. There were no significant community differences from early to late post LNG-IUS placement. Conclusions The baboon vaginal microbiome is unique to each individual and is polymicrobial. In this pilot study, the vaginal microbiome remained stable from early to late post LNG-IUS placement. PMID:24266633

  4. Common vaginal and vulvar disorders.

    PubMed

    Prabhu, Andrea; Gardella, Carolyn

    2015-05-01

    Vaginal and vulvar disorders are among the leading causes for women to visit a health care professional. Therefore, it is important to have a basic understanding of these diseases. Although rarely life threatening, these disorders can impact significantly a woman's sexual function and sense of well-being. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. The management of vaginal melanoma.

    PubMed

    Bonner, J A; Perez-Tamayo, C; Reid, G C; Roberts, J A; Morley, G W

    1988-11-01

    Between 1964 and 1987 ten patients with vaginal melanoma were treated at The University of Michigan Hospital. Five of the six patients who underwent radical surgery had adequate information concerning the first site of relapse, and in four of these five, pelvic sites or locoregional lymph nodes were the first sites of recurrent disease. One of these patients developed a 17-cm pelvic recurrence, which responded with a 75% reduction in size 3 months after completion of radiotherapy given in high individual fractions (400 cGy X 11). Three patients were managed with local resection, and all developed recurrent locoregional disease. One patient presented with metastatic disease. We conclude that locoregional control of vaginal melanoma is difficult to achieve with surgery alone. We hypothesize that preoperative radiotherapy to the pelvis (500 cGy X 6 given 3 days a week to the whole pelvis with subsequent consideration for a vaginal boost field) may improve the poor rate of locoregional control of vaginal melanoma that is seen when surgery alone is used.

  6. Vaginal lactobacilli, probiotics, and IVF.

    PubMed

    Verstraelen, Hans; Senok, Abiola C

    2005-12-01

    Perturbation of the normal lactobacilli-dominated vaginal microflora is associated with reproductive failure and adverse pregnancy outcomes, ranging from early pregnancy loss to late miscarriage and preterm birth. As high rates of bacterial vaginosis are observed with IVF patients, abnormal vaginal microflora presumably explain, at least to some extent, reproductive failure as well as the increased risk of adverse pregnancy outcome seen in these patients. Accordingly, there may be a window of opportunity for improving IVF success rates and outcomes. At present, a screen-and-treat procedure to restore the normal vaginal microflora is not a routine part of the infertility work-up and treatment. While Gram staining of vaginal smears would offer an inexpensive and validated means for screening and diagnosis, probiotics that contain live lactobacilli capable of re-colonizing the vagina may offer an elegant and safe choice of treatment. Carefully designed trials using well characterized probiotic strains and treatment regimens are still required to evaluate the effect of probiotics on IVF-embryo transfer pregnancy rates.

  7. Current Concepts of Treating Vaginitis

    PubMed Central

    Robinson, Theresa

    1977-01-01

    Vaginitis can be a frustrating entity to treat, since the incidence of recurrence is high. This paper examines evidence from the literature concerning diagnosis and treatment of Candida albicans, Trichomonas vaginalis, Corynebacterium vaginale, herpes simplex type 2 and gonorrhea. A protocol based on these readings is outlined. PMID:21304797

  8. Vaginal bleeding in late pregnancy

    MedlinePlus

    ... keep the blood from soaking your clothes. What Causes Bleeding Later in Pregnancy? When labor begins, the cervix starts to open up more, or dilate. You may notice a small amount of blood mixed in with normal vaginal discharge, or mucus. Mid- or late-term bleeding may also be caused by: Having sex ( ...

  9. [Vaginal infections screening in pregnancy].

    PubMed

    Hájek, Z; Masata, J; Svihovec, P

    2005-01-01

    Preterm birth before the 37th gestational week is most frequently caused by infection. The agents are aerobic and anaerobic bacteria. Infection usually ascends from the vagina. Microorganisms entering the choriodecidual space induce pro-inflammatory cytokines, which trigger prostaglandin synthesis and contraction activity of the uterus. Cytokines can also release proteases, which cause premature outflow of the amnionic fluid. Screening of vaginal infections is indicated in all cases of imminent preterm parturition and in the group of risk pregnancies. Screening on Streptococcus B is indicated to all pregnant women in the gravidity weeks 35 to 37. Beside streptococcus infections with the risk of disease of the neonate being 2 to 3 per 1000 of vital newborns, bacterial vaginosis caused by Gardnerela vaginalis is frequently diagnosed. Effective treatment of symptomatic cases of the advanced pregnancy is five days long administration of Metronidazol or Clindamycin--vaginal crème. Another frequent cause of the preterm birth is chlamydial infection. The best contemporary treatment is Azitromycine for five days. Therapy of women without symptoms of the imminent preterm parturition does not decrease its occurrence. It is therefore not recommended as well as is not recommended the therapy of pregnant women with asymptomatic bacterinuria. Beside the classical cultivations, detection of antibodies, DNA analysis and serum infection markers (leucocytes, C-reactive protein), detection of pro- inflammatory cytokines in the serum and in the vaginal secret (IL-6, IL-8, TNFalpha etc.) are used to diagnose vaginal infections.

  10. Optical clearing of vaginal tissues

    NASA Astrophysics Data System (ADS)

    Chang, Chun-Hung; Myers, Erinn M.; Kennelly, Michael J.; Fried, Nathaniel M.

    2017-02-01

    Near-IR laser energy in conjunction with applied tissue cooling is being investigated for thermal remodeling of endopelvic fascia during minimally invasive treatment of female stress urinary incontinence. Previous simulations of light transport, heat transfer, and tissue thermal damage have shown that a transvaginal approach is more feasible than a transurethral approach. However, undesirable thermal insult to vaginal wall was predicted. This study explores whether an optical clearing agent (OCA) can improve optical penetration depth and completely preserve vaginal wall during subsurface treatment of endopelvic fascia. Several OCA mixtures were tested, and 100% glycerol was found to be optimal. Optical transmission studies, optical coherence tomography, reflection spectroscopy, and computer simulations of thermal damage to tissue using glycerol were performed. The OCA produced a 61% increase in optical transmission through porcine vaginal wall at 37 °C after 30 min. Monte Carlo (MC) light transport, heat transfer, and Arrhenius integral thermal damage simulations were performed. MC model showed improved energy deposition in endopelvic fascia using OCA. Without OCA, 62, 37, and 1% of energy was deposited in vaginal wall, endopelvic fascia, and urethral wall, compared with 50, 49, and 1% with OCA. Use of OCA also yielded 0.5 mm increase in treatment depth, allowing potential thermal tissue remodeling at 3 mm depth.

  11. The vaginal microbiome in health and disease

    PubMed Central

    White, Bryan A.; Creedon, Douglas J.; Nelson, Karen E.; Wilson, Brenda A.

    2011-01-01

    Infections of the vaginal tract result from perturbations in the complex interactions between the microbiome and the host vaginal ecosystem. Recent data have linked specific vaginal microbes and urogenital infection with pre-term birth. Here we discuss how next generation sequencing-based approaches to study the vaginal microbiome will be important for defining what constitutes an imbalance of the microbiome and the associated host conditions that lead to subsequent infection and disease states. These studies will provide clinicians reliable diagnostic tools and treatments for women who are at increased risk for vaginal infections, preterm birth, HIV and other sexually acquired diseases, and will provide opportunities for intervention. PMID:21757370

  12. Impact of targeted counseling on reported vaginal hygiene practices and bacterial vaginosis: the HIV Prevention Trials Network 035 study.

    PubMed

    Kasaro, Margaret P; Husnik, Marla J; Chi, Benjamin H; Reid, Cheri; Magure, Tsitsi; Makanani, Bonus; Tembo, Tchangani; Ramjee, Gita; Maslankowski, Lisa; Rabe, Lorna; Brad Guffey, M

    2017-04-01

    The objective of this study was to describe the impact of intense counseling to reduce vaginal hygiene practices and its effect on bacterial vaginosis. A secondary data analysis of the HIV Prevention Trials Network 035 study was undertaken, focusing on HIV-negative, nonpregnant women who were at least 18 years old, in seven African sites and one US site. At enrollment and during follow-up quarterly visits, vaginal hygiene practices were determined by face-to-face administration of a behavioral assessment questionnaire. Vaginal hygiene practices were categorized as insertion into the vagina of (1) nothing, (2) water only, and (3) other substances with or without water. Each practice was quantified by frequency and type/combination of inserted substances. At quarterly visits, diagnosis of bacterial vaginosis was made using the Nugent score. Trends for vaginal hygiene practices and bacterial vaginosis were evaluated using generalized estimating equation models. A total of 3087 participants from the HIV Prevention Trials Network 035 study were eligible for this analysis. At enrollment, 1859 (60%) reported recent vaginal hygiene practices. By one year, this figure had decreased to 1019 (33%) with counseling. However, bacterial vaginosis prevalence remained consistent across the study observation period, with 36%-38% of women testing positive for the condition ( p for trend = 0.27). Overall, those who reported douching with water only (AOR = 1.03, 95%CI: 0.94-1.13) and those who reported inserting other substances (AOR= 0.98, 95%CI: 0.88-1.09) in the past quarter were not more likely to have bacterial vaginosis compared to those who reported no insertions. However, in South Africa, an increase in bacterial vaginosis was seen among those who reported inserting other substances (AOR: 1.48, 95%CI: 1.17, 1.88). In conclusion, targeted counseling against vaginal hygiene practices resulted in change in self-reported behavior but did not have an impact on bacterial vaginosis

  13. Impact of targeted counseling on reported vaginal hygiene practices and bacterial vaginosis: the HIV Prevention Trials Network 035 study

    PubMed Central

    Kasaro, Margaret P; Husnik, Marla J; Chi, Benjamin H; Reid, Cheri; Magure, Tsitsi; Makanani, Bonus; Tembo, Tchangani; Ramjee, Gita; Maslankowski, Lisa; Rabe, Lorna; Guffey, M Brad

    2016-01-01

    Objective We describe the impact of intense counseling to reduce vaginal hygiene practices and its effect on bacterial vaginosis (BV). Design Secondary data analysis of HPTN 035 trial Setting Seven African and one U.S. site Population HIV negative, non-pregnant women at least 18years old Methods At enrollment and during follow-up quarterly visits, vaginal hygiene practices were determined by face-to-face administration of a behavioral assessment questionnaire. Vaginal hygiene practices were categorized as insertion into the vagina of: (1) nothing; (2) water only; and (3) other substances with or without water. Each practice was quantified by frequency and type/combination of inserted substances. At quarterly visits, diagnosis of BV was made using the Nugent score. Trends for vaginal hygiene practices and BV were evaluated using generalized estimating equation models. Results 3087 participants from the HPTN 035 study were eligible for this analysis. At enrollment, 1859 (60%) reported recent vaginal hygiene practices. By one year, this figure had decreased to 1019 (33%) with counseling. However, BV prevalence remained consistent across the study observation period, with 36–38% of women testing positive for the condition (p for trend= 0.27). Overall, those who reported douching with water only (AOR= 1.03, 95%CI: 0.94 – 1.13) and those who reported inserting other substances (AOR= 0.98, 95%CI: 0.88 – 1.09) in the past quarter were not more likely to have BV compared to those who reported no insertions. However, in South Africa, an increase in BV was seen among those who reported inserting other substances (AOR: 1.48, 95%CI: 1.17, 1.88). Conclusions Targeted counseling against vaginal hygiene practices resulted in change in self-reported behavior, but did not have an impact on BV diagnosis in all but one site. PMID:27277555

  14. True vaginal prolapse in a bitch.

    PubMed

    Alan, M; Cetin, Y; Sendag, S; Eski, F

    2007-08-01

    Frequently, vaginal fold prolapse is the protrusion of edematous vaginal tissue into and through the opening of the vulva occurring during proestrus and estrus stages of the sexual cycle. True vaginal prolapse may occur near parturition, as the concentration of serum progesterone declines and the concentration of serum oestrogen increases. In the bitch, this type of true vaginal prolapse is a very rare condition. This short communication describes a 5-year-old female, cross-breed dog in moderate condition, weighing 33 kg, with distocia and true vaginal prolapse. Abdominal palpation and transabdominal ultrasonography revealed live and dead foetuses in the uterine horns. One dead and four live fetuses were removed from uterus by cesarean section. The ovariohysterectomy was performed after repositioning the vaginal wall with a combination of traction from within the abdomen and external manipulation through the vulva. Re-occurrence of a vaginal prolapse was not observed and the bitch recovered completely after the surgical therapy. Compared to other vaginal disorders, vaginal prolapse is an uncommon condition in the bitch. In the present case, extreme tenesmus arising from distocia may have predisposed to the vaginal prolapse. The cause of dystocia was probably the disposition of the first foetus. We concluded that the vaginal prolapse was the result of dystocia in the present case.

  15. Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial.

    PubMed

    Rapkin, Rachel B; Achilles, Sharon L; Schwarz, E Bimla; Meyn, Leslie; Cremer, Miriam; Boraas, Christy M; Chen, Beatrice A

    2016-09-01

    To evaluate self-administration of vaginal lidocaine gel to decrease pain with intrauterine device (IUD) insertion in nulliparous women. In this randomized, double-blind, placebo-controlled trial, women self-administered 2% lidocaine or placebo vaginal gel 5 minutes before IUD insertion. The primary outcome was change in pain from baseline to IUD insertion on a 100-mm visual analog scale. We also assessed pain after speculum insertion, tenaculum placement, uterine sounding, and 5 minutes after IUD insertion. Secondary outcomes included patient acceptability, ease of IUD insertion, and need for pain medication for up to 7 days. From July 2012 to May 2013, 59 women were randomized; 30 received lidocaine gel and 29 placebo. Baseline demographics, including age, race, and body mass index, were similar. There was no difference in median change in pain during IUD insertion in women receiving lidocaine (61 mm [interquartile range 53-71]) compared with placebo (69 mm [interquartile range 63-80], P=.06). Women receiving lidocaine experienced less pain with tenaculum placement (32 mm [interquartile range 18-54]) compared with placebo (56 mm [interquartile range 26-75], P=.02). Most (76%) women were satisfied with their IUD insertion experience and 86% would probably or definitely recommend an IUD to a friend. Thirty-four percent of women required pain medication for at least 3 days after IUD insertion. For nulliparous women, self-administered vaginal lidocaine gel does not reduce pain with IUD insertion, but does decrease pain with tenaculum placement. ClinicalTrials.gov, http://clinicaltrials.gov, NCT01534520.

  16. Partial protection against multiple RT-SHIV162P3 vaginal challenge of rhesus macaques by a silicone elastomer vaginal ring releasing the NNRTI MC1220

    PubMed Central

    Fetherston, Susan M.; Geer, Leslie; Veazey, Ronald S.; Goldman, Laurie; Murphy, Diarmaid J.; Ketas, Thomas J.; Klasse, Per Johan; Blois, Sylvain; La Colla, Paolo; Moore, John P.; Malcolm, R. Karl

    2013-01-01

    Objectives The non-nucleoside reverse transcriptase inhibitor MC1220 has potent in vitro activity against HIV type 1 (HIV-1). A liposome gel formulation of MC1220 has previously been reported to partially protect rhesus macaques against vaginal challenge with a simian HIV (SHIV). Here, we describe the pre-clinical development of an MC1220-releasing silicone elastomer vaginal ring (SEVR), including pharmacokinetic (PK) and efficacy studies in macaques. Methods In vitro release studies were conducted on SEVRs loaded with 400 mg of MC1220, using simulated vaginal fluid (SVF, n = 4) and 1 : 1 isopropanol/water (IPA/H2O, n = 4) as release media. For PK evaluation, SEVRs were inserted into adult female macaques (n = 6) for 30 days. Following a 1week washout period, fresh rings were placed in the same animals, which were then challenged vaginally with RT-SHIV162P3 once weekly for 4 weeks. Results SEVRs released 1.66 and 101 mg of MC1220 into SVF and IPA/H2O, respectively, over 30 days, the differential reflecting the low aqueous solubility of the drug. In macaque PK studies, MC1220 was consistently detected in vaginal fluid (peak 845 ng/mL) and plasma (peak 0.91 ng/mL). Kaplan–Meier analysis over 9weeks showed significantly lower infection rates for animals given MC1220-containing SEVRs than placebo rings (hazard ratio 0.20, P = 0.0037). Conclusions An MC1220-releasing SEVR partially protected macaques from vaginal challenge. Such ring devices are a practical method for providing sustained, coitally independent protection against vaginal exposure to HIV-1. PMID:23109186

  17. Partial protection against multiple RT-SHIV162P3 vaginal challenge of rhesus macaques by a silicone elastomer vaginal ring releasing the NNRTI MC1220.

    PubMed

    Fetherston, Susan M; Geer, Leslie; Veazey, Ronald S; Goldman, Laurie; Murphy, Diarmaid J; Ketas, Thomas J; Klasse, Per Johan; Blois, Sylvain; La Colla, Paolo; Moore, John P; Malcolm, R Karl

    2013-02-01

    The non-nucleoside reverse transcriptase inhibitor MC1220 has potent in vitro activity against HIV type 1 (HIV-1). A liposome gel formulation of MC1220 has previously been reported to partially protect rhesus macaques against vaginal challenge with a simian HIV (SHIV). Here, we describe the pre-clinical development of an MC1220-releasing silicone elastomer vaginal ring (SEVR), including pharmacokinetic (PK) and efficacy studies in macaques. In vitro release studies were conducted on SEVRs loaded with 400 mg of MC1220, using simulated vaginal fluid (SVF, n = 4) and 1 : 1 isopropanol/water (IPA/H(2)O, n = 4) as release media. For PK evaluation, SEVRs were inserted into adult female macaques (n = 6) for 30 days. Following a 1 week washout period, fresh rings were placed in the same animals, which were then challenged vaginally with RT-SHIV162P3 once weekly for 4 weeks. SEVRs released 1.66 and 101 mg of MC1220 into SVF and IPA/H(2)O, respectively, over 30 days, the differential reflecting the low aqueous solubility of the drug. In macaque PK studies, MC1220 was consistently detected in vaginal fluid (peak 845 ng/mL) and plasma (peak 0.91 ng/mL). Kaplan-Meier analysis over 9 weeks showed significantly lower infection rates for animals given MC1220-containing SEVRs than placebo rings (hazard ratio 0.20, P = 0.0037). An MC1220-releasing SEVR partially protected macaques from vaginal challenge. Such ring devices are a practical method for providing sustained, coitally independent protection against vaginal exposure to HIV-1.

  18. The effects of hyaluronic acid vaginal gel on the vaginal epithelium of ovariectomized rats.

    PubMed

    Liu, Shuai-Bin; Liu, Shao-Li; Gan, Xiao-Ling; Zhou, Qin; Hu, Li-Na

    2015-03-01

    Hyaluronic acid is one of the best materials of water retention which can be used in vaginal atrophy. This study is to evaluate the role and mechanism of the hyaluronic acid vaginal gel (Hyalofemme) in the vaginal epithelium of ovariectomized rats. Sixty SD rats were randomly divided into control group (Sham ovariectomy, Sham-OVX), tendency group (ovariectomy, OVX), and experiment group (ovariectomy+Hyalofemme, OVX+Hyalofemme). The hyaluronic acid vaginal gel was administered local vaginal therapy to the experiment group with cytologicaly confirmed vaginal atrophy. The doses were adjusted by animal weight according to human dosage. After daily treatment for 14 days, VEGF and P-AKT activations were detected by Western blot in the experiment group. The hyaluronic acid vaginal gel proved to be very effective in the cytological reversal of vaginal atrophy but did not increase uterine weight. Vaginal microecosystem indicators were negative in the control group and the experiment group. By contrast, the indicators were positive in the tendency group. Hyaluronic acid vaginal gel is effective in the reversal of vaginal atrophy and is beneficial for improving vaginal microecosystem in the postmenopausal rat model. The hyaluronic acid vaginal gel can also improve the repair capacity of the vaginal epithelium.

  19. Limitations of the Dye-Based Method for Determining Vaginal Applicator Use in Microbicide Trials

    PubMed Central

    Austin, Michele N.; Rabe, Lorna K.; Hillier, Sharon L.

    2009-01-01

    Background A dye-based method for determining applicator usage in microbicide trials has been developed to assess whether applicators have been exposed to vaginal fluid. Our objective was to evaluate this method on polypropylene HTI applicators which are being widely used in several effectiveness trials of microbicides. Methods Study participants enrolled in a clinical trial assessing SPL7013 (VivaGel) inserted gel intravaginally twice daily for 14 days and returned used and unused applicators. Prior to staining, smears were prepared from each participant-inserted applicator, Gram stained and assessed independently for the presence of vaginal cells and bacteria. Of the 169 participant-inserted applicators, 168 (99%) had vaginal cells identified by Gram stain. Participant-inserted applicators were stained with a 0.05% FD&C Blue Dye No. 1 solution and compared to 70 inserted positive control applicators and 70 unused negative control applicators. Intravaginally inserted applicators should stain turquoise, while unused applicators should not retain any stain. The individual responsible for labeling and preparing the applicators did not serve as an evaluator. Results Under optimized conditions, the sensitivity and specificity ranged from 81–95% and 86–93%, respectively for single use and unused applicators. The dye-based method was only 47–77% sensitive for participant-inserted applicators obtained from women using gel twice daily. Conclusion The dye test for HTI polypropylene applicators had a sensitivity of 47–95% depending on the evaluator and whether gel was present in the vagina. The sensitivity was decreased with multiple gel applications. The dye-based method cannot be recommended for HTI polypropylene applicators to monitor product adherence. PMID:19556930

  20. ALS insertion devices

    NASA Astrophysics Data System (ADS)

    Hoyer, E.; Chin, J.; Halbach, K.; Hassenzahl, W. V.; Humphries, D.; Kincaid, B.; Lancaster, H.; Plate, D.

    1991-08-01

    The Advanced Light Source (ALS), the first US third generation synchrotron radiation source, is currently under construction at the Lawrence Berkeley Laboratory. The low-emittance, 1.5 GeV electron storage ring and the insertion devices are specifically designed to produce high brightness beams in the UV to soft X-Ray range. The planned initial complement of insertion devices includes four 4.6 m long undulators, with period lengths of 3.9 cm, 5.0 cm (2) and 8.0 cm, and a 2.9 m long wiggler of 16 cm period length. Undulator design is well advanced and fabrication has begun on the 5.0 cm and 8.0 cm period length undulators. This paper discusses ALS insertion device requirements; general design philosophy; and design of the magnetic structure, support structure/drive systems, control system and vacuum system.

  1. Vacuum-Assisted Vaginal Delivery

    PubMed Central

    Ali, Unzila A; Norwitz, Errol R

    2009-01-01

    Approximately 5% (1 in 20) of all deliveries in the United States are operative vaginal deliveries. The past 20 years have seen a progressive shift away from the use of forceps in favor of the vacuum extractor as the instrument of choice. This article reviews in detail the indications, contraindications, patient selection criteria, choice of instrument, and technique for vacuum-assisted vaginal delivery. The use of vacuum extraction at the time of cesarean delivery will also be discussed. With vacuum extraction becoming increasingly popular, it is important that obstetric care providers are aware of the maternal and neonatal risks associated with such deliveries and of the options available to effect a safe and expedient delivery. PMID:19399290

  2. Evaluation and Management of Vaginitis

    PubMed Central

    Carr, Phyllis L; Felsenstein, Donna; Friedman, Robert H

    1998-01-01

    OBJECTIVE To evaluate recent advances in our understanding of the clinical relevance, diagnosis, and treatment of vaginal infections, and to determine an efficient and effective method of evaluating this clinical problem in the outpatient setting. DATA SOURCES Relevant papers on vaginitis limited to the English language obtained through a MEDLINE search for the years 1985 to 1997 were reviewed. DATA SYNTHESIS Techniques that enable the identification of the various strains of candida have helped lead to a better understanding of the mechanisms of recurrent candida infection. From this information a rationale for the treatment of recurrent disease can be developed. Bacterial vaginosis has been associated with complications, including upper genital tract infection, preterm delivery, and wound infection. Women undergoing pelvic surgery, procedures in pregnancy, or pregnant women at risk of preterm delivery should be evaluated for bacterial vaginosis to decrease the rate of complications associated with this condition. New, more standardized criteria for the diagnosis of bacterial vaginosis may improve diagnostic consistency among clinicians and comparability of study results. Use of topical therapies in the treatment of bacterial vaginosis are effective and associated with fewer side effects than systemic medication. Trichomonas vaginalis, although decreasing in incidence, has been associated with upper genital tract infection. Therapy of T. vaginalis infection has been complicated by an increasing incidence of resistance to metronidazole. CONCLUSIONS Vaginitis is a common medical problem in women that is associated with significant morbidity and previously unrecognized complications. Research in recent years has improved diagnostic tools as well as treatment modalities for all forms of vaginitis. PMID:9613891

  3. Antifungal resistance in yeast vaginitis.

    PubMed Central

    Dun, E.

    1999-01-01

    The increased number of vaginal yeast infections in the past few years has been a disturbing trend, and the scientific community has been searching for its etiology. Several theories have been put forth to explain the apparent increase. First, the recent widespread availability of low-dosage, azole-based over-the-counter antifungal medications for vaginal yeast infections encourages women to self-diagnose and treat, and women may be misdiagnosing themselves. Their vaginitis may be caused by bacteria, parasites or may be a symptom of another underlying health condition. As a result, they may be unnecessarily and chronically expose themselves to antifungal medications and encourage fungal resistance. Second, medical technology has increased the life span of seriously immune compromised individuals, yet these individuals are frequently plagued by opportunistic fungal infections. Long-term and intense azole-based antifungal treatment has been linked to an increase in resistant Candida and non-Candida species. Thus, the future of limiting antifungal resistance lies in identifying the factors promoting resistance and implementing policies to prevent it. PMID:10907778

  4. Case of early postoperative adhesion in a patient with molimina due to transverse vaginal septum concomitant with imperforate hymen.

    PubMed

    Koyama-Sato, Makiko; Hashida, Osamu; Nakamura, Tomomi; Hirahara, Fumiki; Sakakibara, Hideya

    2015-07-01

    Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.

  5. Insertion in Persian

    ERIC Educational Resources Information Center

    Kambuziya, Aliyeh Kord-e Zafaranlu; Dehghan, Masoud

    2011-01-01

    This paper investigates epenthesis process in Persian to catch some results in relating to vowel and consonant insertion in Persian lexicon. This survey has a close relationship to the description of epenthetic consonants and the conditions in which these consonants are used. Since no word in Persian may begin with a vowel, so that hiatus can't be…

  6. MELFI Sample Insertion

    NASA Image and Video Library

    2010-06-28

    ISS024-E-006699 (28 June 2010) --- NASA astronaut Doug Wheelock, Expedition 24 flight engineer, prepares to insert biological samples into trays in the Minus Eighty Laboratory Freezer for ISS-2 (MELFI-2) in the Destiny laboratory of the International Space Station.

  7. MELFI Sample Insertion

    NASA Image and Video Library

    2010-07-02

    ISS024-E-007346 (2 July 2010) --- NASA astronauts Tracy Caldwell Dyson (background) and Shannon Walker, both Expedition 24 flight engineers, prepare to insert biological samples in a dewar tray in the Minus Eighty Laboratory Freezer for ISS (MELFI-1) in the Kibo laboratory of the International Space Station.

  8. MELFI Sample Insertion

    NASA Image and Video Library

    2010-06-28

    ISS024-E-006697 (28 June 2010) --- NASA astronaut Doug Wheelock, Expedition 24 flight engineer, prepares to insert biological samples into trays in the Minus Eighty Laboratory Freezer for ISS-2 (MELFI-2) in the Destiny laboratory of the International Space Station.

  9. Vaginal absorption of hexachlorophene during labor.

    PubMed

    Strickland, D M; Leonard, R G; Stavchansky, S; Benoit, T; Wilson, R T

    1983-12-01

    Surgical soap that contains hexachlorophene is used as an antiseptic lubricant for vaginal examinations during labor in some centers. Theoretically, hexachlorophene can be absorbed from the vaginal mucosa and be potentially toxic to the fetus and neonate. To evaluate vaginal absorption and placental transfer of hexachlorophene, we measured levels in mixed arterial/venous cord serum and postpartum maternal serum in 28 women whose vaginal examinations were lubricated with pHisoHex during labor. The serum of 12 women had detectable levels of hexachlorophene, with a high level of 942 ng/ml. Cord serum had detectable levels in nine neonates, with a high level of 617 ng/ml. The conclusion is that hexachlorophene from vaginal lubricants is variably absorbed from the vaginal mucosa, and appreciable amounts can be detected in maternal and cord serum. Because of the potential for neonatal hexachlorophene toxicity, we recommend the use of alternative lubricants for pelvic examinations during labor.

  10. [Late vaginal mesh exposure after prolapse repair].

    PubMed

    Chanelles, O; Poncelet, C

    2010-12-01

    Mesh exposure is the major complication of vaginal prolapse repair. Incidence rates are variable according to the series. Mesh exposure usually occurs during the year following the intervention. We report here the first case of a patient with a late exposure of an anterior vaginal mesh 4 years after a surgical cystocele repair. The mesh has been easily removed at the operative theatre by vaginal approach.

  11. Vaginal delivery of breech presentation.

    PubMed

    Kotaska, Andrew; Menticoglou, Savas; Gagnon, Robert

    2009-06-01

    To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth. Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term. Reduced perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short- and long-term maternal morbidity and mortality. Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008. The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. This guideline was compared with the 2006 American College of Obstetrician's Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Vaginal breech birth can be associated with a higher risk of perinatal mortality and short-term neonatal morbidity than

  12. Safety of Manual Morcellation After Vaginal or Laparoscopic-assisted Vaginal Hysterectomy.

    PubMed

    Balgobin, Sunil; Maldonado, Pedro A; Chin, Kathleen; Schaffer, Joseph I; Hamid, Cherine A

    2016-01-01

    STUDY  To determine the safety of manual vaginal morcellation by evaluating the rates of incidental uterine malignancy and manual vaginal morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. Retrospective analysis (Canadian Task Force classification II-2). University of Texas Southwestern Medical Center, Dallas, TX. Women (n = 1,629) undergoing vaginal or laparoscopic-assisted vaginal hysterectomy. Vaginal hysterectomy (n = 1,091) or laparoscopic-assisted vaginal hysterectomy (n = 538) with and without scalpel morcellation. The number of uterine malignancies, rate of vaginal morcellation, surgical indications, pathology diagnoses, and uterine weights were evaluated. Chi-square analysis was used to compare categoric data, and analysis of variance was used to compare uterine weights. There were no cases of leiomyosarcomas. There were 2 other sarcomas, 4 smooth muscle tumors of uncertain malignant potential, and 8 endometrial adenocarcinomas. The vaginal morcellation rate was 19.4%, but no malignancy was morcellated. Myomas were more common preoperatively and histologically in morcellated specimens. Mean (± standard deviation) uterine weights for morcellated versus nonmorcellated laparoscopic-assisted vaginal hysterectomy specimens were 285.5 ± 159.3 versus 140.1 ± 83.6 g (p < .001), respectively, and 199.9 ± 92.8 versus 111.9 ± 61.4 (p < .001), respectively, for vaginal hysterectomy. Vaginal manual morcellation is safe with a low risk of incidental malignancy. Variables that influence the decision for the vaginal approach may also affect malignancy risk and morcellation decisions. Thus, all patients undergoing vaginal or laparoscopic-assisted vaginal hysterectomy should be counseled regarding incidental malignancy, risk of morcellation, and alternatives for intact specimen removal. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  13. An isolated vaginal metastasis from rectal cancer.

    PubMed

    Sadatomo, Ai; Koinuma, Koji; Horie, Hisanaga; Lefor, Alan K; Sata, Naohiro

    2016-02-01

    Isolated vaginal metastases from colorectal cancer are extremely rare. There are only a few reported cases in the English literature, and the characteristics of such cases of metastasis remain relatively unknown. We present a case of isolated vaginal metastasis from rectal cancer in a 78-year-old female patient. The patient had no symptoms related to vaginal tumor. Magnetic resonance imaging (MRI) showed thickening of the middle rectum and a vaginal tumor. Biopsy from the vaginal tumor showed adenocarcinoma, similar to the rectal lesion. Low anterior resection with ileostomy, hystero-oophorectomy, and transvaginal tumor resection was performed. After nineteen months, computed tomography scan revealed multiple lung metastases and recurrent tumor in the pelvis. The patient refused chemotherapy and is alive three months after developing recurrent disease. Most cases of primary vaginal carcinoma are squamous cell carcinoma. Other histologic types such as adenocarcinoma are usually metastatic lesions. Primary lesions associated with metastatic vaginal adenocarcinoma are most often the uterus, and are very rarely from the colon or rectum. We review previous case reports of isolated vaginal metastases from colorectal cancer and discuss their symptoms, treatments, and outcomes. We should keep the vagina within the field of view of pelvic MRI, which is one of the preoperative diagnostic tools for colorectal cancer. If female patients show gynecological symptoms, gynecological examination should be recommended. Isolated vaginal metastases are an indication for surgical resection, and adjuvant chemotherapy is also recommended.

  14. A universal combination treatment for vaginitis.

    PubMed

    Bornstein, Jacob; Zarfati, Doron

    2008-01-01

    We compared a novel vaginal tablet consisting of 100 mg of clotrimazole and 100 mg of metronidazole ('Clo-Met') to a 100-mg clotrimazole tablet in the treatment of vaginitis. A multicenter, double-blind, randomized controlled study. Women with vaginal discharge and diagnosed as suffering from vaginitis caused by Trichomonas vaginalis, bacterial vaginosis or Candida albicans, or any combination of the three, and who had not received treatment for vaginitis during the previous month, were studied. 165 patients were enrolled into the study--84 into the combined therapy group, and 81 into the clotrimazole group. In women with Candida vaginitis, Clo-Met was more effective than clotrimazole treatment (p < 0.012 and p < 0.05, respectively). A combination vaginal tablet consisting of clotrimazole and metronidazole is therapeutically effective in candidal vaginitis. The effectiveness of Clo-Met on bacterial vaginosis, T. vaginalis infection as well as on vaginal infections due to a combination of these microorganisms should be studied further.

  15. High Speed Video Insertion

    NASA Astrophysics Data System (ADS)

    Janess, Don C.

    1984-11-01

    This paper describes a means of inserting alphanumeric characters and graphics into a high speed video signal and locking that signal to an IRIG B time code. A model V-91 IRIG processor, developed by Instrumentation Technology Systems under contract to Instrumentation Marketing Corporation has been designed to operate in conjunction with the NAC model FHS-200 High Speed Video Camera which operates at 200 fields per second. The system provides for synchronizing the vertical and horizontal drive signals such that the vertical sync precisely coincides with five millisecond transitions in the IRIG time code. Additionally, the unit allows for the insertion of an IRIG time message as well as other data and symbols.

  16. Thought Insertion Clarified

    PubMed Central

    Ratcliffe, Matthew; Wilkinson, Sam

    2016-01-01

    ‘Thought insertion’ in schizophrenia involves somehow experiencing one’s own thoughts as someone else’s. Some philosophers try to make sense of this by distinguishing between ownership and agency: one still experiences oneself as the owner of an inserted thought but attributes it to another agency. In this paper, we propose that thought insertion involves experiencing thought contents as alien, rather than episodes of thinking. To make our case, we compare thought insertion to certain experiences of ‘verbal hallucination’ and show that they amount to different descriptions of the same phenomenon: a quasi-perceptual experience of thought content. We add that the agency/ownership distinction is unhelpful here. What requires explanation is not why a person experiences a type of intentional state without the usual sense of agency, but why she experiences herself as the agent of one type of intentional state rather than another. We conclude by sketching an account of how this might happen. PMID:28123340

  17. More frequent vaginal orgasm is associated with experiencing greater excitement from deep vaginal stimulation.

    PubMed

    Brody, Stuart; Klapilova, Katerina; Krejčová, Lucie

    2013-07-01

    Research indicated that: (i) vaginal orgasm (induced by penile-vaginal intercourse [PVI] without concurrent clitoral masturbation) consistency (vaginal orgasm consistency [VOC]; percentage of PVI occasions resulting in vaginal orgasm) is associated with mental attention to vaginal sensations during PVI, preference for a longer penis, and indices of psychological and physiological functioning, and (ii) clitoral, distal vaginal, and deep vaginal/cervical stimulation project via different peripheral nerves to different brain regions. The aim of this study is to examine the association of VOC with: (i) sexual arousability perceived from deep vaginal stimulation (compared with middle and shallow vaginal stimulation and clitoral stimulation), and (ii) whether vaginal stimulation was present during the woman's first masturbation. A sample of 75 Czech women (aged 18-36), provided details of recent VOC, site of genital stimulation during first masturbation, and their recent sexual arousability from the four genital sites. The association of VOC with: (i) sexual arousability perceived from the four genital sites and (ii) involvement of vaginal stimulation in first-ever masturbation. VOC was associated with greater sexual arousability from deep vaginal stimulation but not with sexual arousability from other genital sites. VOC was also associated with women's first masturbation incorporating (or being exclusively) vaginal stimulation. The findings suggest (i) stimulating the vagina during early life masturbation might indicate individual readiness for developing greater vaginal responsiveness, leading to adult greater VOC, and (ii) current sensitivity of deep vaginal and cervical regions is associated with VOC, which might be due to some combination of different neurophysiological projections of the deep regions and their greater responsiveness to penile stimulation. © 2013 International Society for Sexual Medicine.

  18. Guidelines for operative vaginal birth.

    PubMed

    Cargill, Yvonne M; MacKinnon, Catherine Jane; Arsenault, Marc-Yvon; Bartellas, Elias; Daniels, Sue; Gleason, Tom; Iglesias, Stuart; Klein, Michael C; Lane, Carolyn A; Martel, Marie-Jocelyne; Sprague, Ann E; Roggensack, Ann; Wilson, Ann Kathleen

    2004-08-01

    To provide guidelines for operative vaginal birth in the management of the second stage of labour. Non-operative techniques, episiotomy, and Caesarean section are compared to operative vaginal birth. outcome: Reduced fetal and maternal morbidity and mortality. MEDLINE and Cochrane databases were searched using the key words 'vacuum' and 'birth' as well as 'forceps' and 'birth' for literature published in English from January 1970 to June 2004. The level of evidence and quality of recommendations made are described using the Evaluation of Evidence from the Canadian Task Force on the Periodic Health Examination. 1. Non-operative interventions such as one-to-one support, partogram use, oxytocin use, and delayed pushing in women using epidurals will decrease need for operative birth. (I-A) 2. Manual rotation may be used alone or in conjunction with instrumental birth with little or no increased risk to the pregnant woman or to the fetus. (III-B) 3. Routine episiotomy is not necessary for an assisted vaginal birth. (II-1E) 4. When operative intervention in the second stage of labour is required, the options, risks, and benefits of vacuum, forceps, and Caesarean section must be considered. The choice of intervention needs to be individualized, as one is not clearly safer or more effective than the other. (II-B) 5. Failure of the chosen method, vacuum and/or forceps, to achieve delivery of the fetus in a reasonable time should be considered an indication for abandonment of the method. (III-C) 6. Adequate clinical experience and appropriate training of the operator are essential to the safe performance of operative deliveries. Hospital credentialing boards should grant privileges for performing these techniques only to an appropriately trained individual who demonstrates adequate skills. (III-C). The Clinical Practice Obstetrics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada approved these guidelines.

  19. Premenstrual vaginal colonization of Candida and symptoms of vaginitis.

    PubMed

    Watson, Cathy J; Grando, Danilla; Garland, Suzanne M; Myers, Stephen; Fairley, Christopher K; Pirotta, Marie

    2012-11-01

    Although premenstrual exacerbation of vulvovaginal symptoms attributed to Candida spp. is well documented, the causation of these symptoms is not well understood. This study describes the daily vaginal colonization of Candida in three women. A single pilot study was designed to test the methodology of the proposed randomized controlled trial, Garlic and Candida. This study reports the colonization of Candida spp. in three women. Ten women aged 18-50 who reported at least one episode of vulvovaginal candidiasis were recruited by the University of Melbourne. Each participant took daily vaginal swabs for 2 weeks during the luteal phase of their menstrual cycle, which were analysed for quantitative colony counts of Candida spp. Of these, three women were colonized with Candida spp. For the first time, to our knowledge, daily colonization of Candida during the luteal phase of the menstrual cycle is described in three women, demonstrating an increase in the colony count preceding symptom development. This small study demonstrated the colonization of Candida spp. during the luteal phase of the menstrual cycle in three women. Candida colonization is poorly understood, yet investigating the relevance of the link between symptom exacerbation and the menstrual cycle in those women who experience recurrent episodes of vulvovaginal candidiasis may influence the management of this condition.

  20. Study of the intravaginal insert (IVI): acceptability, side effects, and post-coital spermicidal activity.

    PubMed

    Ahmad, M; Asch, R H

    1984-01-01

    The authors describe their experience with a group of 49 sexually active, already protected women in order to evaluate the acceptability, side effects and post-coital spermicidal activity of a new vaginal contraceptive. The intravaginal insert (IVI) consists of a polyester resin plug (sponge) containing a 5% solution of nonoxynol-9 bound in a cold formation process, and having a cotton loop attached to the lower end. The results of this study indicate that this new vaginal contraceptive is free of major side effects, is well accepted by users, and has strong spermicidal and mechanical activity. Future clinical testing in order to try its anti-conceptive effectiveness is warranted.

  1. Supracervical hysterectomy - the vaginal route.

    PubMed

    Wilczyński, Miłosz; Cieślak, Jarosław; Malinowski, Andrzej

    2014-06-01

    Removal of the cervix during hysterectomy is not mandatory. There has been no irrefutable evidence so far that total hysterectomy is more beneficial to patients in terms of pelvic organ function. The procedure that leaves the cervix intact is called a subtotal hysterectomy. Traditional approaches to this surgery include laparoscopic and abdominal routes. Vaginal total hysterectomy has been proven to present many advantages over the other approaches. Therefore, it seems that this route should also be applied in the case of subtotal hysterectomy. We present 9 cases of patients who underwent subtotal hysterectomy performed through the vagina for benign gynecological diseases.

  2. [Shoulder dystocia during vaginal delivery].

    PubMed

    Hruban, Lukás; Procházka, M; Janků, P

    2010-08-01

    Shoulder dystocia is defined as a complication of vaginal delivery that requires additional obstetric manoeuvres to release the shoulders of the baby. Reported incidence of shoulder dystocia is around 0.6-1.4%. Serious perinatal morbidity is associated with this type of complication. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia. Some cases results in permanent brachial plexus dysfunction. A high level of awareness and training for all birth attendants is recommended. The purpose of this article is to review the current evidence regarding the possible prediction and management of shoulder dystocia.

  3. Long-retained vaginal foreign body causing chronic vaginitis in a bulldog.

    PubMed

    Snead, Elisabeth C; Pharr, John W; Ringwood, Brendon P; Beckwith, Jennifer

    2010-01-01

    A vaginal foreign body consisting of a piece of retained calvarium from a macerated fetus was identified and removed using vaginoscopy in a 4-year-old, spayed female bulldog. The dog had a 12-month history of chronic mucopurulent vaginitis. Vaginal foreign bodies, although uncommon, are a differential diagnosis for recurrent mucopurulent or hemorrhagic chronic vaginal discharge. A case of chronic vaginitis caused by a long-retained intravaginal foreign body in a dog is described and compared to four other canine cases reported in the literature.

  4. VBAC (Vaginal Birth After C-Section)

    MedlinePlus

    Tests and Procedures Vaginal birth after C-section (VBAC) By Mayo Clinic Staff If you've delivered a baby by C-section and you're ... scheduling a repeat C-section or attempting vaginal birth after C-section (VBAC). For many women, VBAC ...

  5. Spontaneous diaphragm rupture associated with vaginal delivery.

    PubMed

    Hamaji, Masatsugu; Burt, Bryan M; Ali, Syed Osman; Cohen, Daniel M

    2013-08-01

    Spontaneous rupture of the diaphragm associated with vaginal delivery is a rare occurrence, but has high rates of morbidity and mortality. Herein, we present a first uncomplicated case of spontaneous rupture of the diaphragm associated with vaginal delivery, which was treated successfully with surgery via a thoracotomy.

  6. The vaginal microbiome in health and disease.

    PubMed

    White, Bryan A; Creedon, Douglas J; Nelson, Karen E; Wilson, Brenda A

    2011-10-01

    Infections of the vaginal tract result from perturbations in the complex interactions between the microbiome and the host vaginal ecosystem. Recent data have linked specific vaginal microbes and urogenital infection with preterm birth. Here we discuss how next-generation sequencing-based approaches to study the vaginal microbiome will be important for defining what constitutes an imbalance of the microbiome and the associated host conditions that lead to subsequent infection and disease states. These studies will provide clinicians with reliable diagnostic tools and treatments for women who are at increased risk for vaginal infections, preterm birth, HIV and other sexually acquired diseases, and will provide opportunities for intervention. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Dermatologic causes of vaginitis: a clinical review.

    PubMed

    Edwards, Libby

    2010-10-01

    The concept of vaginitis is widely accepted. Most physicians assume that vaginitis represents an infection, with nearly all vaginal complaints diagnosed as Candidiasis, bacterial vaginosis, or trichomonas. However, like the mouth, the vagina is covered with squamous epithelium, and therefore affected by various dermatoses. Some dermatoses prominently affect mucous membranes, such as lichen planus, pemphigus vulgaris, cicatricial pemphigoid, and blistering forms of erythema multiforme. In addition, some dermatoses affect only the vagina, including desquamative inflammatory vaginitis and atrophic vaginitis. The diagnosis and management of these diseases are hampered by the difficulty of visualizing the vagina, and the lack of medications other than antimicrobials available for use in the vagina. Copyright © 2010. Published by Elsevier Inc.

  8. Vaginitis

    MedlinePlus

    ... see your health care professional. What is bacterial vaginosis? Bacterial vaginosis is caused by overgrowth of the ... the vagina. What are the symptoms of bacterial vaginosis? The main symptom is increased discharge with a ...

  9. Vaginitis

    MedlinePlus

    ... Resources & Publications Committee Opinions Practice Bulletins Patient Education Green Journal Clinical Updates Practice Management Coding Health Info Technology Professional Liability Managing Your Practice Patient Safety & Quality ...

  10. Timing of the IUD insertion.

    PubMed

    Edelman, D A; Zipper, J; Rivera, M; Medel, M

    1979-05-01

    The relationship between the time in the menstrual cycle when a TCu-200 or Cu-7-200 is inserted and subsequent IUD-related events was evaluated. For women who had either TCus or Cu-7s inserted, the pregnancy, expulsion and medical removal rates were similar for insertions performed at any time of the menstrual cycle.

  11. Vaginal practices diary: development of a pictorial data collection tool for sensitive behavioural data

    PubMed Central

    Francis, Suzanna C.; Lees, Shelley S.; Andrew, Bahati; Zalwango, Flavia; Vandepitte, Judith; Ao, Trong; Baisley, Kathy; Kapiga, Saidi; Grosskurth, Heiner; Hayes, Richard

    2013-01-01

    Background Intravaginal practices (IVP) are highly prevalent behaviours among women at increased risk for HIV in sub-Saharan Africa. IVP data collected by face-to-face interviews (FTFI) may be subject to recall or social desirability bias. Daily self-administered diaries may help to decrease bias associated with FTFI. IVP data from a diary and FTFI were compared during a multi-site microbicide feasibility study in Tanzania and Uganda. Methods Two hundred women were recruited and given diaries to complete daily for six weeks. Data obtained in the diary were compared to data from the FTFI during clinical visits to assess the consistency of reporting of IVP between the data collection methods. Results In Tanzania, proportions of overall vaginal cleansing and insertion were similar for the FTFI and the diary, but the diary indicated higher frequency of cleansing and use of a cloth or other applicator. In Uganda, proportions of overall vaginal cleansing were similar for FTFI and the diary, but the diary indicated higher frequency of cleansing, use of soaps and cloths for cleansing, and insertion. Most of the inconsistencies between the two data collection methods were from reported frequency of IVP or IVP related to sexual intercourse. Conclusions The comparison of FTFI and the vaginal practice diary suggests that recall of IVP may be improved by a daily self-administered diary, especially for frequency of cleansing and cleansing in proximity to sexual intercourse. The vaginal practices diary can provide a more detailed understanding of IVP and aid in the interpretation of findings from FTFI. Vaginal practices diary: development of a pictorial data collection tool for sensitive behavioural data. PMID:22801344

  12. Use of vaginal prostaglandin gel before induction of labour.

    PubMed

    Murphy, A J; Jalland, M; Pepperell, R J; Quinn, M A

    1980-05-01

    Tylose gel containing either 1.5 mg, 3.0 mg or 10.0 mg of prostaglandin F2 alpha was inserted into the posterior vaginal fornix of 165 patients on the evening before induction of labour. A control group of 100 patients received the gel alone. There was a significant reduction in the induction-delivery interval in nulliparae receiving at least 3.0 mg of prostaglandin, whereas, in multiparae all doses achieved this effect. There was also a significant reduction in the incidence of forceps delivery in nulliparae who received 3.0 mg or more of the prostaglandin gel; however, there was no difference in the incidence of spontneous labour, epidural anaesthesia or Caesarean section between the patients who received prostaglandin or those receiving gel alone.

  13. What do Portuguese Women Prefer Regarding Vaginal Products? Results from a Cross-Sectional Web-Based Survey

    PubMed Central

    Palmeira-de-Oliveira, Rita; Duarte, Paulo; Palmeira-de-Oliveira, Ana; das Neves, José; Amaral, Maria Helena; Breitenfeld, Luiza; Martinez-de-Oliveira, José

    2014-01-01

    Therapeutic outcomes of vaginal products depend not only on their ability to deliver drugs to or through the vagina but also on acceptability and correct use. Women’s preferences, in turn, may vary according to age and cultural backgrounds. In this work, an anonymous online survey was completed by 2529 Portuguese women to assess their preferences for physical characteristics and mode of application of vaginal products, according to age. Additionally, intention to use and misconceptions about these issues were assessed. The majority of women of all age groups would use vaginal products to treat or prevent diseases, upon medical prescription. Women preferred vaginal products to be odorless and colorless gels, creams and ointments composed by natural origin drugs/excipients and applied by means of an applicator. Although the majority of women would prefer not to insert any product in the vagina, intention to use for self and recommendation to use for others was associated with previous experiences with vaginal products. General concerns and misconceptions related to use of vaginal products were rare. These data may contribute to the development of products that women are more prone to use. PMID:25337676

  14. Treatment of Vaginal Atrophy with Vaginal Estrogen Cream in Menopausal Indian Women

    PubMed Central

    Shah, Maitri; Karena, Zalak; Patel, Sangita V.; Parmar, Niyati; Singh, Pawan K.; Sharma, Atul

    2017-01-01

    Objectives To measure the effect of vaginal estrogen cream in the treatment of vaginal atrophy in menopausal Indian women. Methods A total of 50 menopausal women aged between 40 and 80 years old with symptoms of vaginal atrophy were selected and treated with 0.5 g vaginal estrogen cream, twice weekly for 12 weeks. The women were followed-up monthly where symptom score, Genital Health Clinical Evaluation (GHCE) score, vaginal pH, and vaginal maturation index (VMI) were assessed and compared to baseline data. Any adverse events were recorded. Results There was a significant improvement (p < 0.010) in complaints such as vaginal dryness, itching, burning, and dyspareunia at the end of the study period. The clinical improvement of these patients was reflected in a decrease in GHCE score on every visit. Vaginal pH and VMI score also showed statistically significant improvements (p < 0.010). No side effects with the drugs used were recorded during the study period. Conclusions Vaginal estrogen cream causes symptomatic relief in women of menopausal age in India suffering from vaginal atrophy. PMID:28042397

  15. Effect of vaginal or systemic estrogen on dynamics of collagen assembly in the rat vaginal wall.

    PubMed

    Montoya, T Ignacio; Maldonado, P Antonio; Acevedo, Jesus F; Word, R Ann

    2015-02-01

    The objective of this study was to compare the effects of systemic and local estrogen treatment on collagen assembly and biomechanical properties of the vaginal wall. Ovariectomized nulliparous rats were treated with estradiol or conjugated equine estrogens (CEEs) either systemically, vaginal CEE, or vaginal placebo cream for 4 wk. Low-dose local CEE treatment resulted in increased vaginal epithelial thickness and significant vaginal growth without uterine hyperplasia. Furthermore, vaginal wall distensibility increased without compromise of maximal force at failure. Systemic estradiol resulted in modest increases in collagen type I with no change in collagen type III mRNA. Low-dose vaginal treatment, however, resulted in dramatic increases in both collagen subtypes whereas moderate and high dose local therapies were less effective. Consistent with the mRNA results, low-dose vaginal estrogen resulted in increased total and cross-linked collagen content. The inverse relationship between vaginal dose and collagen expression may be explained in part by progressive downregulation of estrogen receptor-alpha mRNA with increasing estrogen dose. We conclude that, in this menopausal rat model, local estrogen treatment increased total and cross-linked collagen content and markedly stimulated collagen mRNA expression in an inverse dose-effect relationship. High-dose vaginal estrogen resulted in downregulation of estrogen receptor-alpha and loss of estrogen-induced increases in vaginal collagen. These results may have important clinical implications regarding the use of local vaginal estrogen therapy and its role as an adjunctive treatment in women with loss of vaginal support.

  16. Management of Spontaneous Vaginal Delivery.

    PubMed

    Dresang, Lee T; Yonke, Nicole

    2015-08-01

    Most of the nearly 4 million births in the United States annually are normal spontaneous vaginal deliveries. In the first stage of labor, normal birth outcomes can be improved by encouraging the patient to walk and stay in upright positions, waiting until at least 6 cm dilation to diagnose active stage arrest, providing continuous labor support, using intermittent auscultation in low-risk deliveries, and following the Centers for Disease Control and Prevention guidelines for group B streptococcus prophylaxis. Most women with a low transverse uterine incision are candidates for a trial of labor after cesarean delivery and should be counseled accordingly. Pain management during labor includes complementary modalities and systemic opioids, epidural anesthesia, and pudendal block. Outcomes in the second stage of labor can be improved by using warm perineal compresses, allowing women more time to push before intervening, and offering labor support. Delayed pushing increases the length of the second stage of labor and does not affect the rate of spontaneous vaginal delivery. A tight nuchal cord can be clamped twice and cut before delivery of the shoulders, or the baby may be delivered using a somersault maneuver in which the cord is left nuchal and the distance from the cord to placenta minimized by pushing the head toward the maternal thigh. After delivery, skin-to-skin contact with the mother is recommended. Beyond 35 weeks' gestation, there is no benefit to bulb suctioning the nose and mouth. Postpartum maternal and neonatal outcomes can be improved through delayed cord clamping, active management to prevent postpartum hemorrhage, careful examination for external anal sphincter injuries, and use of absorbable synthetic suture for second-degree perineal laceration repair. Practices that will not improve outcomes and may result in negative outcomes include discontinuation of epidurals late in labor and routine episiotomy.

  17. A comparative study of vaginal estrogen cream and sustained-release estradiol vaginal tablet (Vagifem) in the treatment of atrophic vaginitis in Isfahan, Iran in 2010-2012.

    PubMed

    Hosseinzadeh, Pardis; Ghahiri, Atallah; Daneshmand, Freshteh; Ghasemi, Mojdeh

    2015-12-01

    Atrophic vaginitis is a disease, which affects up to 50% of postmenopausal women. This study compared the effectiveness and user-friendliness of Vagifem (an estradiol vaginal tablet) and vaginal estrogen cream in the treatment of atrophic vaginitis. One hundred and sixty postmenopausal women with symptoms of atrophic vaginitis were randomly divided into two groups of treatment with Vagifem or with vaginal estrogen cream for 12 weeks. Patients used the medication daily for the first 2 weeks of the study, and twice weekly. Severity of vaginal atrophy and four main symptoms of atrophic vaginitis including dysuria, dyspareunia, vaginal itching, and dryness were evaluated and compared before and after treatment. In addition, patients were asked regarding user-friendliness and hygienic issues of medications. Both vaginal estrogen cream and Vagifem significantly improved symptoms of atrophic vaginitis but in terms of effectiveness for the treatment symptoms of atrophic vaginitis, there was no significant difference between the two medications. Vagifem compared to estrogen cream resulted in significantly lower rate of hygienic problems (0% versus 23%, P < 0.001), and was reported by the patients as a significantly easier method of treatment (90% versus 55%, P < 0.0001). This investigation showed that Vagifem is an appropriate medication for the treatment of atrophic vaginitis, which is as effective as vaginal estrogen creams and is more user-friendly.

  18. Metal and cofactor insertion.

    PubMed

    Mendel, Ralf R; Smith, Alison G; Marquet, Andree; Warren, Martin J

    2007-10-01

    Cells require metal ions as cofactors for the assembly of metalloproteins. Principally one has to distinguish between metal ions that are directly incorporated into their cognate sites on proteins and those metal ions that have to become part of prosthetic groups, cofactors or complexes prior to insertion of theses moieties into target proteins. Molybdenum is only active as part of the molybdenum cofactor, iron can be part of diverse Fe-S clusters or of the heme group, while copper ions are directly delivered to their targets. We will focus in greater detail on molybdenum metabolism because molybdenum metabolism is a good example for demonstrating the role and the network of metals in metabolism: each of the three steps in the pathway of molybdenum cofactor formation depends on a different metal (iron, copper, molybdenum) and also the enzymes finally harbouring the molybdenum cofactor need additional metal-containing groups to function (iron sulfur-clusters, heme-iron).

  19. Pyometra and complete vaginal adhesion in a miniature horse

    PubMed Central

    Cozens, Elizabeth R.W.

    2009-01-01

    A 4-year-old miniature horse experienced intermittent episodes of pyrexia, lethargy, and purulent vaginal discharge following dsytocia. Vaginal endoscopy and transrectal ultrasonography revealed a blind-ending vaginal cavity and distended uterus. Surgical treatment was declined and the mare was euthanized. Post-mortem examination confirmed the diagnosis of pyometra and vaginal adhesions. PMID:19949560

  20. 21 CFR 884.5900 - Therapeutic vaginal douche apparatus.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Therapeutic vaginal douche apparatus. 884.5900... Devices § 884.5900 Therapeutic vaginal douche apparatus. (a) Identification. A therapeutic vaginal douche... except it is not for contraceptive use. After filling the therapeutic vaginal douche apparatus with...

  1. 21 CFR 884.5900 - Therapeutic vaginal douche apparatus.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Therapeutic vaginal douche apparatus. 884.5900... Devices § 884.5900 Therapeutic vaginal douche apparatus. (a) Identification. A therapeutic vaginal douche... except it is not for contraceptive use. After filling the therapeutic vaginal douche apparatus with...

  2. 21 CFR 884.5900 - Therapeutic vaginal douche apparatus.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Therapeutic vaginal douche apparatus. 884.5900... Devices § 884.5900 Therapeutic vaginal douche apparatus. (a) Identification. A therapeutic vaginal douche... except it is not for contraceptive use. After filling the therapeutic vaginal douche apparatus with...

  3. Postcoital vaginal rupture after hysterectomy presenting as generalised peritonitis.

    PubMed

    Eid-Arimoku, L; Trompetas, V

    2011-10-01

    Postcoital vaginal rupture is a rare but well documented complication of hysterectomy. Evisceration of the small intestine, vaginal bleeding and pelvic pain are common presenting features. We report the unusual case of vaginal rupture presenting with generalised peritonitis without vaginal evisceration.

  4. Vaginal rings for delivery of HIV microbicides

    PubMed Central

    Malcolm, R Karl; Fetherston, Susan M; McCoy, Clare F; Boyd, Peter; Major, Ian

    2012-01-01

    Following the successful development of long-acting steroid-releasing vaginal ring devices for the treatment of menopausal symptoms and contraception, there is now considerable interest in applying similar devices to the controlled release of microbicides against HIV. In this review article, the vaginal ring concept is first considered within the wider context of the early advances in controlled-release technology, before describing the various types of ring device available today. The remainder of the article highlights the key developments in HIV microbicide-releasing vaginal rings, with a particular focus on the dapivirine ring that is presently in late-stage clinical testing. PMID:23204872

  5. The Vaginal Microbiota and Urinary Tract Infection.

    PubMed

    Stapleton, Ann E

    2016-12-01

    The vagina is a key anatomical site in the pathogenesis of urinary tract infection (UTI) in women, serving as a potential reservoir for infecting bacteria and a site at which interventions may decrease the risk of UTI. The vaginal microbiota is a dynamic and often critical factor in this pathogenic interplay, because changes in the characteristics of the vaginal microbiota resulting in the loss of normally protective Lactobacillus spp. increase the risk of UTI. These alterations may result from the influence of estrogen deficiency, antimicrobial therapy, contraceptives, or other causes. Interventions to reduce adverse effects on the vaginal microbiota and/or to restore protective lactobacilli may reduce the risks of UTI.

  6. Proinflammatory Cytokines as Regulators of Vaginal Microbiota.

    PubMed

    Kremleva, E A; Sgibnev, A V

    2016-11-01

    It was shown that IL-1β, IL-8, and IL-6 in concentrations similar to those in the vagina of healthy women stimulated the growth of normal microflora (Lactobacillus spp.) and suppressed the growth and biofilm production by S. aureus and E. coli. On the contrary, these cytokines in higher concentrations typical of vaginal dysbiosis suppressed normal microflora and stimulated the growth of opportunistic microorganisms. TGF-β1 in both doses produced a stimulating effects on study vaginal microsymbionts. It is hypothesized that pro-inflammatory cytokines serve as the molecules of interspecies communication coordinating the interactions of all components of the vaginal symbiotic system.

  7. Pudendal nerve block for vaginal birth.

    PubMed

    Anderson, Deborah

    2014-01-01

    Pudendal nerve block is a safe and effective pain relief method for vaginal birth. Providing analgesia to the vulva and anus, it is used for operative vaginal birth and subsequent repair, late second stage pain relief with spontaneous vaginal birth, repair of complex lacerations, or repair of lacerations in women who are unable to achieve adequate or satisfactory pain relief during perineal repair with local anesthesia. Key to its efficacy is the knowledge of pudendal nerve anatomy, the optimal point of infiltration of local anesthetic, and an understanding of the amount of time necessary to effect adequate analgesia.

  8. Surgical removal of a large vaginal calculus formed after a tension-free vaginal tape procedure.

    PubMed

    Zilberlicht, Ariel; Feiner, Benjamin; Haya, Nir; Auslender, Ron; Abramov, Yoram

    2016-11-01

    Vaginal calculus is a rare disorder which has been reported in association with urethral diverticulum, urogenital sinus anomaly, bladder exstrophy and the tension-free vaginal tape (TVT) procedure. We report a 42-year-old woman who presented with persistent, intractable urinary tract infection (UTI) following a TVT procedure. Cystoscopy demonstrated an eroded tape with the formation of a bladder calculus, and the patient underwent laser cystolithotripsy and cystoscopic resection of the tape. Following this procedure, her UTI completely resolved and she remained asymptomatic for several years. Seven years later she presented with a solid vaginal mass. Pelvic examination followed by transvaginal ultrasonography and magnetic resonance imaging demonstrated a large vaginal calculus located at the lower third of the anterior vaginal wall adjacent to the bladder neck. This video presents the transvaginal excision and removal of the vaginal calculus.

  9. [High vaginal uterosacral ligament suspension for treatment of uterine prolapse].

    PubMed

    Lu, Yong-xian; Shen, Wen-jie; Liu, Xin; Liu, Jing-xia; Zhang, Ying-hui; Zhao, Ying; Zhang, Lin; Hu, Man-luo; Ge, Jing; Ke, Niu

    2007-12-01

    To evaluate the physiological and anatomic basis,indications,surgical skills, prevention of ureter injury and clinic outcomes of using high uterosacral ligament suspension (HUS) for correction of advanced uterine prolapse by the vaginal route. Fifty women with advanced uterine prolapse underwent transvaginal HUS after vaginal hysterectomy with reconstruction of pubocervical and rectovaginal fascia to correct their uterine prolapse between June 2003 and September 2007. The average age of the women was 60.1 years. The mean follow-up period was 24 months (range 4-51 months). The degree of pelvic organ prolapse preoperatively and anatomic outcomes postoperatively were assessed with pelvic organ prolapse quantification system (POP-Q). The remnants of the uterosacral ligaments were clearly identified and palpated posterior and medial to the ischial spines by traction with a 24 cm long Allis clamp and used for successful vaginal vault suspension and reconstruction in all 50 consecutive advanced uterine prolapse patients. The ureter injury was avoided by complete knowledge of the ureter's course from the cervix/apex toward its insertion in the sacral region and how far outside of the uterosacral ligament, by uteri palpation and by suturing purposefully placed "deep" dorsally and posteriorly toward the sacrum, as well as by cystoscopy examination of the spillage of urine from both ureters. Mean POP-Q point C improved from 1.5 to -7.5 cm with a median follow-up of 24 months. If the successful HUS was defined as point C < or = stage I prolapse, both the objective and subjective cure rates were as high as 100% with a maximum follow-up of 51 months. None of the 50 patients had repeat operation for recurrence of prolapse. There was no major intra-or postoperative complications, such as ureter and other pelvic organ injury. HUS with fascial reconstruction seems to be a safe, minimal traumatic, tolerable and highly successful procedure for vaginal repair of advanced uterine

  10. The best option: Umbilical LESS radical nephrectomy with vaginal extraction.

    PubMed

    Andrés, G; García-Mediero, J M; García-Tello, A; Arance, I; Cabrera, P M; Angulo, J C

    2015-04-01

    Umbilical laparoendoscopic single-site (LESS) surgery represents an excellent alternative to laparoscopic or robotic multiport surgery. LESS surgery offers faster recovery, less postoperative pain and optimal cosmetic results. The reusable nature of its instruments also has significant economic advantages. We present a 34-year-old patient with a solid mesorenal lesion measuring 8 cm in the left kidney treated with pure LESS radical nephrectomy assisted by vaginal extraction of the specimen. The umbilical approach using a single-site multichannel KeyPort (Richard Wolf GmbH, Knittlingen, Germany) with DuoRotate curved instruments allows for minimum crushing and fewer spatial conflicts. Its perfect umbilical adaptation provides a hermetic system. The instrument's double rotation provides considerable movement precision. Vaginal extraction avoids damage to the abdominal wall and the need for widening the umbilical incision. After the placement of the device and triangulation of the clips, we proceeded to operate on posterior parietal peritoneum. The descending colon was mobilized to access the retroperitoneum and dissect the renal hilum. Hem-o-lok clips were placed on the artery and vein, which were subsequently sectioned. The specimen was inserted into a laparoscopic bag. Under direct vision, we placed a 15-mm trocar through the bottom of the vaginal posterior fornix to facilitate the extraction of the bag's thread. The incision was widened with the fingers, and the specimen was extracted, closing the vagina from the perineum with visualization from the navel. Abdominal drainage was not employed. The surgical time was 180 min. The patient was discharged the following day without needing analgesia. A year later, the patient was disease-free and had no complications. Umbilical LESS radical nephrectomy with vaginal extraction is feasible in selected cases. The procedure is oncologically safe, avoids scars and facilitates early recovery. From a practical point of view

  11. Postplacental or delayed levonorgestrel intrauterine device insertion and breastfeeding duration

    PubMed Central

    Chen, Beatrice A.; Reeves, Matthew F.; Creinin, Mitchell D.; Schwarz, E. Bimla

    2011-01-01

    BACKGROUND The objective was to assess the effect of timing of postpartum levonorgestrel-releasing IUD insertion on breastfeeding continuation. STUDY DESIGN Women interested in using a levonorgestrel IUD postpartum were randomized to immediate postplacental insertion (postplacental group) or insertion 6–8 weeks after vaginal delivery (delayed group). Duration and exclusivity of breastfeeding were assessed at 6–8 weeks, 3 months, and 6 months postpartum. Only women who received an IUD were included in this analysis. RESULTS Breastfeeding was initiated by 32/50 (64%) of women receiving a postplacental IUD and 27/46 (58.7%) of women receiving a delayed IUD (p=0.59). More women in the delayed group compared to the postplacental group continued to breastfeed at 6–8 weeks (16/46 vs 15/50, p=0.62), 3 months (13/46 vs 7/50, p=0.13), and 6 months postpartum (11/46 vs 3/50, p=0.02). The results did not differ when only women who initiated breastfeeding or only primiparous women with no prior breastfeeding experience were analyzed. CONCLUSIONS Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breastfeeding and less exclusive breastfeeding. Further studies are needed of the effects of early initiation of progestin-only methods on women’s lactation experience. PMID:22018124

  12. [Local combined therapy of vaginal infections by nifuratel-nistatin].

    PubMed

    Jahić, Mahira; Balić, Adem; Nurkić, Mahmud; Dragović, Jasmina; Adzajlić, Amela; Habibović, Amra; Mesalić, Lejla; Zigić, Aza

    2010-02-01

    A test included 40 women in the reproductive age with clinical symptoms of vaginitis and microbiological examination. They were treated by combined therapy of vaginal tablets of nifuratel, 500 mg and nistatin 200 000 i. u. during six days, after which they underwent gynaecological reexamination and repeated microbiological examination of vaginal and cervical smears. An analiysis of vaginal secretion found bacterial flora in 34 smears (65%), fungus (Candida albicans) in 15 (24%) and Trichomonas vaginalis in 7 (11%). Local vaginal therapy in vaginitis caused by Trichomonas vaginalis was successfull in all 7 patients, vaginitis caused by Candida albicans was successly treated in 14 (93%) patients. Bacterial vaginitis was cured in 29 (71%) patients during this tharapy. Local vaginal combined therapy of nifuratel and nistatin is eficient in patients with vaginitis caused by fungi and Trichomonas vaginalis too.

  13. The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy.

    PubMed

    Hill, Amanda Marie; Davis, K Meryl; Clark-Donat, Lindsay; Hammons, Lee Marvin; Azodi, Masoud; Silasi, Dan-Arin

    2017-01-01

    STUDY OBJECTIVE: To determine whether vertical versus horizontal closure of the vaginal cuff during laparoscopic hysterectomy has an effect on postoperative vaginal length and pelvic organ prolapse. A prospective randomized controlled trial. Subjects were randomly assigned to vertical or horizontal vaginal cuff closure at the time of total laparoscopic hysterectomy. Pelvic organ prolapse quantization (POP-Q) tests were performed before surgery, 2 to 4 weeks after surgery, and 3 to 4 months after surgery (Canadian Task Force classification I). An academic university-affiliated community hospital. Patients undergoing laparoscopic or robotic-assisted laparoscopic total hysterectomy for benign or malignant disease, excluding those undergoing radical hysterectomy or concomitant pelvic floor procedure. Subjects were randomized into the vertical or horizontal vaginal cuff closure group. Total hysterectomy was completed with traditional laparoscopic techniques or with robotic assistance. A colpotomy ring was used in each subject. Vaginal cuff closure was performed with barbed suture in a running fashion according to the group assignment. A total of 43 subjects were enrolled and randomized. One patient was excluded because the vaginal cuff was closed vaginally, 1 cancelled surgery, and 1 was completed without a uterine manipulator. The mean change in vaginal length was -0.89 cm (standard deviation [SD] = 1.03) in the horizontal group and -0.86 cm (SD = 1.19) in the vertical group (p = .57). POP-Q evaluation revealed no differences between groups and an overall trend toward improved POP-Q measurements. The average duration of vaginal cuff closure did not differ (p = .45), and there were no intraoperative complications related to vaginal cuff closure. Horizontal and vertical laparoscopic closure of the vaginal cuff after laparoscopic hysterectomy results in similar changes in vaginal length and other POP-Q scores. Copyright © 2016 AAGL. Published by Elsevier Inc

  14. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk.

    PubMed

    Kindinger, Lindsay M; Bennett, Phillip R; Lee, Yun S; Marchesi, Julian R; Smith, Ann; Cacciatore, Stefano; Holmes, Elaine; Nicholson, Jeremy K; Teoh, T G; MacIntyre, David A

    2017-01-19

    Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing, we undertook a prospective study in women at risk of preterm birth (n = 161) to assess (1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth risk and (2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix. Lactobacillus iners dominance at 16 weeks of gestation was significantly associated with both a short cervix <25 mm (n = 15, P < 0.05) and preterm birth <34(+0) weeks (n = 18; P < 0.01; 69% PPV). In contrast, Lactobacillus crispatus dominance was highly predictive of term birth (n = 127, 98% PPV). Cervical shortening and preterm birth were not associated with vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (<18, 22, 28, and 34 weeks) was then undertaken in women receiving vaginal progesterone (400 mg/OD, n = 25) versus controls (n = 42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (<34 weeks). L. iners dominance of the vaginal microbiota at 16 weeks of gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about "infection risk" associated with the use of a vaginal pessary during high-risk pregnancy can be reassured.

  15. Vaginal atrophy in breast cancer survivors: role of vaginal estrogen therapy.

    PubMed

    Mariani, Luciano; Gadducci, Angiolo; Vizza, Enrico; Tomao, Silverio; Vici, Patrizia

    2013-01-01

    Early menopause and related vaginal atrophy is a well known side-effect of hormone adjuvant treatment in breast cancer patients, particularly during aromatase-inhibitors therapy. Due to estrogens contra-indication, proper therapy for such symptom remains often an inadequately addressed clinical problem. After an accurate assessment of the risk/benefit ratio, vaginal low-dose estrogen treatment (better with estriol) [corrected] may have a role in controlling vaginal atrophy in selected and informed breast cancer women.

  16. Vaginal Calculus in a Woman With Mixed Urinary Incontinence and Vaginal Mesh Exposure.

    PubMed

    Winkelman, William D; Rabban, Joseph T; Korn, Abner P

    2016-01-01

    Vaginal calculi are extremely rare and are most commonly encountered in the setting of an urethrovaginal or vesicovaginal fistula. We present a case of a 72-year-old woman with mixed urinary incontinence and vaginal mesh exposure incidentally found to have a large vaginal calculus. We removed the calculus surgically and analyzed the components. Results demonstrated the presence of ammonium-magnesium phosphate hexahydrate and carbonate apatite.

  17. Effects of Electrosurgery and Vaginal Closure Technique on Postoperative Vaginal Cuff Dehiscence

    PubMed Central

    Kesterson, Joshua; Davies, Matthew; Green, Janis; Penezic, Lindsey; Vargas, Roberto; Harkins, Gerald

    2013-01-01

    Background and Objectives: The aim of our study is to evaluate the role of electrosurgery and vaginal closure technique in the development of postoperative vaginal cuff dehiscence. Methods: From prospective surgical databases, we identified 463 patients who underwent total laparoscopic hysterectomy (TLH) for benign disease and 147 patients who underwent laparoscopic-assisted vaginal hysterectomy (LAVH) for cancer. All TLHs and LAVHs were performed entirely by use of electrosurgery, including colpotomy. Colpotomy in the TLH group was performed with Harmonic Ace Curved Shears (Ethicon Endo-Surgery, Cincinnati, OH, USA), and in the LAVH group, it was performed with a monopolar electrosurgical pencil. The main surgical difference was vaginal cuff closure—laparoscopically in the TLH group and vaginally in the LAVH group. Results: Although patients in the LAVH group were at increased risk for poor healing (significantly older, higher body mass index, more medical comorbidities, higher blood loss, and longer operative time), there were no vaginal cuff dehiscences in the LAVH group compared with 17 vaginal cuff dehiscences (4%) in the TLH group (P = .02). Conclusion: It does not appear that the increased vaginal cuff dehiscence rate associated with TLH is due to electrosurgery; rather, it is due to the vaginal closure technique. PMID:24018078

  18. Facility target insert shielding assessment

    SciTech Connect

    Mocko, Michal

    2015-10-06

    Main objective of this report is to assess the basic shielding requirements for the vertical target insert and retrieval port. We used the baseline design for the vertical target insert in our calculations. The insert sits in the 12”-diameter cylindrical shaft extending from the service alley in the top floor of the facility all the way down to the target location. The target retrieval mechanism is a long rod with the target assembly attached and running the entire length of the vertical shaft. The insert also houses the helium cooling supply and return lines each with 2” diameter. In the present study we focused on calculating the neutron and photon dose rate fields on top of the target insert/retrieval mechanism in the service alley. Additionally, we studied a few prototypical configurations of the shielding layers in the vertical insert as well as on the top.

  19. Nursing considerations in patients with vaginitis.

    PubMed

    Holloway, Debra

    Vaginitis is defined as an inflammation of the vagina. It can result in symptoms of any or all of the following: discharge, itching and pain, and often irritation or infection of the vulva. There is no specific cause for vaginitis, and many other conditions can cause the symptoms. Vaginitis is a distressing condition that affects many women of reproductive age and beyond, and encompasses candidiasis (also known as thrush), bacterial vaginosis, and trichomoniasis. It can occur in a single episode, or recur throughout a woman's lifetime. Some women will seek medical help, but many more self-treat with over-the-counter medications, suspecting the recurrence of Candida in particular. This article aims to explore the causes, signs and symptoms, and treatments of vaginitis to provide nurses with the necessary background information to feel more confident in dealing with women's health issues.

  20. Vaginal birth after C-section

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000589.htm Vaginal birth after C-section To use the sharing features ... please enable JavaScript. If you had a cesarean birth (C-section) before, it does not mean that ...

  1. Vaginal Bleeding: MedlinePlus Health Topic

    MedlinePlus

    ... Bleeding (American Academy of Family Physicians) Also in Spanish Abnormal Uterine Bleeding (Beyond the Basics) (UpToDate) Abnormal ... College of Obstetricians and Gynecologists) - PDF Also in Spanish Vaginal Bleeding (Mayo Foundation for Medical Education and ...

  2. What Are the Symptoms of Vaginitis?

    MedlinePlus

    ... the type of vaginitis a woman has 1 : Bacterial vaginosis often causes a thin, milky discharge from the ... How is it diagnosed? » Related A-Z Topics Bacterial Vaginosis Sexually Transmitted Diseases (STDs) NICHD News and Spotlights ...

  3. [Vaginal reconstruction with tissue engineering technology].

    PubMed

    Zhang, Mingle; Li, Yachai; Huang, Xianghua

    2011-07-01

    To summarize the research and development of vaginal reconstruction with tissue engineering technology. The recent literature concerning vaginal reconstruction with tissue engineering technology at home and abroad was extensively reviewed and the research and development were summarized. Tissue engineering provides an ideal material as the inner tissue in vaginoplasty. The reconstructed tissue closely resembles native vaginal tissue in the cellular organization and physical properties. The clinical use of the tissue engineered vagina in vaginoplasty can not be harmful to an organism, and the neovagina has sufficient length and depth. However, the long-term follow-up is needed. Vaginal reconstruction with tissue engineering technology may have good application prospects, but further research is required.

  4. Vaginal Discharge: What's Normal, What's Not

    MedlinePlus

    ... amount of vaginal fluids to vary throughout a girl's menstrual cycle , some changes in discharge may indicate a problem. First, it helps to learn some of the differences between normal and abnormal ...

  5. How Do Health Care Providers Diagnose Vaginitis?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose vaginitis? Skip sharing on social media ... out the cause of a woman's symptoms, her health care provider will Examine the vagina, the vulva, and ...

  6. Relationship between contraceptive method and vaginal flora.

    PubMed

    Peddie, B A; Bishop, V; Bailey, R R; McGill, H

    1984-08-01

    This study was undertaken to assess whether the vaginal flora was affected by the method of contraception, and in particular as to whether the incidence of vaginal candidiasis increased when oral contraceptives were used. One thousand and two consecutive vaginal or cervical swabs from women attending a family planning centre were cultured. Candida albicans was isolated from 13% of women using no contraception, 16% using oral contraceptives, and from 9%, 19% and 18% of those using diaphragms, intrauterine contraceptive devices (IUCD) and condoms respectively. These differences were not statistically significant. Women using an IUCD had significantly more Gram-positive cocci cultured than women in any other group, while those using diaphragms had significantly more Gram-negative bacilli. Our clinical impression that the use of oral contraceptives led to an increase in vaginal candidiasis, was not confirmed by this study.

  7. Vaginal Discharge: What's Normal, What's Not

    MedlinePlus

    ... period Vaginal infections, such as bacterial vaginosis, candidiasis (yeast infection), and trichomoniasis are common causes of abnormal ... having sex, such as bacterial vaginosis or a yeast infection. If you notice any changes in your ...

  8. The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial.

    PubMed

    Ekin, Murat; Yaşar, Levent; Savan, Kadir; Temur, Muzaffer; Uhri, Mehmet; Gencer, Işıl; Kıvanç, Esra

    2011-03-01

    To compare the effectiveness of the vaginal tablets of hyaluronic acid and estrodiol for the treatment of atrophic vaginitis. Forty-two postmenopausal women with symptoms of atrophic vaginitis were randomized to take vaginal tablets of 25 μg estradiol (n = 21) (group I) or 5 mg hyaluronic acid sodium salt (n = 21) (group II) for 8 weeks. The symptoms of atrophic vaginitis were evaluated by a self-assessed 4-point scale of composite score and the degree of epithelial atrophy was determined as, none, mild, moderate and severe. Vaginal pH and maturation index were measured and compared in both the groups. The symptoms were relieved significantly in both the groups (P < 0.001). The relief of symptoms was significantly superior in group I compared with group II (P < 0.05). A significant decrease in epithelial atrophy and vaginal pH were detected in both the groups (P < 0.01) after treatment. The vaginal maturation values were also significantly improved at both study groups (P < 0.001). The mean maturation value was significantly higher in group I when compared with group II (P < 0.001). Both treatments provided relief of vaginal symptoms, improved epithelial atrophy, decreased vaginal pH, and increased maturation of the vaginal epithelium. Those improvements were greater in group I. Hyaluronic acid vaginal tablets can be used in patients with atrophic vaginitis who do not want to or can not take local estrogen treatment.

  9. Impedance calculation for ferrite inserts

    SciTech Connect

    Breitzmann, S.C.; Lee, S.Y.; Ng, K.Y.; /Fermilab

    2005-01-01

    Passive ferrite inserts were used to compensate the space charge impedance in high intensity space charge dominated accelerators. They study the narrowband longitudinal impedance of these ferrite inserts. they find that the shunt impedance and the quality factor for ferrite inserts are inversely proportional to the imaginary part of the permeability of ferrite materials. They also provide a recipe for attaining a truly passive space charge impedance compensation and avoiding narrowband microwave instabilities.

  10. Vaginal Health During Breast Cancer Treatment.

    PubMed

    Falk, Sandy J; Bober, Sharon

    2016-05-01

    There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result in effects on vaginal health that may affect quality of life. These effects may impact sexual function, daily comfort, or the ability to perform a pelvic examination. Vulvovaginal atrophy, or genitourinary syndrome of menopause, may be treated with nonhormonal or hormonal measures. Breast cancer survivors who are menopausal and/or on endocrine therapy should be screened for issues with vaginal health and counseled about treatment options.

  11. Effect of vaginal estrogen on pessary use

    PubMed Central

    Dessie, Sybil G.; Armstrong, Katherine; Modest, Anna M.; Hacker, Michele R.

    2016-01-01

    Introduction and hypothesis Many providers recommend concurrent estrogen therapy with pessary use to limit complications; however, limited data exist to support this practice. We hypothesized that vaginal estrogen supplementation decreases incidence of pessary-related complications and discontinuation. Methods We performed a retrospective cohort study of women who underwent a pessary fitting from 1 January 2007 through 1 September 2013 at one institution; participants were identified by billing code and were eligible if they were post-menopausal and had at least 3 months of pessary use and 6 months of follow-up. All tests were two sided, and P values < 0.05 were considered statistically significant. Results Data from 199 women were included; 134 used vaginal estrogen and 65 did not. Women who used vaginal estrogen had a longer median follow-up time (29.5 months) compared with women who did not (15.4 months) and were more likely to have at least one pessary check (98.5 % vs 86.2 %, P < 0.001). Those in the estrogen group were less likely to discontinue using their pessary (30.6 % vs 58.5 %, P < 0.001) and less likely to develop increased vaginal discharge than women who did not [hazard ratio (HR) 0.31, 95 % confidence interval (CI) 0.17–0.58]. Vaginal estrogen was not protective against erosions (HR 0.93, 95 % CI 0.54–1.6) or vaginal bleeding (HR 0.78, 95 % CI 0.36–1.7). Conclusions Women who used vaginal estrogen exhibited a higher incidence of continued pessary use and lower incidence of increased vaginal discharge than women who did not. PMID:26992727

  12. Vaginal Rejuvenation with Gore-Mycromesh.

    PubMed

    Park, Tae Hwan; Whang, Kwi Whan

    2015-08-01

    Recently, we introduced functional vaginal rejuvenation with elastic silicone threads. However, some patients with specific indications need other biocompatible materials for rejuvenation of the vagina. Gore-Mycromesh is one of the most commonly used materials in plastic and reconstructive surgical fields and it is composed of expanded poly-tetrafluroethylene. In this study, we introduced our clinical experience with static vaginal rejuvenation using Gore-Mycromesh to specifically assess the overall patient satisfaction (Female Sexual Function Index, FSFI). This study included 50 patients who underwent vaginal rejuvenation with a Gore-Mycromesh between 2010 and 2012. After marking two incisions at the inner side of the vaginal inlet and posterior wall, respectively, we performed submucosal dissection at the posterior vaginal wall and then grafted and secured a Gore-Mycromesh to the dissected area (muscle/fascia). Overall the FSFI improved as time progressed up to a year postoperatively. This is especially prominent in the FSFI satisfaction subscore. All but eight patients (42/50, 84 %) were "very satisfied (5)" or "satisfied (4)" with the outcomes after the vaginal rejuvenation. The overall complication rate was 8 %. Based on our clinical experience with the 50 cases, we think that vaginal rejuvenation with Gore-Mycromesh significantly improved postoperative outcomes, resulting in improved sexual function with a focus on improving the FSFI satisfaction subscore in mid-term follow-up. Elderly patients experience better outcomes using gore mycromesh rather than silicone thread because we can plicate the vaginal posterior wall with senile changes simultaneously using an open technique. However, further studies would be warranted for better positioning and adherence of grafted implants to surrounding tissue and for increasing the tightening effect of the implant and its sufficient longevity.

  13. Vaginal microbiota and viral sexually transmitted diseases.

    PubMed

    Nardis, C; Mosca, L; Mastromarino, P

    2013-01-01

    Healthy vaginal microbiota is an important biological barrier to pathogenic microorganisms. When this predominantly Lactobacillus community is disrupted, decreased in abundance and replaced by different anaerobes, bacterial vaginosis (BV) may occur. BV is associated with prevalence and incidence of several sexually transmitted infections. This review provides background on BV, discusses the epidemiologic data to support a role of altered vaginal microbiota for acquisition of sexually transmitted diseases and analyzes mechanisms by which lactobacilli could counteract sexually transmitted viral infections.

  14. Mechanisms for Complex Chromosomal Insertions

    PubMed Central

    Szafranski, Przemyslaw; Akdemir, Zeynep Coban; Yuan, Bo; Cooper, Mitchell L.; Magriñá, Maria A.; Bacino, Carlos A.; Lalani, Seema R.; Patel, Ankita; Song, Rodger H.; Bi, Weimin; Cheung, Sau Wai; Carvalho, Claudia M. B.; Lupski, James R.

    2016-01-01

    Chromosomal insertions are genomic rearrangements with a chromosome segment inserted into a non-homologous chromosome or a non-adjacent locus on the same chromosome or the other homologue, constituting ~2% of nonrecurrent copy-number gains. Little is known about the molecular mechanisms of their formation. We identified 16 individuals with complex insertions among 56,000 individuals tested at Baylor Genetics using clinical array comparative genomic hybridization (aCGH) and fluorescence in situ hybridization (FISH). Custom high-density aCGH was performed on 10 individuals with available DNA, and breakpoint junctions were fine-mapped at nucleotide resolution by long-range PCR and DNA sequencing in 6 individuals to glean insights into potential mechanisms of formation. We observed microhomologies and templated insertions at the breakpoint junctions, resembling the breakpoint junction signatures found in complex genomic rearrangements generated by replication-based mechanism(s) with iterative template switches. In addition, we analyzed 5 families with apparently balanced insertion in one parent detected by FISH analysis and found that 3 parents had additional small copy-number variants (CNVs) at one or both sides of the inserting fragments as well as at the inserted sites. We propose that replicative repair can result in interchromosomal complex insertions generated through chromothripsis-like chromoanasynthesis involving two or three chromosomes, and cause a significant fraction of apparently balanced insertions harboring small flanking CNVs. PMID:27880765

  15. Mechanisms for Complex Chromosomal Insertions.

    PubMed

    Gu, Shen; Szafranski, Przemyslaw; Akdemir, Zeynep Coban; Yuan, Bo; Cooper, Mitchell L; Magriñá, Maria A; Bacino, Carlos A; Lalani, Seema R; Breman, Amy M; Smith, Janice L; Patel, Ankita; Song, Rodger H; Bi, Weimin; Cheung, Sau Wai; Carvalho, Claudia M B; Stankiewicz, Paweł; Lupski, James R

    2016-11-01

    Chromosomal insertions are genomic rearrangements with a chromosome segment inserted into a non-homologous chromosome or a non-adjacent locus on the same chromosome or the other homologue, constituting ~2% of nonrecurrent copy-number gains. Little is known about the molecular mechanisms of their formation. We identified 16 individuals with complex insertions among 56,000 individuals tested at Baylor Genetics using clinical array comparative genomic hybridization (aCGH) and fluorescence in situ hybridization (FISH). Custom high-density aCGH was performed on 10 individuals with available DNA, and breakpoint junctions were fine-mapped at nucleotide resolution by long-range PCR and DNA sequencing in 6 individuals to glean insights into potential mechanisms of formation. We observed microhomologies and templated insertions at the breakpoint junctions, resembling the breakpoint junction signatures found in complex genomic rearrangements generated by replication-based mechanism(s) with iterative template switches. In addition, we analyzed 5 families with apparently balanced insertion in one parent detected by FISH analysis and found that 3 parents had additional small copy-number variants (CNVs) at one or both sides of the inserting fragments as well as at the inserted sites. We propose that replicative repair can result in interchromosomal complex insertions generated through chromothripsis-like chromoanasynthesis involving two or three chromosomes, and cause a significant fraction of apparently balanced insertions harboring small flanking CNVs.

  16. The vaginal microbiome: rethinking health and diseases

    PubMed Central

    Ma, Bing; Forney, Larry J.; Ravel, Jacques

    2013-01-01

    Vaginal microbiota form a mutually beneficial relationship with their host and have major impact on health and disease. In recent years our understanding of vaginal bacterial community composition and structure has significantly broadened as a result of investigators using cultivation-independent methods based on the analysis of 16S ribosomal RNA (rRNA) gene sequences. In asymptomatic, otherwise healthy women, several kinds of vaginal microbiota exist, the majority often dominated by species of Lactobacillus, while others comprise a diverse array of anaerobic microorganisms. Bacterial vaginosis is the most common vaginal conditions and is vaguely characterized as the disruption of the equilibrium of the ‘normal’ vaginal microbiots. A better understanding of ‘normal’ and ‘healthy’ vaginal ecosystems that is based on its ‘true’ function and not simply on its composition would help better define health and further improve disease diagnostics as well as the development of more personalized regimens to promote health and treat diseases. PMID:22746335

  17. Consistently inconsistent, the posterior vaginal wall.

    PubMed

    Hale, Douglass S; Fenner, Dee

    2016-03-01

    Posterior vaginal wall prolapse is one of the most common prolapses encountered by gynecological surgeons. What appears to be a straightforward condition to diagnose and treat surgically for physicians has proven to be frustratingly unpredictable with regard to symptom relief for patients. Functional disorders such as dyssynergic defecation and constipation are often attributed to posterior vaginal wall prolapse. Little scientific evidence supports this assumption, emphasizing that structure and function are not synonymous when treating posterior vaginal wall prolapse. Rectoceles, enteroceles, sigmoidoceles, peritoneoceles, rectal and intraanal intussusception, rectal prolapse, and descending perineal syndrome are all conditions that have an impact on the posterior vaginal wall. All too often these different anatomic conditions are treated with the same surgical approach, addressing a posterior vaginal wall bulge with a traditional posterior colporrhaphy. Studies that examine the correlation between stage of posterior wall prolapse and patient symptoms have failed to reliably do so. Surgical outcomes measured by prolapse staging appear successful, yet patient expectations are often not met. As increasing attention is being placed on patient satisfaction outcomes concerning surgical treatments, this fact will need to be addressed. Surgeons will have to clearly communicate what can and what cannot be expected with surgical repair of posterior vaginal wall prolapse. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Incidental vaginal müllerianosis.

    PubMed

    Val-Bernal, José-Fernando; Mayorga, Marta

    2016-06-01

    Müllerianosis is the term used to designate lesions composed of an admixture of two or three types of müllerian-derivation glands in heterotopic location. In this report, we describe a case of incidental vaginal müllerianosis in a 59-year-old woman who underwent rectosigmoidectomy for rectal adenocarcinoma. In the vaginal cuff removed for neoplastic invasion, a separate multilocular mass measuring 1.5cm was found. The microscopic examination of the vaginal wall revealed endosalpingeal, endocervical and endometrial dilated or cystic glands with predominance of the endosalpingeal epithelium. Müllerian epithelium showed positivity for cytokeratins 7 and 8/18, high molecular weight cytokeratin, estrogen receptor alpha, and androgen receptor. The periglandular stroma was condensed and reactive for smooth-muscle actin, h-caldesmon, and CD10. To the best of our knowledge, a case of vaginal müllerianosis has not been previously reported. This lesion should be differentiated form vaginal adenosis and primary well-differentiated vaginal adenocarcinoma. The vagina should be added to the list of locations in which müllerianosis can be observed. Copyright © 2016 Elsevier GmbH. All rights reserved.

  19. Vaginal Dysbiosis from an Evolutionary Perspective

    PubMed Central

    Schlabritz-Loutsevitch, Natalia; Gygax, Scott E; Dick, Edward; Smith, William L.; Snider, Cathy; Hubbard, Gene; Ventolini, Gary

    2016-01-01

    Evolutionary approaches are powerful tools for understanding human disorders. The composition of vaginal microbiome is important for reproductive success and has not yet been characterized in the contexts of social structure and vaginal pathology in non-human primates (NHPs). We investigated vaginal size, vulvovaginal pathology and the presence of the main human subtypes of Lactobacillus spp./ BV-related species in the vaginal microflora of baboons (Papio spp.). We performed morphometric measurements of external and internal genitalia (group I, n = 47), analyzed pathology records of animals from 1999–2015 (group II, n = 64 from a total of 12,776), and evaluated vaginal swabs using polymerase chain reaction (PCR) (group III, n = 14). A total of 68 lesions were identified in 64 baboons. Lactobacillus iners, Gardnerella vaginalis, Atopobium vaginae, Megasphaera I, and Megasphaera II were not detected. L. jensenii, L. crispatus, and L. gasseri were detected in 2/14 (14.2%), 1/14 (7.1%), and 1/14 (7.1%) samples, respectively. BVAB2 was detected in 5/14 (35.7%) samples. The differences in the vaginal milieu between NHP and humans might be the factor associated with human-specific pattern of placental development and should be taken in consideration in NHP models of human pharmacology and microbiology. PMID:27226349

  20. Insertion device and method for accurate and repeatable target insertion

    DOEpatents

    Gubeli, III, Joseph F.; Shinn, Michelle D.; Bevins, Michael E.; Dillon-Townes, Lawrence; Neil, George R.

    2017-07-04

    The present invention discloses a device and a method for inserting and positioning a target within a free electron laser, particle accelerator, or other such device that generates or utilizes a beam of energy or particles. The system includes a three-point registration mechanism that insures angular and translational accuracy and repeatability of positioning upon multiple insertions within the same structure.

  1. Comparison of intramenstrual IUD insertion with insertion following menstrual regulation.

    PubMed

    Otolorin, E O; Ladipo, O A

    1985-03-01

    To evaluate the use-effectiveness and safety of IUD insertion immediately after menstrual regulation (MR) for delayed menses, a Lippes Loop D (LLD) intrauterine device was inserted in each of 100 consecutive clients at the University College Hospital, Ibadan, immediately after menstrual regulation. Pertinent event rates after 12 months of use were compared with those of 100 consecutive women who had the LLD inserted during menstruation. The cumulative net expulsion rate after 12 months of use was 8% for the study group and 4% for the controls. The overall rate of removals was 15% for the study group and 16% for the control group. None of the observed differences was statistically significant. The continuation rates at 12 months were comparable for both groups (78% and 80%, respectively). There were no accidental pregnancies during the study period. The authors suggest that IUD insertion immediately after menstrual regulation is as effective and safe as intramenstrual insertion, provided prophylactic antibiotics are given.

  2. Twice-daily application of HIV microbicides alter the vaginal microbiota.

    PubMed

    Ravel, Jacques; Gajer, Pawel; Fu, Li; Mauck, Christine K; Koenig, Sara S K; Sakamoto, Joyce; Motsinger-Reif, Alison A; Doncel, Gustavo F; Zeichner, Steven L

    2012-12-18

    be one of the most promising female-controlled products, in that women themselves insert the microbicides into the vagina to prevent HIV transmission during sexual intercourse. The failure of several microbicides in clinical trials has raised questions concerning the low in vivo efficacy of such anti-HIV molecules. This study was designed to gain insights into the failures of two microbicides by testing the hypothesis that the microbicides negatively affect a critical line of defense against HIV, the vaginal microbiota. The results suggest that in the early assessment of candidate microbicides, culture-independent evaluation of their effect on the vaginal microbiota should be considered and may constitute a critical endpoint.

  3. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis.

    PubMed

    Brody, Stuart; Weiss, Petr

    2010-08-01

    Evidence was recently provided for vaginal orgasm, orgasm triggered purely by penile-vaginal intercourse (PVI), being associated with better psychological functioning. Common sex education and sexual medicine approaches might undermine vaginal orgasm benefits. To examine the extent to which women's vaginal orgasm consistency is associated with (i) being told in childhood or adolescence that the vagina was the important zone for inducing female orgasm; (ii) how well they focus mentally on vaginal sensations during PVI; (iii) greater PVI duration; and (iv) preference for above-average penis length.   In a representative sample of the Czech population, 1,000 women reported their vaginal orgasm consistency (from never to almost every time; only 21.9% never had a vaginal orgasm), estimates of their typical foreplay and PVI durations, what they were told in childhood and adolescence was the important zone for inducing female orgasm, their degree of focus on vaginal sensations during PVI, and whether they were more likely to orgasm with a longer than average penis. The association of vaginal orgasm consistency with the predictors noted above. Vaginal orgasm consistency was associated with all hypothesized correlates. Multivariate analysis indicated the most important predictors were being educated that the vagina is important for female orgasm, being mentally focused on vaginal sensations during PVI, and in some analyses duration of PVI (but not foreplay) and preferring a longer than average penis. Focusing attention on penile-vaginal sensation supports vaginal orgasm and the myriad benefits thereof. Brody S, and Weiss P. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis. © 2009 International Society for Sexual Medicine.

  4. Concomitant Imperforate Hymen and Transverse Vaginal Septum Complicated with Pyocolpos and Abdominovaginal Fistula

    PubMed Central

    Dilbaz, Berna; Kiykac Altinbas, Sadiman; Altinbas, Namik Kemal; Sengul, Ozlem; Dilbaz, Serdar

    2014-01-01

    A 13-year-old patient with a complaint of worsening lower abdominal pain during the past 4 months was admitted to the emergency department. An abdominopelvic ultrasound scan revealed a distended uterocervical cavity suggestive of hematometrocolpos. Imperforate hymen was observed on examination of the external genitalia. MRI scan revealed an air-fluid level representing pyometrocolpos within a distended vagina. Posterior vaginal extraperitoneal leakage as the sign of a fistula between the vagina and the rectovaginal space was detected. Although laparoscopic approach was planned, malodorous pus expelled after the insertion of the Veress needle, it was decided to proceed to laparotomy. Pus with peritoneal microabscess formations was observed at laparotomy. The imperforate hymen and TVS were excised vaginally. A more complex anomaly should be suspected in cases with hematometra and concomitant imperforated hymen without any bulging and thorough evaluation using radiological imaging techniques should be performed before surgical approach. PMID:24660080

  5. Vaginal practices: eroticism and implications for women's health and condom use in Mozambique.

    PubMed

    Bagnol, Brigitte; Mariano, Esmeralda

    2008-08-01

    This paper analyses two female sexual practices in Tete Province, Mozambique: (1) the practice of elongating the labia minora and (2) what is sometimes called 'dry sex' involving the insertion of natural and/or synthetic products into the vagina or the ingestion of these products orally. These practices are fundamental to the construction of female identity, eroticism and the experience of pleasure. Notions such as 'closed/open', 'dry/damp', 'hot/cold', 'heavy/light', 'life/death', 'wealth/poverty' and 'sweet/not sweet' are central to local understandings of sexual practices and reproduction. These notions may affect the women's sexual health because they influence preferences for sex without a condom. These practices may also be associated with the alteration of the vaginal flora and vaginal lesions that may make women more vulnerable to sexually transmitted infections.

  6. Sink Inserts for Flood Prevention

    NASA Astrophysics Data System (ADS)

    Fleming, Fraser F.; Bodnar, Daniel J.; Hardesty, David L.

    2004-09-01

    A simple, inexpensive insert is described for preventing flooding in lab sinks. The insert is essentially a tube with slots cut into the side that fits snugly into the drain outlet, preventing water buildup and providing additional drainage sites to avoid constriction by small lab items and paper towels.

  7. Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy.

    PubMed

    Abe, Akiko; Matoda, Maki; Okamoto, Sanshiro; Kondo, Eiji; Kato, Kazuyoshi; Omatsu, Kohei; Umayahara, Kenji; Utsugi, Kuniko; Takeshima, Nobuhiro

    2015-04-02

    We describe our experiences with vaginal vault resection for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. After operative treatment, the rate of vaginal vault recurrence of uterine cervical cancer is reported to be about 5%. There is no consensus regarding the treatment for these cases. Between 2004 and 2012, eight patients with vaginal vault recurrence underwent removal of the vaginal wall via laparotomy after hysterectomy and radiotherapy. The median patient age was 45 years (range 35 to 70 years). The median operation time was 244.5 min (range 172 to 590 min), the median estimated blood loss was 362.5 mL (range 49 to 1,890 mL), and the median duration of hospitalization was 24.5 days (range 11 to 50 days). Two patients had intraoperative complications: a grade 1 bowel injury and a grade 1 bladder injury. The following postoperative complications were observed: one patient had vaginal vault bleeding, three patients developed vesicovaginal fistulae, and one patient had repeated ileus. Two patients needed clean intermittent catheterization. Local control was achieved in five of the eight cases. Vaginal vault resection is an effective treatment for vaginal recurrence of cervical cancer after hysterectomy and radiotherapy. However, complications of this procedure can be expected to reduce quality of life. Therefore, this operation should be selected with great care.

  8. Expansion of altered vaginal flora states in vaginitis to include a spectrum of microflora.

    PubMed

    Fowler, R Stuart

    2007-02-01

    To define the existence of 2 patterns of altered vaginal flora in symptomatic women identified on wet preparations that are not in the current vaginitis classification system. Testing of vaginal secretions from gynecologic patients at Mayo Clinic, Scottsdale, Arizona, who presented with vulvo-vaginal symptoms by vaginal pH, whiff testing, and saline and potassium hydroxide wet preparations. Over 14 years, approximately 5,000 samples were analyzed. Wet preparations were analyzed under low- (x 100) and high-power (x 400) phase-contrast microscopy. The first pattern has mixed bacteria with few or no lactobacilli, increased leukocytes and elevated pH. This pattern has a spectrum of severity, with the severe form meeting the diagnostic definition of desquamative inflammatory vaginitis. The mild-to-moderate form, termed inflammatory vaginitis, falls outside established diagnostic categories. The second pattern also has a spectrum of severity. The mild-to-moderate form, termed noninflammatory vaginosis, has mixed bacteria speckling squamous cells (but not obscuring edges), few or no lactobacilli, no leukocyte response and mildly elevated pH. This form differs from the severe form, which meets Amsel's criteria for bacterial vaginosis. The current classification system requires revision because it oversimplifies and ignores the full spectrum of altered vaginal microflora.

  9. Patterns of Expression of Vaginal T-Cell Activation Markers during Estrogen-Maintained Vaginal Candidiasis.

    PubMed

    Al-Sadeq, Ameera; Hamad, Mawieh; Abu-Elteen, Khaled

    2008-12-15

    : The immunosuppressive activity of estrogen was further investigated by assessing the pattern of expression of CD25, CD28, CD69, and CD152 on vaginal T cells during estrogen-maintained vaginal candidiasis. A precipitous and significant decrease in vaginal fungal burden toward the end of week 3 postinfection was concurrent with a significant increase in vaginal lymphocyte numbers. During this period, the percentage of CD3+, CD3+CD4+, CD152+, and CD28+ vaginal T cells gradually and significantly increased. The percentage of CD3+ and CD3+CD4+ cells increased from 43% and 15% at day 0 to 77% and 40% at day 28 postinfection. Compared with 29% CD152+ vaginal T cells in naive mice, > 70% of vaginal T cells were CD152+ at day 28 postinfection. In conclusion, estrogen-maintained vaginal candidiasis results in postinfection time-dependent changes in the pattern of expression of CD152, CD28, and other T-cell markers, suggesting that T cells are subject to mixed suppression and activation signals.

  10. Patterns of Expression of Vaginal T-Cell Activation Markers during Estrogen-Maintained Vaginal Candidiasis

    PubMed Central

    2008-01-01

    The immunosuppressive activity of estrogen was further investigated by assessing the pattern of expression of CD25, CD28, CD69, and CD152 on vaginal T cells during estrogen-maintained vaginal candidiasis. A precipitous and significant decrease in vaginal fungal burden toward the end of week 3 postinfection was concurrent with a significant increase in vaginal lymphocyte numbers. During this period, the percentage of CD3+, CD3+CD4+, CD152+, and CD28+ vaginal T cells gradually and significantly increased. The percentage of CD3+ and CD3+CD4+ cells increased from 43% and 15% at day 0 to 77% and 40% at day 28 postinfection. Compared with 29% CD152+ vaginal T cells in naive mice, > 70% of vaginal T cells were CD152+ at day 28 postinfection. In conclusion, estrogen-maintained vaginal candidiasis results in postinfection time-dependent changes in the pattern of expression of CD152, CD28, and other T-cell markers, suggesting that T cells are subject to mixed suppression and activation signals. PMID:20525139

  11. Thromboprophylaxis post vaginal delivery: are we forgetting it? Audit on thromboprophylaxis prescription post vaginal births.

    PubMed

    Tan, E K; Wisdom, S J

    2006-01-01

    Pulmonary thromboembolism is the leading direct cause of maternal deaths in the UK. The majority of deaths occur in the puerperium. Caesarean section has been recognised as a risk factor but there is concern that more attention to thromboprophylaxis after vaginal births is needed. The hospital maternity unit in Dumfries has written guidelines on thromboprophylaxis after vaginal births. This audit assessed the compliance with these guidelines within this maternity unit. The case notes relating to spontaneous vaginal births over a 2-month period (n=148) and instrumental vaginal births over a 7-month period (n=29) were reviewed. Information concerning venous thromboembolism risk and any thromboprophylaxis given was extracted. The audit showed that 9% of spontaneous vaginal births and 62% of instrumental vaginal births required specific thromboprophylaxis. However, only 31% of the spontaneous vaginal births and 22% of the instrumental vaginal births in which thromboprophylaxis was indicated did indeed receive the required treatment. Failure to respond to venous thromboembolism risk factors was common. Measures to increase the awareness of maternity staff to these factors are suggested.

  12. Management of vaginal extrusion after tension-free vaginal tape procedure for urodynamic stress incontinence.

    PubMed

    Giri, Subhasis K; Sil, Debasri; Narasimhulu, Girish; Flood, Hugh D; Skehan, Mark; Drumm, John

    2007-06-01

    To report our experience in the management of vaginal extrusion after the tension-free vaginal tape (TVT) procedure for urodynamic stress incontinence. Five patients diagnosed with vaginal extrusion after a TVT procedure performed at our institution were identified. We reviewed the patients' records retrospectively. The interval from TVT placement to diagnosis, presenting symptoms and signs, duration of symptoms, diagnostic test findings, treatment, and postoperative results were recorded. Patients were followed up for at least 12 months. From January 2001 to June 2004, a total of 166 patients underwent the TVT procedure. Of these, 5 patients (3%) were diagnosed with isolated vaginal extrusion 4 to 40 months postoperatively. No cases of urethral or bladder erosion occurred in this series. The symptoms included vaginal discharge, pain, bleeding, and dyspareunia. The eroded margin of the vaginal mucosa was trimmed, mobilized, and closed over the tape with interrupted vertical mattress sutures in a single layer using 2-0 polyglactin 910 to avoid mucosal inversion. All patients remained symptom free without any evidence of defective healing or additional extrusion at a minimal follow-up of 12 months. Primary reclosure of the vaginal mucosa over the TVT tape is an effective first-line treatment option for vaginal extrusion without compromising continence. Patients undergoing the TVT procedure should be adequately counseled about the possibility of this complication and the available treatment options.

  13. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term.

    PubMed

    Kelly, Anthony J; Malik, Sidra; Smith, Lee; Kavanagh, Josephine; Thomas, Jane

    2009-10-07

    Prostaglandins have been used for induction of labour since the 1960s. Initial work focused on prostaglandin F2a as prostaglandin E2 was considered unsuitable for a number of reasons. With the development of alternative routes of administration, comparisons were made between various formulations of vaginal prostaglandins. To determine the effects of vaginal prostaglandins E2 and F2a for third trimester cervical ripening or induction of labour in comparison with placebo/no treatment or other vaginal prostaglandins (except misoprostol). We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009) and bibliographies of relevant papers. Clinical trials comparing vaginal prostaglandins used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. We assessed studies and extracted data independently. Sixty-three (10,441 women) have been included.Vaginal prostaglandin E2 compared with placebo or no treatment reduced the likelihood of vaginal delivery not being achieved within 24 hours (18.1% versus 98.9%, risk ratio (RR) 0.19, 95% confidence interval (CI) 0.14 to 0.25, two trials, 384 women). The risk of the cervix remaining unfavourable or unchanged was reduced (21.6% versus 40.3%, RR 0.46, 95% CI 0.35 to 0.62, five trials, 467 women); and the risk of oxytocin augmentation reduced (35.1% versus 43.8%, RR 0.83, 95% CI 0.73 to 0.94, 12 trials, 1321 women) when PGE2 was compared to placebo. There was no evidence of a difference between caesarean section rates, although the risk of uterine hyperstimulation with fetal heart rate changes was increased (4.4% versus 0.49%, RR 4.14, 95% CI 1.93 to 8.90, 14 trials, 1259 women).PGE2 tablet, gel and pessary appear to be as efficacious as each other and the use of sustained release PGE2 inserts appear to be associated with a reduction in instrumental vaginal delivery rates (9.9 % versus 19.5%, RR 0

  14. Vaginal film for prevention of HIV: using visual and tactile evaluations among potential users to inform product design.

    PubMed

    Guthrie, K M; Rohan, L; Rosen, R K; Vargas, S E; Shaw, J G; Katz, D; Kojic, E M; Ham, A S; Friend, D; Buckheit, K W; Buckheit, R W

    2017-06-21

    Topical prevention of HIV and other STIs is a global health priority. To provide options for users, developers have worked to design safe, effective and acceptable vaginal dissolving film formulations. We aimed to characterize user experiences of vaginal film size, texture and color, and their role in product-elicited sensory perceptions (i.e. perceptibility), acceptability and willingness to use. In the context of a user-centered product evaluation study, we elicited users' 'first impressions' of various vaginal film formulation designs via visual and tactile prototype inspection during a qualitative user evaluation interview. Twenty-four women evaluated prototypes. Participants considered size and texture to be important for easy insertion. Color was more important following dissolution than prior to insertion. When asked to combine and balance all properties to arrive at an ideal film, previously stated priorities for individual characteristics sometimes shifted, with the salience of some individual characteristics lessening when multiple characteristics were weighted in combination. While first impressions alone may not drive product uptake, users' willingness to initially try a product is likely impacted by such impressions. Developers should consider potential users' experiences and preferences in vaginal film design. This user-focused approach is useful for characterizing user sensory perceptions and experiences relevant to early design of prevention technologies.

  15. Semaphorin 4D induces vaginal epithelial cell apoptosis to control mouse postnatal vaginal tissue remodeling.

    PubMed

    Ito, Takuji; Bai, Tao; Tanaka, Tetsuji; Yoshida, Kenji; Ueyama, Takashi; Miyajima, Masayasu; Negishi, Takayuki; Kawasaki, Takahiko; Takamatsu, Hyota; Kikutani, Hitoshi; Kumanogoh, Atsushi; Yukawa, Kazunori

    2015-02-01

    The opening of the mouse vaginal cavity to the skin is a postnatal tissue remodeling process that occurs at approximately five weeks of age for the completion of female genital tract maturation at puberty. The tissue remodeling process is primarily composed of a hormonally triggered apoptotic process predominantly occurring in the epithelium of the distal section of the vaginal cavity. However, the detailed mechanism underlying the apoptotic induction remains to be elucidated. In the present study, it was observed that the majority of BALB/c mice lacking the class 4 semaphorin, semaphorin 4D (Sema4D), developed imperforate vagina and hydrometrocolpos resulting in a perpetually unopened vaginal cavity regardless of a normal estrogen level comparable with that in wild‑type (WT) mice. Administration of β‑estradiol to infant Sema4D‑deficient (Sema4D‑/‑) mice did not induce precocious vaginal opening, which was observed in WT mice subjected to the same β‑estradiol administration, excluding the possibility that the closed vaginal phenotype was due to insufficient estrogen secretion at the time of vaginal opening. In order to assess the role of Sema4D in the postnatal vaginal tissue remodeling process, the expression of Sema4D and its receptor, plexin‑B1, was examined as well as the level of apoptosis in the vaginal epithelia of five‑week‑old WT and Sema4D‑/‑ mice. Immunohistochemical analyses confirmed the localization of Sema4D and plexin‑B1 in the mouse vaginal epithelia. Terminal deoxynucleotidyl transferase dUTP nick end labeling assay and immunohistochemistry detecting activated caspase‑3 revealed significantly fewer apoptotic cells in situ in the vaginal mucosa of five‑week‑old Sema4D‑/‑ mice compared with WT mice. The addition of recombinant Sema4D to Sema4D‑/‑ vaginal epithelial cells in culture significantly enhanced apoptosis of the vaginal epithelial cells, demonstrating the apoptosis‑inducing activity of Sema4D. The

  16. Is vaginal microscopy an essential tool for the management of women presenting with vaginal discharge?

    PubMed

    Lascar, R M; Devakumar, H; Jungmann, E; Copas, A; Arthur, G; Mercey, D

    2008-12-01

    Point-of-care microscopy is the gold standard for the diagnosis of vaginal discharge in genitourinary (GU) medicine clinics but not used in primary care settings and reproductive health clinics to which many patients present. In our GU medicine clinic setting, we conducted an audit to assess the utility of microscopy of vaginal secretions versus clinical diagnosis alone for the differential diagnosis of uncomplicated lower vaginal infections. Clinical diagnosis (including pH) of bacterial vaginosis had a sensitivity between 85% and 88% at two clinic sites. Our results suggest that it may be safe and more cost-effective to restrict vaginal microscopy to a subgroup of women presenting with vaginal discharge.

  17. Current status of frameless anchored IUD for immediate intracesarean insertion.

    PubMed

    Wildemeersch, Dirk; Goldstuck, Norman D; Hasskamp, Thomas

    2016-01-01

    Immediate postpartum intrauterine device (IUD) insertion deserves great attention as it can provide immediate, timely and convenient contraception plus the added benefit of preventing repeat unintended pregnancies. Although women post vaginal delivery can benefit from immediate post-placenta contraception, women undergoing Cesarean section clearly need contraception, as an inter-delivery interval shorter than 18 months places them at a high risk for uterine rupture. The main drawback of currently available framed IUD devices for immediate postpartum insertion of an IUD is their high expulsion and displacement rates when inserted immediately postpartum after both vaginal and Cesarean delivery. Current research suggests that a brief window of opportunity exists of 10 minutes for insertion of conventional IUDs after which time expulsion rates both immediately and over time are greatly enhanced. This paper summarizes the current research conducted to overcome the expulsion problems associated with conventional T-shaped devices as well as through the use of an anchored frameless device. In the 1970s and 1980s, attempts were made to solve the expulsion problem by modifying existing devices, such as adding absorbable sutures (Delta-T) or additional appendages. These attempts proved to be clinically unsuccessful as the catgut suture added to the transverse arms did not provide sufficient resistance to prevent downward displacement and expulsion. An anchoring technique to suspend a copper IUD to the fundus of the uterus was developed in Belgium in the 1980s and has been the subject of extensive ongoing clinical research since 1985. Recently the frameless copper releasing anchor IUD, GyneFix, has been tested for postplacental insertion. Initially, the anchor was modified by the inclusion of a biodegradable cone which was added below the anchoring knot. Clinical studies confirmed the adequacy of this approach suggesting that it was technically possible to anchor an IUD

  18. Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications?

    PubMed

    Bulchandani, Supriya; Toozs-Hobson, Philip; Verghese, Tina; Latthe, Pallavi

    2015-12-01

    Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse. © The Author(s) 2015.

  19. Vaginal estrogen preparations: a review of safety and efficacy for vaginal atrophy.

    PubMed

    Crandall, Carolyn

    2002-12-01

    A theoretical advantage of local (i.e., vaginal) therapy of genitourinary symptoms could be avoidance of systemic adverse effects. Review of efficacy and adverse effects of commonly prescribed vaginal estrogens is of great clinical relevance. A Medline (1966-present) search was performed for randomized controlled trials involving vaginal estrogens. Reference lists of papers were reviewed for additional references. Twenty-two references were randomized controlled trials of vaginal estrogens used by postmenopausal women with signs or symptoms of vaginal atrophy. Subject numbers ranged from 20 to 251. Duration ranged from 2 weeks to 1 year. Different preparations and schedules were used across the trials. All treatments alleviated signs and symptoms of atrophic vaginitis, regardless of whether objective signs of atrophy were required for study entry. Data for urinary symptoms was conflicting; the ring may prevent recurrent urinary tract infections (UTIs). The trials with endometrial scrutiny were less than one year and had mixed results. Nonhormonal lubricant is effective in improving some atrophic signs and symptoms. All preparations were associated with vaginal irritation. Bleeding with vaginal estradiol tablets may be less than that with CEE cream. Vaginal tablets or rings were preferred over other preparations. There were no serious adverse events reported. There was occasional expulsion of estradiol ring in the setting of prior hysterectomy. All preparations are effective in decreasing signs and symptoms of vaginal atrophy, but they differ slightly in their adverse event profiles. Long-term safety of the preparations is best established for estradiol tablets (1 year), but is lacking for all preparations.

  20. [Evaluation of efficacy of ketoconazole 800 mg-clindamycin 100 mg tablets vaginal against ketoconazole 800 mg- clindamycin 100 mg vaginal capsules in candida vaginitis and vaginosis].

    PubMed

    Martínez-García, Alfonso; Cejudo-Alvarez, José; Bravo-Topete, Enrique Gómez; Herrera-Villalobos, Javier Edmundo; Garibay-Valencia, Miguel; Mirabent-González, Felio

    2011-02-01

    pharmaceutical forms (presentations) influence treatment compliance and therefore the effectiveness. Here we present the results in the relief of vaginitis and vaginosis with two different dosage forms. To compare the efficacy and safety of a combination of ketoconazole 800 mg + clindamycin in soft vaginal gel capsules 100 mg (vaginal capsules) against ketoconazole 800 mg + 100 mg clindamycin vaginal tablets (TV) in the management of vaginitis by C. albicans and/or vaginosis. In a randomized, multicenter, comparative open label study, patients between 18 and 60 years with a diagnosis of vaginitis by C. albicans and/or vaginosis were included. Patients were evaluated clinically and direct exam of genital discharge and culture were performed. Patients were randomized to one of two treatments vaginal tablets or vaginal capsules, for 3 days. one hundred an sitxty nine patients were included, 85 in TV Group and 84 in vaginal capsules group. We found significant statistical difference in clinical response for tablet group at day three for burning p = 0.032 and itching p = 0.043. Microbiological cure was observed in patients with vaginitis by C. albicans, 92.5% in Group TV vs. 90.47% vaginal capsules group, all patients with G. vaginalis at baseline were negative for the organism at the end of the study, cure in patients with mixed infections were 78.94% for TV group vs. 78.26% vaginal capsules; group no adverse events were reported during treatment. Treatment of vaginitis/vaginosis with vaginal tablets is clinically better than vaginal soft gelatin capsules both treatments were well tolerated.

  1. A cross cultural study of vaginal practices and sexuality: implications for sexual health.

    PubMed

    Martin Hilber, Adriane; Hull, Terence H; Preston-Whyte, Eleanor; Bagnol, Brigitte; Smit, Jenni; Wacharasin, Chintana; Widyantoro, Ninuk

    2010-02-01

    Between 2005 and 2006, we investigated vaginal practices in Yogyakarta, Indonesia; Tete, Mozambique; KwaZulu-Natal, South Africa; and Bangkok and Chonburi, Thailand. We sought to understand women's practices, their motivations for use and the role vaginal practices play in women's health, sexuality and sense of wellbeing. The study was carried out among adult women and men who were identified as using, having knowledge or being involved in trade in products. Further contacts were made using snowball sampling. Across the sites, individual interviews were conducted with 229 people and 265 others participated in focus group discussions. We found that women in all four countries have a variety of reasons for carrying out vaginal practices whose aim is to not simply 'dry' the vagina but rather decrease moisture that may have other associated meanings, and that they are exclusively "intravaginal" in operation. Practices, products and frequency vary. Motivations generally relate to personal hygiene, genital health or sexuality. Hygiene practices involve external washing and intravaginal cleansing or douching and ingestion of substances. Health practices include intravaginal cleansing, traditional cutting, insertion of herbal preparations, and application of substances to soothe irritated vaginal tissue. Practices related to sexuality can involve any of these practices with specific products that warm, dry, and/or tighten the vagina to increase pleasure for the man and sometimes for the woman. Hygiene and health are expressions of femininity connected to sexuality even if not always explicitly expressed as such. We found their effects may have unexpected and even undesired consequences. This study demonstrates that women in the four countries actively use a variety of practices to achieve a desired vaginal state. The results provide the basis for a classification framework that can be used for future study of this complex topic.

  2. Vaginal Parity and Pelvic Organ Prolapse

    PubMed Central

    Quiroz, Lieschen H.; Muñoz, Alvaro; Shippey, Stuart H.; Gutman, Robert E.; Handa, Victoria L.

    2011-01-01

    OBJECTIVE To investigate whether the odds of pelvic organ prolapse vary significantly with the number of vaginal births and whether cesarean birth is associated with prolapse. STUDY DESIGN In this cross-sectional study of women over the age of 40, pelvic organ prolapse was defined as descent to or beyond the hymen. Logistic regression was used to estimate the relative odds of pelvic organ prolapse for each vaginal birth or cesarean birth, controlling for confounders. RESULTS Two hundred ninety women underwent a pelvic organ prolapse quantification POPQ examination, and 72 were found to have pelvic organ prolapse. A single vaginal birth significantly increased the odds of prolapse (OR 9.73, 95% CI 2.68-35.35). Additional vaginal births were not associated with a significant increase in the odds of prolapse. Cesarean births were not associated with prolapse (OR 1.31, 95% CI 0.49-3.54). CONCLUSION The odds of pelvic organ prolapse were almost 10 times higher after a single vaginal birth. The mnrginal impact of additiotull births on this association was small. PMID:20506667

  3. Vaginal parity and pelvic organ prolapse.

    PubMed

    Quiroz, Lieschen H; Muñoz, Alvaro; Shippey, Stuart H; Gutman, Robert E; Handa, Victoria L

    2010-01-01

    To investigate whether the odds of pelvic organ prolapse vary significantly with the number of vaginal births and whether cesarean birth is associated with prolapse. In this cross-sectional study of women over the age of 40, pelvic organ prolapse was defined as descent to or beyond the hymen. Logistic regression was used to estimate the relative odds of pelvic organ prolapse for each vaginal birth or cesarean birth, controlling for confounders. Two hundred ninety women underwent a pelvic organ prolapse quantification POPQ examination, and 72 were found to have pelvic organ prolapse. A single vaginal birth significantly increased the odds of prolapse (OR 9.73, 95% CI 2.68-35.35). Additional vaginal births were not associated with a significant increase in the odds of prolapse. Cesarean births were not associated with prolapse (OR 1.31, 95% CI 0.49-3.54). The odds of pelvic organ prolapse were almost 10 times higher after a single vaginal birth. The marginal impact of additional births on this association was small.

  4. The vaginal microbiota and susceptibility to HIV.

    PubMed

    Buve, Anne; Jespers, Vicky; Crucitti, Tania; Fichorova, Raina N

    2014-10-23

    There is some evidence that the risk of HIV infection per heterosexual act is higher in low-income countries than in high-income countries. We hypothesize that variations in per sex-act transmission probability of HIV may in part be attributed to differences in the composition and function of the vaginal microbiota between different populations. This paper presents data that are in support of this hypothesis. Experimental and clinical studies have provided evidence that the normal vaginal microbiota plays a protective role against acquisition of HIV and other sexually transmitted infections. Epidemiological studies have convincingly shown that disturbances of the vaginal microbiome, namely intermediate flora and bacterial vaginosis, increase the risk of acquisition of HIV infection. A review of the literature found large differences in prevalence of bacterial vaginosis between different populations, with the highest prevalence rates found in black populations. Possible explanations for these differences are presented including data suggesting that there are ethnic differences in the composition of the normal vaginal microbiota. Lastly, interventions are discussed to restore and maintain a healthy vaginal environment. 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

  5. Diagnostic and therapeutic advancements for aerobic vaginitis.

    PubMed

    Han, Cha; Wu, Wenjuan; Fan, Aiping; Wang, Yingmei; Zhang, Huiying; Chu, Zanjun; Wang, Chen; Xue, Fengxia

    2015-02-01

    Aerobic vaginitis (AV) is a newly defined clinical entity that is distinct from candidiasis, trichomoniasis and bacterial vaginosis (BV). Because of the poor recognition of AV, this condition can lead to treatment failures and is associated with severe complications, such as pelvic inflammatory disease, infertility, preterm birth and foetal infections. This review describes the diagnosis and treatment of AV and the relationship between AV and pregnancy. The characteristics of AV include severely depressed levels of lactobacilli, increased levels of aerobic bacteria and an inflamed vagina. The diagnosis is made by microscopy on wet mounts of fresh vaginal fluid, and some distinct clinical features are recognized. Vaginal suppositories that contain kanamycin or clindamycin have shown curative effects in nonpregnant women. Additionally, the application of topical probiotics can restore the vaginal flora and reduce the recurrence of AV. Clindamycin vaginal suppositories and probiotics may be a better choice for gravida with AV than metronidazole. AV requires prompt attention, and the early diagnosis and treatment of AV during pregnancy significantly improves perinatal outcomes. Further research is needed to define the pathogenesis, diagnostic criteria and standard treatment guidelines for AV.

  6. Electrosurgical Settings and Vaginal Cuff Complications

    PubMed Central

    Lawlor, Megan L.; Rao, Rama; Manahan, Kelly J.

    2015-01-01

    Background and Objectives: After being encouraged to change the technique for opening the vaginal cuff during robotic surgery, this study was performed to determine the correlation between vaginal cuff complications and electrosurgical techniques. Methods: The study group consisted of patients who had their vaginal cuffs opened with a cutting current compared to the group of patients having their vaginal cuff opened with a coagulation current. Data were collected on 150 women who underwent robotic surgery for endometrial cancer. All patients received preoperative antibiotics. Data, including operative time, type of electrosurgery used, estimated blood loss, transfusion rate, and complications, were collected from the patients' records. Results: Surgeries in 150 women and the associated complications were studied. The mean age of the patients was not significantly different between the groups (P = .63). The mean body mass index was 38 kg/m2 in the coagulation arm and 36 kg/m2 in the cutting arm (P = .03). Transfusion was not required. Estimated blood loss and operative time were not significantly different in the coagulation versus the cutting arms (P = .29 and .5; respectively). No patients in the cutting arm and 4 patients (with 5 complications) in the coagulation arm had cuff complications (P = .02). Conclusions: Complications involving the vaginal cuff appear to occur more frequently when the vagina is entered by using electrosurgery with coagulation versus cutting in this cohort of patients undergoing robot-assisted surgery for endometrial cancer.. PMID:26681912

  7. Vaginal microbicides and their delivery platforms.

    PubMed

    D'Cruz, Osmond J; Uckun, Fatih M

    2014-05-01

    HIV type 1 infection, despite having fallen by one-third over the past decade, remains a global health concern affecting millions of individuals worldwide. A focal point in contemporary research aimed at global HIV prevention has been the development of safe and efficacious coitally dependent and coitally independent anti-HIV microbicides to curb heterosexual HIV transmission. Despite extensive research efforts to develop novel vaginal antiretroviral (ARV) formulations and intravaginal ring delivery systems, the clinical advancement of microbicides with improved safety, efficacy and tolerability has significantly lagged behind. This review focuses on the current status of both coitally dependent and coitally independent delivery platforms designed to increase user acceptability and clinical effectiveness of anti-HIV microbicides. The clinical failure of several vaginal microbicide candidates has propelled the field to mechanism-based ARV candidates that act more specifically on viral receptors, viral enzymes and host proteins. Consequently, improved vaginal microbicide delivery strategies that achieve uniform drug distribution with enhanced solubility, sustained drug release, improved product adherence with reduced dosing frequency and lack of effect on the vaginal mucosa and microbiota are being sought. Clinical success with vaginal microbicides may best be achieved through the combined effects of ARV compounds that exhibit different mechanisms of action with potent activity against multidrug-resistant HIV and efficacious delivery systems.

  8. Vaginal Candida parapsilosis: pathogen or bystander?

    PubMed Central

    Nyirjesy, Paul; Alexander, Alynn B; Weitz, M Velma

    2005-01-01

    OBJECTIVE: Candida parapsilosis is an infrequent isolate on vaginal cultures; its role as a vaginal pathogen remains unstudied. This retrospective study of women with positive culture for C. parapsilosis sought to characterize the significance of this finding and its response to antifungal therapy. METHODS: From February 2001 to August 2002, we identified all individuals with positive fungal isolates among a population of women with chronic vulvovaginal symptoms. Charts of women with C. parapsilosis cultures were reviewed with regard to patient demographics, clinical presentation and therapeutic response. Mycological cure, defined as a negative fungal culture at the next office visit, and clinical cure, i.e. symptom resolution, were determined for each subject. RESULTS: A total of 582 women had positive vaginal cultures for 635 isolates, of which 54 (8.5%) were C. parapsilosis. The charts of 51 subjects with C. parapsilosis were available for review and follow-up cultures and clinical information were available for 39 (76.5%). Microscopy was positive in 9 (17.6%). Antifungal treatment resulted in mycological cure in 17/19 patients with fluconazole, 7/7 with butoconazole, 6/6 with boric acid, 1/1 with miconazole and occurred spontaneously in 6/7: 24/37 (64.9%) patients with a mycological cure experienced clinical cure. CONCLUSIONS: Although C. parapsilosis is often a cause of vaginal symptoms, it seems to respond to a variety of antifungal agents and may even be a transient vaginal colonizer. PMID:16040326

  9. Group B Streptococcus and the Vaginal Microbiota.

    PubMed

    Rosen, Geoffrey H; Randis, Tara M; Desai, Purnahamsi V; Sapra, Katherine J; Ma, Bing; Gajer, Pawel; Humphrys, Michael S; Ravel, Jacques; Gelber, Shari E; Ratner, Adam J

    2017-09-15

    Streptococcus agalactiae (group B Streptococcus [GBS]) is an important neonatal pathogen and emerging cause of disease in adults. The major risk factor for neonatal disease is maternal vaginal colonization. However, little is known about the relationship between GBS and vaginal microbiota. Vaginal lavage samples from nonpregnant women were tested for GBS, and amplicon-based sequencing targeting the 16S ribosomal RNA V3-V4 region was performed. Four hundred twenty-eight of 432 samples met the high-quality read threshold. There was no relationship between GBS carriage and demographic characteristics, α-diversity, or overall vaginal microbiota community state type (CST). Within the non-Lactobacillus-dominant CST IV, GBS positive status was significantly more prevalent in CST IV-A than CST IV-B. Significant clustering by GBS status was noted on principal coordinates analysis, and 18 individual taxa were found to be significantly associated with GBS carriage by linear discriminant analysis. After adjusting for race/ethnicity, 4 taxa were positively associated with GBS, and 6 were negatively associated. Vaginal microbiota CST and α-diversity are not related to GBS status. However, specific microbial taxa are associated with colonization of this important human pathogen, highlighting a potential role for the microbiota in promotion or inhibition of GBS colonization.

  10. Effect of vaginal lubricants on natural fertility.

    PubMed

    Steiner, Anne Z; Long, D Leann; Tanner, Catherine; Herring, Amy H

    2012-07-01

    Over-the-counter vaginal lubricants have been shown to negatively affect in vitro sperm motility. The objective of this study was to estimate the effect of vaginal lubricant use during procreative intercourse on natural fertility. Women aged 30-44 years with no history of infertility who had been trying to conceive for less than 3 months completed a baseline questionnaire on vaginal lubricant use. Subsequently, women kept a diary to record menstrual bleeding, intercourse, and vaginal lubricant use and conducted standardized pregnancy testing for up to 6 months. Diary data were used to determine the fertile window and delineate lubricant use during the fertile window. A proportional hazards model was used to estimate fecundability ratios with any lubricant use in the fertile window considered as a time-varying exposure. Of the 296 participants, 75 (25%) stated in their baseline questionnaire that they use vaginal lubricants while attempting to conceive. Based on daily diary data, 57% of women never used a lubricant, 29% occasionally used a lubricant, and 14% used a lubricant frequently. Women who used lubricants during the fertile window had similar fecundability to those women who did not use lubricants (fecundability ratio 1.05, 95% confidence interval 0.59-1.85) after adjusting for age, partner race, and intercourse frequency in the fertile window. Lubricants are commonly used by couples during procreative intercourse. Lubricant use during procreative intercourse does not appear to reduce the probability of conceiving.

  11. Effect of Vaginal Lubricants on Natural Fertility

    PubMed Central

    Steiner, Anne Z.; Long, D. Leann; Tanner, Catherine; Herring, Amy H.

    2012-01-01

    Objective Over-the-counter vaginal lubricants have been shown to negatively affect in vitro sperm motility. The objective of this study was to estimate the effect of vaginal lubricant use during procreative intercourse on natural fertility. Methods Women aged 30–44 years with no history of infertility who had been trying to conceive for less than 3 months completed a baseline questionnaire on vaginal lubricant use. Subsequently, women kept a diary to record menstrual bleeding, intercourse, and vaginal lubricant use and conducted standardized pregnancy testing for up to 6 months. Diary data were used to determine the fertile window and delineate lubricant use during the fertile window. A proportional hazards model was used to estimate fecundability ratios with any lubricant use in the fertile window considered as a time-varying exposure. Results Of the 296 participants, 75 (25%) stated in their baseline questionnaire that they use vaginal lubricants while attempting to conceive. Based on daily diary data, 57% of women never used a lubricant, 29% occasionally used a lubricant, and 14% used a lubricant frequently. Women who used lubricants during the fertile window had similar fecundability to those women who did not use lubricants (fecundability ratio 1.05, 95% CI: 0.59, 1.85) after adjusting for age, partner race, and intercourse frequency in the fertile window. Conclusion Lubricants are commonly used by couples during procreative intercourse. Lubricant use during procreative intercourse does not appear to reduce the probability of conceiving. PMID:22914390

  12. A comprehensive review of vaginitis phytotherapy.

    PubMed

    Azimi, Hanieh; Fallah-Tafti, Mehrnaz; Karimi-Darmiyan, Maliheh; Abdollahi, Mohammad

    2011-11-01

    To overview phytotherapy of vaginitis in order to identify new approaches for new pharmacological treatments. All related literature databases were searched for herbal medicinal treatment in vaginitis. The search terms were plant, herb, herbal therapy, phytotherapy, vaginitis, vaginal, anti-candida, anti-bacterial and anti-trichomonas. All of the human, animal and in vitro studies were included. Anti-candida, anti-bacterial and anti-trichomonas effects were the key outcomes. The plants including carvacrol, 1,8-cineole, geranial, germacrene-D, limonene, linalool, menthol, terpinen-4-ol and thymol exhibited anti-candida effects. A very low concentration of geranium oil and geraniol blocked mycelial growth, but not yeast. Tea tree oil including terpinen-4-ol, alpha-terpinene, gamma-terpinene and alpha-terpineol showed anti-bacterial, anti-fungal and anti-protozoal properties against trichomonas. Allium hirtifolium (persian shallot) comparable to metronidazole exhibited anti-trichomonas activity due to its components such as allicin, ajoene and other organosulfides. The plants having beneficial effects on vaginitis encompass essential oils that clear the pathway that future studies should be focused to standardize theses herbs.

  13. Comparison of vaginal flora after treatment with a clotrimazole 500 mg vaginal pessary or a fluconazole 150 mg capsule for vaginal candidosis.

    PubMed Central

    Boag, F C; Houang, E T; Westrom, R; McCormack, S M; Lawrence, A G

    1991-01-01

    The effect of antifungal therapy on the vaginal microbial flora was studied in 23 patients suffering from culture-positive, symptomatic vaginal candidosis. They were randomly allocated to receive either a 500 mg clotrimazole vaginal pessary or a 150 mg fluconazole capsule. Quantitative microbiological examination was carried out on samples of vaginal secretions obtained prior, and at intervals up to 10 days after, treatment. No significant difference was found in the vaginal flora before or after therapy in individual patients or between the treatment groups. In patients with C glabrata or C krusei, the yeasts persisted longer in the vagina with poorer response to either of the medications. PMID:2071126

  14. [Clinical characteristics of aerobic vaginitis and its mixed infections].

    PubMed

    Fan, Ai-Ping; Xue, Feng-Xia

    2010-12-01

    To investigate clinical characteristics of aerobic vaginitis (AV) and its mixed infections for diagnosis efficiently. From April 2008 to December 2008, 516 patients with vaginitis treated in Tianjin Medical University General Hospital were enrolled in this study. AV, bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), trichomonal vaginitis (TV), and cytolytic vaginosis (CV) were diagnosed based on symptoms, sign and vaginal discharge examination. Among 516 cases, AV cases were found in 14.7% (76/516), and AV was common vaginal infection. AV mixed infections was diagnosed in 58% (44/76), including mixed with BV (45%, 20/44), mixed with VVC (30%, 13/44), and mixed with TV (25%, 11/44). Those common symptom of AV were yellow vaginal discharge (63%, 20/32), more vaginal discharge (44%, 14/32). Vaginal pH value was usually more than 4.5 (84%, 27/32). Vaginal cleanliness mainly was grade III - IV (88%, 28/32). Six cases with enterococcus faecium and 4 cases with streptococci were frequently isolated. The symptom and sign of mixed AV infection was atypical. Aerobic vaginitis is a common lower vaginal infection and easily mixed with other pathogens, especially with BV, VVC or TV. When patients were diagnosed with AV or other vaginal infection, it should be mentioned whether those patients have mixed vaginal infection or AV.

  15. Firmness Perception Influences Women's Preferences for Vaginal Suppositories.

    PubMed

    Zaveri, Toral; Primrose, Rachel J; Surapaneni, Lahari; Ziegler, Gregory R; Hayes, John E

    2014-09-10

    Microbicides are being actively researched and developed as woman-initiated means to prevent HIV transmission during unprotected coitus. Along with safety and efficacy, assessing and improving compliance is a major area of research in microbicide development. We have developed carrageenan-based semisoft vaginal suppositories and have previously evaluated how physical properties such as firmness, size and shape influence women's willingness to try them. Firmness has previously been quantified in terms of small-strain storage modulus, G', however large-strain properties of the gels may also play a role in the firmness perception. In the current study we prepared two sets of suppositories with the same G' but different elongation properties at four different G' values (250, 2500, 12,500, 25,000 Pa): For convenience we refer to these as "brittle" and "elastic", although these terms were never provided to study participants. In the first of two tests conducted to assess preference, women compared pairs of brittle and elastic suppositories and indicated their preference. We observed an interaction, as women preferred brittle suppositories at lower G' (250, 2500 Pa) and elastic ones at a higher G' (25,000 Pa). In the second test, women evaluated samples across different G', rated the ease-of-insertion and willingness-to-try and ranked the samples in order of preference. Brittle suppositories at G' of 12,500 Pa were most preferred. In vitro studies were also conducted to measure the softening of the suppositories in contact with vaginal simulant fluid (VSF). Release of antiretroviral drug tenofovir in VSF was quantified for the brittle and elastic suppositories at G' of 12,500 Pa to determine the effect of suppository type on release. The initial rate of release was 20% slower with elastic suppositories as compared to brittle suppositories. Understanding how different physical properties simultaneously affect women's preferences and pharmacological efficacy in terms of

  16. Vaginal biogenic amines: biomarkers of bacterial vaginosis or precursors to vaginal dysbiosis?

    PubMed Central

    Nelson, Tiffanie M.; Borgogna, Joanna-Lynn C.; Brotman, Rebecca M.; Ravel, Jacques; Walk, Seth T.; Yeoman, Carl J.

    2015-01-01

    Bacterial vaginosis (BV) is the most common vaginal disorder among reproductive age women. One clinical indicator of BV is a “fishy” odor. This odor has been associated with increases in several biogenic amines (BAs) that may serve as important biomarkers. Within the vagina, BA production has been linked to various vaginal taxa, yet their genetic capability to synthesize BAs is unknown. Using a bioinformatics approach, we show that relatively few vaginal taxa are predicted to be capable of producing BAs. Many of these taxa (Dialister, Prevotella, Parvimonas, Megasphaera, Peptostreptococcus, and Veillonella spp.) are more abundant in the vaginal microbial community state type (CST) IV, which is depleted in lactobacilli. Several of the major Lactobacillus species (L. crispatus, L. jensenii, and L. gasseri) were identified as possessing gene sequences for proteins predicted to be capable of putrescine production. Finally, we show in a small cross sectional study of 37 women that the BAs putrescine, cadaverine and tyramine are significantly higher in CST IV over CSTs I and III. These data support the hypothesis that BA production is conducted by few vaginal taxa and may be important to the outgrowth of BV-associated (vaginal dysbiosis) vaginal bacteria. PMID:26483694

  17. Fasciocutaneous flap for vaginal and perineal reconstruction

    SciTech Connect

    Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.

    1987-07-01

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.

  18. Canine vaginal leiomyoma diagnosed by CT vaginourethrography.

    PubMed

    Weissman, Andrea; Jiménez, David; Torres, Brian; Cornell, Karen; Holmes, Shannon P

    2013-01-01

    A 13 yr old female spayed Labrador retriever presented for vulvar bleeding. Abdominal radiographs revealed a soft tissue mass in the ventral pelvic canal. A computed tomography (CT) exam and a CT vaginourethrogram localized the mass to the vagina, helped further characterize the mass, and aided in surgical planning. A total vaginectomy was performed and the histologic diagnosis was leiomyoma. Vaginal tumors make up 1.9-3% of all tumors. Seventy-three percent of vaginal tumors are benign, and 83% of those are leiomyomas. Leiomyomas often have a good long-term prognosis with surgical resection. The diagnostic investigation of this case report utilized a multimodal imaging approach to determine the extent and respectability of the vaginal mass. To the best of the authors' knowledge, this is the first report describing a CT vaginourethrogram.

  19. Effect of vaginal lubricants on natural fertility.

    PubMed

    Mesen, Tolga B; Steiner, Anne Z

    2014-06-01

    Vaginal lubricants are commonly utilized to facilitate more comfortable and enjoyable intercourse. The impact of these lubricants on fertility is unclear. The aim of this review is to summarize the current in-vitro and clinical data pertaining to lubricants' effect on natural conception. In-vitro studies suggest lubricants can be toxic to sperm in the artificial laboratory environment. Lubricants formulated to be nontoxic to sperm have no effect on sperm motility or viability in vitro compared to controls. However, a recent longitudinal cohort study suggests lubricant use and choice has no effect of fecundity. As a result of the conflicting in-vitro and clinical data, the effect of vaginal lubricants on fertility is still unresolved. A randomized controlled trial is needed to determine the effects of vaginal lubricants on fertility.

  20. Surgery for women with apical vaginal prolapse.

    PubMed

    Maher, Christopher; Feiner, Benjamin; Baessler, Kaven; Christmann-Schmid, Corina; Haya, Nir; Brown, Julie

    2016-10-01

    Apical vaginal prolapse is a descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available and there are no guidelines to recommend which is the best. To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse. We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched July 2015) and ClinicalTrials.gov (searched January 2016). We included randomised controlled trials (RCTs). We used Cochrane methods. Our primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse (any site). We included 30 RCTs (3414 women) comparing surgical procedures for apical vaginal prolapse. Evidence quality ranged from low to moderate. Limitations included imprecision, poor methodological reporting and inconsistency. Vaginal procedures versus sacral colpopexy (six RCTs, n = 583; one to four-year review). Awareness of prolapse was more common after vaginal procedures (risk ratio (RR) 2.11, 95% confidence interval (CI) 1.06 to 4.21, 3 RCTs, n = 277, I(2) = 0%, moderate-quality evidence). If 7% of women are aware of prolapse after sacral colpopexy, 14% (7% to 27%) are likely to be aware after vaginal procedures. Repeat surgery for prolapse was more common after vaginal procedures (RR 2.28, 95% CI 1.20 to 4.32; 4 RCTs, n = 383, I(2) = 0%, moderate-quality evidence). The confidence interval suggests that if 4% of women require repeat prolapse surgery after sacral colpopexy, between 5% and 18% would require it after vaginal procedures.We found no conclusive evidence that vaginal procedures increaserepeat surgery for stress urinary incontinence (SUI) (RR 1.87, 95% CI 0.72 to 4.86; 4 RCTs, n = 395; I(2) = 0%, moderate

  1. Tool Removes Coil-Spring Thread Inserts

    NASA Technical Reports Server (NTRS)

    Collins, Gerald J., Jr.; Swenson, Gary J.; Mcclellan, J. Scott

    1991-01-01

    Tool removes coil-spring thread inserts from threaded holes. Threads into hole, pries insert loose, grips insert, then pulls insert to thread it out of hole. Effects essentially reverse of insertion process to ease removal and avoid further damage to threaded inner surface of hole.

  2. Non-insertional Achilles tendinopathy

    PubMed Central

    Pearce, Christopher J.; Tan, Audrey

    2016-01-01

    Non-insertional Achilles tendinopathy is a degenerative condition characterised by pain on activity. Eccentric stretching is the most effective treatment. Surgical treatment is reserved for recalcitrant cases. Minimally-invasive and tendinoscopic treatments are showing promising results. Cite this article: Pearce CJ, Tan A. Non-insertional Achilles tendinopathy. EFORT Open Rev 2016;1:383-390. DOI: 10.1302/2058-5241.1.160024. PMID:28461917

  3. Twin vaginal delivery: innovate or abdicate.

    PubMed

    Easter, Sarah Rae; Taouk, Laura; Schulkin, Jay; Robinson, Julian N

    2017-05-01

    Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P<.01) and were more likely to be in an academic practice environment (36.1% vs 10.9%; P<.01) and to practice in high-volume centers that deliver >30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; P<.01). In an adjusted analysis, the 46% of providers with a perceived need for more training were far less likely to prefer breech extraction for delivery of a noncephalic second twin (adjusted odds ratio, 0.38; 95% confidence interval, 0.16-0.95). Furthermore, 57% of providers who would not offer their patient breech extraction would be willing to consult a colleague for support with a noncephalic twin delivery. These results suggest that scientific evidence and society opinion are likely insufficient to reverse the national

  4. MRSA as a rare cause of vaginitis.

    PubMed

    de Bree, L C J; van Rijen, M M L; Coertjens, H P M; van Wijngaarden, P

    2015-12-01

    We describe a 26-year-old otherwise healthy woman with MRSA vaginitis. Traditional MRSA risk factors were absent and additional screening sites were negative. Patient was treated successfully with oral antibiotics combined with topical lactic acid emulsion. Because her partner appeared to have solitary MRSA carriage on the glans, a suggestion of sexual transmission was made. He was treated successfully with topical mupirocin ointment. Although solitary vaginal MRSA carriage and infection seems to be rare and its clinical impact is yet undefined, clinicians should consider adding the genitourinary tract to traditional screening sites in case of recurrent MRSA infections.

  5. Microbes on the human vaginal epithelium

    PubMed Central

    Hyman, Richard W.; Fukushima, Marilyn; Diamond, Lisa; Kumm, Jochen; Giudice, Linda C.; Davis, Ronald W.

    2005-01-01

    Using solely a gene-based procedure, PCR amplification of the 16S ribosomal RNA gene coupled with very deep sequencing of the amplified products, the microbes on 20 human vaginal epithelia of healthy women have been identified and quantitated. The Lactobacillus content on these 20 healthy vaginal epithelia was highly variable, ranging from 0% to 100%. For four subjects, Lactobacillus was (virtually) the only bacterium detected. However, that Lactobacillus was far from clonal and was a mixture of species and strains. Eight subjects presented complex mixtures of Lactobacillus and other microbes. The remaining eight subjects had no Lactobacillus. Instead, Bifidobacterium, Gardnerella, Prevotella, Pseudomonas, or Streptococcus predominated. PMID:15911771

  6. Vaginal Estrogen for Genitourinary Syndrome of Menopause

    PubMed Central

    Rahn, David D.; Carberry, Cassandra; Sanses, Tatiana V.; Mamik, Mamta M.; Ward, Renée M.; Meriwether, Kate V.; Olivera, Cedric K.; Abed, Husam; Balk, Ethan M.; Murphy, Miles

    2016-01-01

    OBJECTIVE To comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines. DATA SOURCES MEDLINE and Cochrane databases were searched from inception to April 2013. We included randomized controlled trials and prospective comparative studies. Interventions and comparators included all commercially available vaginal estrogen products. Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators. METHODS OF STUDY SELECTION We double-screened 1,805 abstracts, identifying 44 eligible studies. Discrepancies were adjudicated by a third reviewer. Studies were individually and collectively assessed for methodologic quality and strength of evidence. TABULATION, INTEGRATION, AND RESULTS Studies were extracted for participant, intervention, comparator, and outcomes data, including patient-reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events. Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Urinary tract infection rates decreased. The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high-dose conjugated equine estrogen cream. Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen. Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar

  7. Directed shift of vaginal microbiota induced by vaginal application of sucrose gel in rhesus macaques.

    PubMed

    Hu, Kai-tao; Zheng, Jin-xin; Yu, Zhi-jian; Chen, Zhong; Cheng, Hang; Pan, Wei-guang; Yang, Wei-zhi; Wang, Hong-yan; Deng, Qi-wen; Zeng, Zhong-ming

    2015-04-01

    Sucrose gel was used to treat bacterial vaginosis in a phase III clinical trial. However, the changes of vaginal flora after treatment were only examined by Nugent score in that clinical trial, While the vaginal microbiota of rhesus macaques is characterized by anaerobic, Gram-negative bacteria, few lactobacilli, and pH levels above 4.6, similar to the microbiota of patients with bacterial vaginosis. This study is aimed to investigate the change of the vaginal microbiota of rehsus macaques after topical use of sucrose gel to reveal more precisely the bacterial population shift after the topical application of sucrose gel. Sixteen rhesus macaques were treated with 0.5 g sucrose gel vaginally and three with 0.5 g of placebo gel. Vaginal swabs were collected daily following treatment. Vaginal pH levels and Nugent scores were recorded. The composition of the vaginal micotbiota was tested by V3∼V4 16S rDNA metagenomic sequencing. Dynamic changes in the Lactobacillus genus were analyzed by qPCR. The vaginal microbiota of rhesus macaques are dominated by anaerobic Gram-negative bacteria, with few lactobacilli and high pH levels above 4.6. After five days' treatment with topical sucrose gel, the component percentage of Lactobacillus in vaginal microbiota increased from 1.31% to 81.59%, while the component percentage of Porphyromonas decreased from 18.60% to 0.43%, Sneathia decreased from 15.09% to 0.89%, Mobiluncus decreased from 8.23% to 0.12%, etc.. The average vaginal pH values of 16 rhesus macaques of the sucrose gel group decreased from 5.4 to 3.89. There were no significant changes in microbiota and vaginal pH observed in the placebo group. Rhesus macaques can be used as animal models of bacterial vaginosis to develop drugs and test treatment efficacy. Furthermore, the topical application of sucrose gel induced the shifting of vaginal flora of rhesus macaques from a BV kind of flora to a lactobacilli-dominating flora. Copyright © 2015 The Authors. Published by

  8. Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis.

    PubMed

    Dorr, Mary Beth; Nelson, Anita L; Mayer, Philip R; Ranganath, Radhika P; Norris, Paul M; Helzner, Eileen C; Preston, Richard A

    2010-11-01

    In this open-label, randomized, multiple-dose, two-treatment crossover study, 24 postmenopausal women with moderate to severe atrophic vaginitis received 0.3 mg conjugated estrogens daily for 14 days: 7 days orally (0.3 mg tablet) and 7 days vaginally (0.5 g cream). Steady-state plasma concentrations of E2 and estrone were one-third lower after vaginal versus oral administration of conjugated estrogens. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  9. 21 CFR 884.5900 - Therapeutic vaginal douche apparatus.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Therapeutic vaginal douche apparatus. 884.5900... Devices § 884.5900 Therapeutic vaginal douche apparatus. (a) Identification. A therapeutic vaginal douche apparatus is a device that is a bag or bottle with tubing and a nozzle. The apparatus does not...

  10. 21 CFR 884.5900 - Therapeutic vaginal douche apparatus.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Therapeutic vaginal douche apparatus. 884.5900... Devices § 884.5900 Therapeutic vaginal douche apparatus. (a) Identification. A therapeutic vaginal douche apparatus is a device that is a bag or bottle with tubing and a nozzle. The apparatus does not...

  11. Prepubertal vaginal discharge: Vaginoscopy to rule out foreign body.

    PubMed

    Ekinci, Saniye; Karnak, İbrahim; Tanyel, Feridun Cahit; Çiftçi, Arbay Özden

    2016-01-01

    Medical records of all prepubertal patients who underwent vaginoscopy to rule out vaginal foreign body between 2004 and 2013 were reviewed retrospectively. All patients were evaluated by pediatricians prior to surgical consultation. Vaginoscopy is performed in the operating room under general anesthesia. During the study period, 20 girls with persistent vaginal discharge with a mean age of 6.8 years (1-13 years) underwent vaginoscopy to rule out vaginal foreign body. Six patients had bloody vaginal discharge and 4 had recurrent vaginal bleeding lasting for more than one month. Ten patients had purulent vaginal discharge lasting for 1-7 months. None of vaginal cultures revealed pathological bacteria or candida species. Preoperative imaging techniques revealed vaginal foreign body in one patient only. Vaginoscopy demonstrated vaginal foreign bodies in four patients. Foreign bodies were grass inflorescence, safety pin and undefined brownish particles (n=2), which may be pieces of toilet paper or feces. There was no complication related to vaginoscopy and removal of foreign body. Hymen integrity was preserved in all patients. Persistent or recurrent vaginal discharge in prepubertal girls should raise the suspect of vaginal foreign body. Continuous flow vaginoscopy is mandatory to detect and remove any vaginal foreign body. Early diagnosis would prevent complications secondary to long-standing foreign bodies.

  12. Abdominal radical trachelectomy for vaginal cancer - A case report.

    PubMed

    Matsuoka, Mari; Yamamoto, Rumiko; Tsuji, Natsuki; Terakawa, Koichi; Nagano, Tadayoshi

    2017-08-01

    Vaginal cancer is most common in elderly woman and very rare in young woman.•Stage I vaginal cancer is treated with surgery and radiotherapy.•Vaginal cancer in a young patient was treated by intra-arterial chemotherapy followed by abdominal radical trachelectomy.

  13. Universal vaginal applicator for the uniform distribution of vaginal gel and cream formulations: a magnetic resonance imaging study.

    PubMed

    Omar, Rabeea F; Trottier, Sylvie; Brousseau, Ghislain; Ouellet, Christine; Danylo, Alexis; Ong, Thomas; Bergeron, Michel G

    2014-01-01

    Conventional vaginal applicators with a single apical hole do not distribute vaginal formulations homogenously and do not cover the entire vaginal and cervical mucosa. To overcome this problem and offer women further protection against vaginal infections, we designed a unique vaginal applicator with multiple apical and lateral holes. We have previously shown that the new applicator distributes an investigational vaginal gel homogenously over the entire vaginal and cervical mucosa. In this study, we investigated (using MRI) whether the new applicator works as well with marketed vaginal gels and creams. Eighteen women participated in the study and six vaginal gels and creams were tested. Each woman used a marketed vaginal product with its own commercial applicator (CA) once and with our universal vaginal applicator (UVA) once to deliver the same product. The applications were separated by a one-week period. Pelvic MRI was performed immediately after vaginal application to evaluate the product's distribution and mucosal coverage. Immediately after application of the vaginal product, the UVA homogenously distributed the six products (3 gels and 3 creams) over the entire vaginal and cervical mucosa. On the other hand, the tested CA delivered four products (3 gels and 1 cream) mainly to the cervix and the upper vagina, but not to the mid and lower vagina; for the other two creams, the distribution was similar to that of UVA. Furthermore, the UVA received the highest acceptability score. The UVA can be used to deliver different vaginal gel and cream products homogenously throughout the vagina. This was the first time the UVA had been tested with marketed vaginal gels and creams. This applicator, giving uniform mucosal coverage and being highly acceptable, may help women to better protect themselves against sexually transmitted infections.

  14. Laminaria vs. vaginal misoprostol for cervical preparation before second-trimester surgical abortion: a randomized clinical trial.

    PubMed

    Sagiv, Ron; Mizrachi, Yossi; Glickman, Hagit; Kerner, Ram; Keidar, Ran; Bar, Jacob; Golan, Abraham

    2015-05-01

    To compare the efficacy and tolerability of vaginal misoprostol and laminaria for cervical preparation before second-trimester surgical abortion. We performed a prospective, randomized trial comparing midnight administration of misoprostol 600 mcg vaginally to midnight placement of laminaria, before surgical abortions among women at 13-20 weeks of gestation. The primary outcome was preoperative cervical dilation. Secondary outcomes were the need for further dilation, procedure duration and difficulty, immediate complications and side effects. Eighty-four women were randomized, with a median gestational age of 16.5 weeks. The mean time interval between misoprostol and laminaria placement and dilatation and evacuation initiation was 11.0±2.9 and 11.2±2.0h, respectively (p=.17). Cervical dilation was not greater in the laminaria group as compared to the misoprostol group (12.8 vs. 12.4mm, respectively; p=.32). No difference was demonstrated regarding the need for additional dilation or the difficulty of the procedure. Procedures performed after laminaria insertion were 1 min longer (median 11 vs. 10 min, p=.04). Participants found laminaria placement more uncomfortable than vaginal misoprostol placement. Other than pain, additional side effects occurred only in the misoprostol group, primarily nausea and vomiting. One participant in the misoprostol group experienced fetal expulsion during the night before the intended procedure. Either vaginal misoprostol or laminaria provides adequate dilation for second-trimester surgical abortion. Laminaria causes more pain at insertion and misoprostol causes more side effects. We found that cervical preparation in an inpatient setting for approximately 11h with misoprostol 600 mcg vaginally is comparable to 11h of laminaria. However, given the potential for spontaneous expulsion and more side effects with misoprostol, laminaria is likely a better general option in such a setting. Copyright © 2015 Elsevier Inc. All rights

  15. Development and in vitro evaluation of an acid buffering bioadhesive vaginal gel for mixed vaginal infections.

    PubMed

    Ahmad, Farhan Jalees; Alam, Mohd Aftab; Khan, Zeenat Iqbal; Khar, Roop Krishen; Ali, Mushir

    2008-12-01

    An acid buffering bioadhesive vaginal (ABBV) gel was developed for the treatment of mixed vaginal infections. Different bioadhesive polymers were evaluated on the basis of their bioadhesive strength, stability and drug release properties. Bioadhesion and release studies showed that guar gum, xanthan gum and hydroxypropyl methylcelullose K4M formed a good combination of bioadhesive polymers to develop the ABBV gel. Monosodium citrate was used as an acid buffering agent to provide acidic pH (4.4). The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as antibacterial) were used in the formulation along with Lactobacillus spores to treat mixed vaginal infections. The ex vivo retention study showed that the bioadhesive polymers hold the gel for 12-13 hours inside the vaginal tube. Results of the in vitro antimicrobial study indicated that the ABBV gel had better antimicrobial action than the commercial intravaginal drug delivery systems and retention was prolonged in an ex vivo retention experiment.

  16. Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction.

    PubMed

    Chavakula, Pearlin R; Benjamin, Santosh J; Abraham, Anuja; Londhe, Vaibhav; Jeyaseelan, Visalakshi; Mathews, Jiji E

    2015-05-01

    To compare 25μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction. A randomized controlled trial was conducted in a tertiary center in South India. Women with fetal growth restriction (n=100) were randomized to be induced with three doses of vaginal misoprostol (25μg) every 6hours or with an intracervical Foley catheter, inserted 12hours before rupture of membranes, and oxytocin if needed. The primary outcome was uterine tachysystole with fetal cardiotocography abnormalities. Secondary outcomes pertained to effectiveness, complications, and patient satisfaction. One woman in the misoprostol group and none in the Foley catheter group had uterine tachysystole. The duration of labor from IOL to delivery was similar in both groups (P=0.416). More women in the misoprostol group had a vaginal delivery within 12hours (26.1% versus 5.6%; P=0.005). Women induced with misoprostol were less likely to deliver by lower-segment cesarean delivery (15.2% versus 29.6%; P=0.168) and to require oxytocin augmentation (60.9% versus 85.2%; P=0.007). Complications were few in both group. Few women had uterine tachysystole with cardiotocography abnormalities. Vaginal misoprostol at 25μg was more effective than a Foley catheter for IOL in fetal growth restriction. Clinical Trials Registry India:CTRI/2014/02/004411. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Vaginocutaneous fistula and buttock abscess formation 7 years after polypropylene transobturator tape insertion.

    PubMed

    Abdallah, A; Nisolle, M; de Landsheere, L

    2017-01-01

    Surgical treatment for stress urinary incontinence (SUI) using transobturator tape insertion is widely accepted. However, several postoperative complications were reported in the literature including infections, abscess and fistula formation. Here, we report a case of 57-year-old female who presented with abscess and left vaginocutaneous buttock fistula 7 years after transobturator polypropylene tape insertion. Treatment included abscess drainage with dissection of the fistulous tract and removal of the left arm of the transobturator tape along with antibiotic coverage. Sinus drainage stopped after 3 days. Stress urinary incontinence did not recur. Suspicion of fistula formation should rise in patients presenting with bothersome vaginal or cutaneous discharge after transobturator tape insertion. This case is particular since it describes a fistula complication with polypropylene tape, which is unusual with this type of tapes. Treatment of such complication should always consist of surgical removal of the mesh to allow closure of the fistulous tract. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  18. Lactobacilli Dominance and Vaginal pH: Why Is the Human Vaginal Microbiome Unique?

    PubMed

    Miller, Elizabeth A; Beasley, DeAnna E; Dunn, Robert R; Archie, Elizabeth A

    2016-01-01

    The human vaginal microbiome is dominated by bacteria from the genus Lactobacillus, which create an acidic environment thought to protect women against sexually transmitted pathogens and opportunistic infections. Strikingly, lactobacilli dominance appears to be unique to humans; while the relative abundance of lactobacilli in the human vagina is typically >70%, in other mammals lactobacilli rarely comprise more than 1% of vaginal microbiota. Several hypotheses have been proposed to explain humans' unique vaginal microbiota, including humans' distinct reproductive physiology, high risk of STDs, and high risk of microbial complications linked to pregnancy and birth. Here, we test these hypotheses using comparative data on vaginal pH and the relative abundance of lactobacilli in 26 mammalian species and 50 studies (N = 21 mammals for pH and 14 mammals for lactobacilli relative abundance). We found that non-human mammals, like humans, exhibit the lowest vaginal pH during the period of highest estrogen. However, the vaginal pH of non-human mammals is never as low as is typical for humans (median vaginal pH in humans = 4.5; range of pH across all 21 non-human mammals = 5.4-7.8). Contrary to disease and obstetric risk hypotheses, we found no significant relationship between vaginal pH or lactobacilli relative abundance and multiple metrics of STD or birth injury risk (P-values ranged from 0.13 to 0.99). Given the lack of evidence for these hypotheses, we discuss two alternative explanations: the common function hypothesis and a novel hypothesis related to the diet of agricultural humans. Specifically, with regard to diet we propose that high levels of starch in human diets have led to increased levels of glycogen in the vaginal tract, which, in turn, promotes the proliferation of lactobacilli. If true, human diet may have paved the way for a novel, protective microbiome in human vaginal tracts. Overall, our results highlight the need for continuing research on non

  19. Lactobacilli Dominance and Vaginal pH: Why Is the Human Vaginal Microbiome Unique?

    PubMed Central

    Miller, Elizabeth A.; Beasley, DeAnna E.; Dunn, Robert R.; Archie, Elizabeth A.

    2016-01-01

    The human vaginal microbiome is dominated by bacteria from the genus Lactobacillus, which create an acidic environment thought to protect women against sexually transmitted pathogens and opportunistic infections. Strikingly, lactobacilli dominance appears to be unique to humans; while the relative abundance of lactobacilli in the human vagina is typically >70%, in other mammals lactobacilli rarely comprise more than 1% of vaginal microbiota. Several hypotheses have been proposed to explain humans' unique vaginal microbiota, including humans' distinct reproductive physiology, high risk of STDs, and high risk of microbial complications linked to pregnancy and birth. Here, we test these hypotheses using comparative data on vaginal pH and the relative abundance of lactobacilli in 26 mammalian species and 50 studies (N = 21 mammals for pH and 14 mammals for lactobacilli relative abundance). We found that non-human mammals, like humans, exhibit the lowest vaginal pH during the period of highest estrogen. However, the vaginal pH of non-human mammals is never as low as is typical for humans (median vaginal pH in humans = 4.5; range of pH across all 21 non-human mammals = 5.4–7.8). Contrary to disease and obstetric risk hypotheses, we found no significant relationship between vaginal pH or lactobacilli relative abundance and multiple metrics of STD or birth injury risk (P-values ranged from 0.13 to 0.99). Given the lack of evidence for these hypotheses, we discuss two alternative explanations: the common function hypothesis and a novel hypothesis related to the diet of agricultural humans. Specifically, with regard to diet we propose that high levels of starch in human diets have led to increased levels of glycogen in the vaginal tract, which, in turn, promotes the proliferation of lactobacilli. If true, human diet may have paved the way for a novel, protective microbiome in human vaginal tracts. Overall, our results highlight the need for continuing research on non

  20. Dynamic clinical measurements of voluntary vaginal contractions and autonomic vaginal reflexes.

    PubMed

    Broens, Paul M A; Spoelstra, Symen K; Weijmar Schultz, Willibrord C M

    2014-12-01

    The vaginal canal is an active and responsive canal. It has pressure variations along its length and shows reflex activity. At present, the prevailing idea is that the vaginal canal does not have a sphincter mechanism. It is hypothesized that an active vaginal muscular mechanism exists and might be involved in the pathophysiology of genito-pelvic pain/penetration disorder. The aim of this study was to detect the presence of a canalicular vaginal "sphincter mechanism" by measuring intravaginal pressure at different levels of the vaginal canal during voluntary pelvic floor contractions and during induced reflexive contractions. Sixteen nulliparous women, without sexual dysfunction and pelvic floor trauma, were included in the study. High-resolution solid-state circumferential catheters were used to measure intravaginal pressures and vaginal contractions at different levels in the vaginal canal. Voluntary intravaginal pressure measurements were performed in the left lateral recumbent position only, while reflexive intravaginal pressure measurements during slow inflation of a vaginal balloon were performed in the left lateral recumbent position and in the sitting position. Intravaginal pressures and vaginal contractions were the main outcome measures. In addition, a general demographic and medical history questionnaire was administered to gain insight into the characteristics of the study population. Fifteen out of the sixteen women had deep and superficial vaginal high-pressure zones. In one woman, no superficial high-pressure zone was found. The basal and maximum pressures, as well as the duration of the autonomic reflexive contractions significantly exceeded the pressures and the duration of the voluntary contractions. There were no significant differences between the reflexive measurements obtained in the left lateral recumbent and the sitting position. The two high-pressure zones found in this study, as a result of voluntary contractions and, even more pronounced

  1. Development and Characterization of a Vaginal Film Containing Dapivirine, a Non- nucleoside Reverse Transcriptase Inhibitor (NNRTI), for prevention of HIV-1 sexual transmission

    PubMed Central

    Akil, Ayman; Parniak, Michael A.; Dezzuitti, Charlene S.; Moncla, Bernard J.; Cost, Marilyn R.; Li, Mingguang; Rohan, Lisa Cencia

    2012-01-01

    Dapivirine, a non-nucleoside reverse transcriptase inhibitor, is a potent and promising anti-HIV molecule. It is currently being investigated for use as a vaginal microbicide in two dosage forms, a semi-solid gel and a silicone elastomer ring. Quick-dissolving films are promising and attractive dosage forms that may provide an alternative platform for the vaginal delivery of microbicide drug candidates. Vaginal films may provide advantages such as discreet use, no product leakage during use, lack of requirement for an applicator for insertion, rapid drug release and minimal packaging and reduced wastage. Within this study the in vitro bioactivity of dapivirine as compared to the NNRTI UC781 was further established and a quick dissolve film was developed for vaginal application of dapivirine for prevention of HIV infection. The developed film was characterized with respect to its physical and chemical attributes including water content, mechanical strength, drug release profile, permeability, compatibility with lactobacilli and bioactivity. The anti-HIV activity of the formulated dapivirine film was confirmed in in vitro and ex vivo models. Importantly the physical and chemical properties of the film as well as its bioactivity were maintained for a period of 18 months. In conclusion, a vaginal film containing dapivirine was developed and characterized. The film was shown to prevent HIV-1 infection in vitro and ex vivo and have acceptable characteristics which make this film a promising candidate for testing as vaginal microbicide. PMID:22708075

  2. Metronidazole for the treatment of vaginal infections.

    PubMed

    Sobel, Ryan; Sobel, Jack D

    2015-05-01

    Metronidazole , undoubtedly the most widely known and used member of the nitroimidazole drug class, remains not only first line therapy for bacterial vaginosis (BV) and trichomoniasis, but serves as drug of first choice. Available and used both orally and topically with high efficacy rates, especially for trichomoniasis, nevertheless numerous unanswered questions remain regarding mechanism of action. Given the extraordinary global frequency of vaginitis due to BV and trichomoniasis, especially the high recurrence rate observed in BV, it is timely to critically examine the therapeutic role of metronidazole in management decisions. Search methodology used PUBMED literature review. In spite of many years of successful use, multiple questions exist regarding optimal dose and duration of therapy especially in the management of BV. Antimicrobial drug resistance remains uncommon in spite of extensive use. The use of metronidazole for vaginitis is reviewed in this article together with challenges to improving its more effective administration. Currently metronidazole or the family of nitroimidazoles, represent the drugs of first choice for trichomonas vaginitis and first line therapy for BV. Drug resistance for both entities remains uncommon; however, in contrast to trichomoniasis where relapse is rare, high recurrence rates are common in women with BV. Metronidazole appears to allow persistence of vaginal microbiome microorganisms which translate into frequent relapses. In the absence of new therapeutic alternatives, strategies are being developed to enhance drug cure rates.

  3. Vaginal parturition decreases recurrence of endometriosis.

    PubMed

    Bulletti, Carlo; Montini, Anna; Setti, Paolo Levi; Palagiano, Antonio; Ubaldi, Filippo; Borini, Andrea

    2010-08-01

    To evaluate the role of parturition in the recurrence of endometriosis. Retrospectively analyzed, prospectively obtained data. Unit of Physiopathology of Reproduction, Health Care Unit of Rimini, and University of Bologna Cervesi General Hospital, Cattolica, Italy. Three hundred forty-five patients with stage II-IV endometriosis, dysmenorrhea, and infertility were treated for endometriosis and divided into four groups according to parity and mode of parturition. The patients were laparoscopically treated for endometriosis upon the occurrence and recurrence of the disease. Ultrasound measurements of the uterine internal ostium (IOS) were performed at each study interval. Degree of dysmenorrhea, occurrence and recurrence of endometriosis, and uterine IOS measurements were established and related to parity and mode of parturition. After parturition, dysmenorrhea recurrence was significantly higher in nulliparous women than in women with vaginal parturition. The endometriosis recurrence rate was higher in women who did not have vaginal parturition. The IOS significantly enlarged after vaginal delivery but not after cesarean delivery. There were significant negative correlations between IOS and the recurrence of endometriosis and dysmenorrhea. Odds ratios indicated that as the IOS enlarged, the risk of recurrence decreased. Vaginal parturition plays a protective role in the recurrence of endometriosis. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Vaginal Lacerations from Consensual Intercourse in Adolescents

    ERIC Educational Resources Information Center

    Frioux, Sarah M.; Blinman, Thane; Christian, Cindy W.

    2011-01-01

    Objective: (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries. Methods:…

  5. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... support the vagina and to hold a skin graft after reconstructive surgery. (b) Classification. Class II...

  6. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... support the vagina and to hold a skin graft after reconstructive surgery. (b) Classification. Class II...

  7. [Terconazol in vaginal candidiasis. Comparative study].

    PubMed

    Llaca Rodríguez, V; Carrión Tizcareño, H; Arguelles Domenzain, P

    1990-11-01

    The antimycotic action and tolerance to terconazole in patients with vaginal candidiasis, were evaluated in a blind study. The medication was given in vaginal ovules (VO) 240 mg, one dose per day, and 80 mg one daily dose for three days; as compared to chlotrimazole, VO 200 mg, daily dose for three days. The patients presented with vaginal candidiasis demonstrated by Nickerson culture medium. Sixty patients were studied in three equivalent groups. The mates of patients treated with terconazole had no treatment; and the mates of patients treated with chlotrimazole received urinary acidifying medication. Symptomatology and mycologic findings were evaluated at 10 and 28 days post treatment. Mycological cure rates at 10 days were: 90 per cent for the terconazole group, 240 mg, one dose; and 95 per cent for patients with terconazole, 80 mg, daily dose for three days; or chlotrimazole, 200 mg, daily dose for three days. Twenty eight days post-treatment, laboratory tests were positive again: 50%, 40% and 15%, respectively. Recidive in patients treated with terconazole, is explained by lack of treatment in mates. In conclusion, terconazole offers a high percentage of clinical and mycological cure in vaginal candidiasis, and it is indispensable treatment for the mate, in order to avoid recidives.

  8. [Terconazole in vaginal candidiasis. A comparative study].

    PubMed

    Llaca Rodríguez, V; Carrión Tizcareño, H; Arguelles Domenzain, P

    1990-11-01

    The antimycotic action and tolerance to terconazole in patients with vaginal candidiasis, were evaluated in a blind study. The medication was given in vaginal ovules (VO)240 mg, one dose per day, and 80 mg one daily dose for three days; as compared to chlotrimazole, VO 200 mg, daily dose for three days. The patients presented with vaginal candidiasis demonstrated by Nickerson culture medium. Sixty patients were studied in three equivalent groups. The mates of patients treated with terconazole had no treatment; and the mates of patients treated with chlotrimazole received urinary acidifying medication. Symptomatology and mycologic findings were evaluated at 10 and 28 days post treatment. Mycological cure rates at 10 days were: 90 per cent for the terconazole group, 240 mg, one dose; and 95 per cent for patients with terconazole, 80 mg, daily dose for three days; or chlotrimazole, 200 mg, daily dose for three days. Twenty eight days post-treatment, laboratory tests were positive again: 50%, 40% and 15%, respectively. Recidive in patients treated with terconazole, is explained by lack of treatment in mates. In conclusion, terconazole offers a high percentage of clinical and mycological cure in vaginal candidiasis, and it is indispensable treatment for the mate, in order to avoid recidives.

  9. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... support the vagina and to hold a skin graft after reconstructive surgery. (b) Classification. Class II...

  10. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vaginal stent. 884.3900 Section 884.3900 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... support the vagina and to hold a skin graft after reconstructive surgery. (b) Classification. Class II...

  11. Vaginal Lacerations from Consensual Intercourse in Adolescents

    ERIC Educational Resources Information Center

    Frioux, Sarah M.; Blinman, Thane; Christian, Cindy W.

    2011-01-01

    Objective: (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries. Methods:…

  12. Postirradiation angiosarcoma of the vaginal vault

    SciTech Connect

    Chan, W.W.; SenGupta, S.K. )

    1991-05-01

    We describe a unique case of an angiosarcoma arising in the vaginal vault 21 years after hysterectomy and radiotherapy for stage I carcinoma of the cervix. We also review the literature regarding angiosarcomas arising after previous radiation therapy for gynecologic malignancies.

  13. Immediate postpartum insertion of the norplant contraceptive device.

    PubMed

    Molland, J R; Morehead, D B; Baldwin, D M; Castracane, V D; Lasley, B; Bergquist, C A

    1996-07-01

    During December 1992 to October 1994, in Texas, clinical researchers conducted a prospective case control study (15 cases receiving Norplant immediately postpartum vs. 6 controls undergoing bilateral tubal ligation immediately postpartum) to determine the safety and efficacy of inserting the contraceptive implant Norplant (6 capsules inserted subdermally, each containing 35 mg levonorgestrel) immediately postpartum. They followed the cases and the controls for three months. The study subjects were 18-35 years old, received prenatal care at one of the Department of Obstetrics and Gynecology's (Texas Tech University Health Sciences Center) community clinics, had an uncomplicated term pregnancy and normal spontaneous vaginal delivery, and did not breast feed. They tended to be poor. During the first week after Norplant insertion, serum levonorgestrel levels peaked at about 2000 pg/ml, then fell abruptly until about the eighth week to about 250 pg/ml. This lower levonorgestrel level concerned the researchers because it is just slightly higher than levels associated with pregnancy. They were also concerned about the possibility of Norplant inducing a hypoestrogenic state in postpartum women. The Norplant group was more likely than the tubal ligation group to experience irregular bleeding (p 0.01), headaches (p 0.01), hair loss (p 0.05), and abdominal discomfort (p 0.05). The various serum metabolic biomarkers, serum electrolytes, and blood components fell into the normal range in both groups. The serum estradiol, progesterone, and urinary steroid biomarkers suggested that the Norplant group experienced very suppressed steroid secretion throughout the three month study period, while the controls had normal postpartum ovarian activity. Thus, ovarian activity was absent in the Norplant group. These findings suggest that postpartum insertion of Norplant is safe and effective. Yet further clinical evaluation is needed to address concerns about the long-term hypoestrogenic

  14. Primary Vaginal Adenocarcinoma Arising in Vaginal Adenosis After CO2 Laser Vaporization and 5-Fluorouracil Therapy

    PubMed Central

    Paczos, Tamera A.; Ackers, Stacey; Odunsi, Kunle; Lele, Shashikant; Mhawech-Fauceglia, Paulette

    2016-01-01

    Summary We present a case of a 45-year-old woman with a long-standing history of persistent cervical dysplasia that resulted in a hysterectomy. Subsequent vaginal smears revealed high-grade vaginal intraepithelial neoplasia (VAIN III) on Pap smear with positive human papilloma virus (HPV) testing. Over the course of 2 years, the patient underwent 2 CO2 laser vaporization procedures of the upper vagina and intermittent 5-fluorouracil therapy. A biopsy performed at the time of the second laser procedure revealed endocervical-type well-differentiated adenocarcinoma, associated with VAIN III. HPV in situ hybridization for HPV types 16 and 18 was positive in both the glandular and squamous mucosa. The patient has no known history of intrauterine diethylstilbestrol exposure or mullerian developmental abnormalities. Subsequently, the patient underwent a radical upper vaginetcomy with bilateral pelvic lymph nodes dissection and bilateral salpingo-oophorectomy. The vaginectomy specimen showed residual adenocarcinoma associated with VAIN-III and extensive vaginal adenosis with free resection margins. This is the second reported case in the literature of adenocarcinoma arising in vaginal adenosis after 5-fluorouracil. Herein, we highlight these important findings and shed some light on the pathogenesis of vaginal adenosis and the subsequent development of vaginal adenocarcinoma. PMID:20173507

  15. [Improvement of vaginal relaxation by vaginal narrowing technique with double suturing].

    PubMed

    Liu, Sanhu; Cen, Ying; Liu, Quan

    2009-12-01

    To investigate the surgical procedures and outcomes of curing the mild and medium vaginal relaxation by double suturing vaginal muscularis. From May 2005 to November 2008, 8 patients (aged 30-45 years old) with mild and medium vaginal relaxation were treated. All the patients were married and had reproductive history of natural childbirth. The double semiring suture was performed in the region 4 cm and 0.5 cm away from the vaginal orifice, respectively, forming the first and the second semicircle to make vagina outside 1/3 segments and vagina muscles tighten. The time of operation was 20-30 minutes (average 25 minutes). There was no obvious bleeding and injury of the rectum and urethra during operation. All the incisions healed by first intention. The vagina accommodated 2 fingers without scar on its mucosa 1-2 months after operation. Eight patients were followed up for 6-24 months and the patients resumed their sexual life 4-8 weeks after operation with satisfied improvement. The technique of double suturing vaginal muscularis is easy and simple to perform with mild injury, fast postoperative recovery, and less postoperative complications. It is one of the effective methods to treat mild and medium vaginal relaxation.

  16. Primary vaginal adenocarcinoma arising in vaginal adenosis after CO2 laser vaporization and 5-fluorouracil therapy.

    PubMed

    Paczos, Tamera A; Ackers, Stacey; Odunsi, Kunle; Lele, Shashikant; Mhawech-Fauceglia, Paulette

    2010-03-01

    We present a case of a 45-year-old woman with a long-standing history of persistent cervical dysplasia that resulted in a hysterectomy. Subsequent vaginal smears revealed high-grade vaginal intraepithelial neoplasia (VAIN III) on Pap smear with positive human papilloma virus (HPV) testing. Over the course of 2 years, the patient underwent 2 CO(2) laser vaporization procedures of the upper vagina and intermittent 5-fluorouracil therapy. A biopsy performed at the time of the second laser procedure revealed endocervical-type well-differentiated adenocarcinoma, associated with VAIN III. HPV in situ hybridization for HPV types 16 and 18 was positive in both the glandular and squamous mucosa. The patient has no known history of intrauterine diethylstilbestrol exposure or mullerian developmental abnormalities. Subsequently, the patient underwent a radical upper vaginetcomy with bilateral pelvic lymph nodes dissection and bilateral salpingo-oophorectomy. The vaginectomy specimen showed residual adenocarcinoma associated with VAIN-III and extensive vaginal adenosis with free resection margins. This is the second reported case in the literature of adenocarcinoma arising in vaginal adenosis after 5-fluorouracil. Herein, we highlight these important findings and shed some light on the pathogenesis of vaginal adenosis and the subsequent development of vaginal adenocarcinoma.

  17. In Vitro Activity of Tea Tree Oil Vaginal Suppositories against Candida spp. and Probiotic Vaginal Microbiota.

    PubMed

    Di Vito, Maura; Mattarelli, Paola; Modesto, Monica; Girolamo, Antonietta; Ballardini, Milva; Tamburro, Annunziata; Meledandri, Marcello; Mondello, Francesca

    2015-10-01

    The aim of this work is to evaluate the in vitro microbicidal activity of vaginal suppositories (VS) containing tea tree oil (TTO-VS) towards Candida spp. and vaginal probiotics. A total of 20 Candida spp. strains, taken from patients with vaginitis and from an established type collection, including reference strains, were analysed by using the CLSI microdilution method. To study the action of VS towards the beneficial vaginal microbiota, the sensitivity of Bifidobacterium animalis subsp. lactis (DSM 10140) and Lactobacillus spp. (Lactobacillus casei R-215 and Lactobacillus acidophilus R-52) was tested. Both TTO-VS and TTO showed fungicidal activity against all strains of Candida spp. whereas placebo-VS or the Aloe gel used as controls were ineffective. The study of fractional fungicidal concentrations (FFC) showed synergistic interaction with the association between Amphotericin B and TTO (0.25 to 0.08 µg/ml, respectively) against Candida albicans. Instead, the probiotics were only affected by TTO concentration ≥ 4% v/v, while, at concentrations < 2% v/v, they remained viable. TTO-VS exhibits, in vitro, a selective fungicidal action, slightly affecting only the Bifidobacteriun animalis strain growth belonging to the vaginal microbiota. In vivo studies are needed to confirm the efficacy to prevent acute or recurrent vaginal candidiasis.

  18. [Induratio penis plastica and the capability of vaginal penetration in the context of forensic evaluation].

    PubMed

    Albrecht, K; Kedia, G T; Ückert, S; Hagemeier, L; Kuczyk, M A; Klintschar, M

    2014-09-01

    The so-called Induratio penis plastica (IPP), also known as Peyronie Disease or Morbus Peyronie, is the most common cause for deviation of the male penis. In most cases, the deviation is directed to the dorsal side. In face of a lawsuit related to a sexual offence, the opponent might argue that, due to an existing IPP, he is generally unable to insert his penis into a female's vagina. The aim of the present study was to examine the clinical files of thirty (30) consecutive patients who presented with IPP. Particular attention was given to the individual degree of penile deviation and the ability of the subjects to conduct vaginal intercourse. Subjects who had a dorsal penile deviation of 800 to 900, or a lateral deviation of 600, were unable to commence vaginal coitus. In contrast, three (3) subjects who presented with a ventral deviation of 30° to 40° had no difficulties in performing vaginal penetration. The medicolegal aspects of these findings are being discussed.

  19. Vaginal Douching Among Latinas: Practices and Meaning

    PubMed Central

    Baquero, María; Anderson, Matthew R.; Alvarez, Adelyn; Karasz, Alison

    2009-01-01

    Objectives Vaginal douching is widely practiced by American women, particularly among minority groups, and is associated with increased risk of pelvic and vaginal infections. This research sought to investigate vaginal hygiene practices and meaning associated with them among Latina women and adolescents. Study results would guide development of an intervention to decrease douching among Latinas. Methods In depth qualitative interviews conducted with English- and Spanish-speaking women aged 16–40, seeking care for any reason who reported douching within the last year (n = 34). Interviews were audiotaped, transcribed and analyzed using qualitative methods. One-third of interviews were conducted in Spanish. Results Two explanatory models for douching motives emerged: one stressed cosmetic benefits; the other, infection prevention and control. Most women reported douching to eliminate menstrual residue; a small number reported douching in context of sexual intercourse or vaginal symptoms. Many were unaware of associated health risks. Respondents typically learned about douching from female family members and friends. Male partners were described as having little to no involvement in the decision to douche. Women varied in their willingness to stop douching. Two-thirds reported receiving harm reduction messages about “overdouching”. About half indicated previous discussion about douching with health care providers; some had reduced frequency in response to counseling. A number of previously unreported vaginal hygiene practices and products were described, including use of a range of traditional hygiene practices, and products imported from outside the US. Conclusions Respondents expressed a range of commitment to douching. Counseling messages acknowledging benefits women perceive as well as health risks should be developed and delivered tailored to individual beliefs. Further research is needed to assess prevalence and safety of previously unreported practices

  20. Gene Insertion Patterns and Sites

    NASA Astrophysics Data System (ADS)

    Vain, Philippe; Thole, Vera

    During the past 25 years, the molecular analysis of transgene insertion patterns and sites in plants has greatly contributed to our understanding of the mechanisms underlying transgene integration, expression, and stability in the nuclear genome. Molecular characterization is also an essential step in the safety assessment of genetically modified crops. This chapter describes the standard experimental procedures used to analyze transgene insertion patterns and loci in cereals and grasses transformed using Agrobacterium tumefaciens or direct transfer of DNA. Methods and protocols enabling the determination of the number and configuration of transgenic loci via a combination of inheritance studies, polymerase chain reaction, and Southern analyses are presented. The complete characterization of transgenic inserts in plants is, however, a holistic process relying on a wide variety of experimental approaches. In this chapter, these additional approaches are not detailed but references to relevant bibliographic records are provided.

  1. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration.

    PubMed

    Koganemaru, Masamichi; Nonoshita, Masaaki; Iwamoto, Ryoji; Kuhara, Asako; Nabeta, Masakazu; Kusumoto, Masashi; Kugiyama, Tomoko; Kozuma, Yutaka; Nagata, Shuji; Abe, Toshi

    2016-08-01

    We evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration. We reviewed seven cases of patients (mean age 30.9 years; range 27-35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery's architecture, technical and clinical success rates, and complications. The vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases. Postpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  2. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

    PubMed Central

    Lester, Joanne; Pahouja, Gaurav; Andersen, Barbara; Lustberg, Maryam

    2015-01-01

    Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors. PMID:25815692

  3. Complete vaginal outlet stenosis in a patient with Sheehan's syndrome.

    PubMed

    Choo, Minji; Park, Hana; Yi, Kyong Wook

    2016-11-01

    We present a case of complete vaginal stenosis in a woman diagnosed with Sheehan's syndrome. The patient delivered at full-term 5 months prior, and experienced massive postpartum bleeding at that time. During evaluation of persistent amenorrhea, we found that her vaginal orifice was completely adhesive and obstructed. Prior to corrective surgery, we managed the patient with an oral contraceptive to induce uterine bleeding into the vaginal outflow tract. After three cycles of an oral contraceptive, we could confirm that there was no stenotic lesion in the vaginal cavity as a hematocolpos was created. Adhesiolysis with scar revision for the vaginal stenosis was successfully performed; it was found that the lesion was limited to only the distal part of the vaginal outlet. Complete vaginal stenosis in reproductive age women with hypopituitarism has not been reported. The artificial induction of hematometrocolpos before surgery was useful in determining the extent of the stenotic lesion, and assured safety.

  4. Comparison between vaginal royal jelly and vaginal estrogen effects on quality of life and vaginal atrophy in postmenopausal women: a clinical trial study

    PubMed Central

    Seyyedi, Fatemeh; Kopaei, Mahmoud Rafiean; Miraj, Sepideh

    2016-01-01

    Objective This study was conducted to evaluate the therapeutic effects of vaginal royal jelly and vaginal estrogen on quality of life and vaginal atrophy in postmenopausal women. Methods This double-blind randomized controlled clinical trial was carried out at gynecology and obstetrics clinics of Hajar Hospital of Shahrekord University of Medical Sciences (Iran) from January 2013 to January 2014. The study was conducted on married postmenopausal women between 50 and 65 years old. Of 120 patients, 30 individuals were excluded based on the exclusion criteria, and 90 women were randomly distributed into three groups of 30 royal jelly vaginal cream 15%, vaginal Premarin, and placebo (lubricant), for three months. At the beginning and the end of the study, quality of life and vaginal cytology assay were evaluated. Data were analyzed by SPSS Version 11. Results Vaginal cream of royal jelly is significantly more effective than vaginal cream of Premarin and lubricant in improvement of quality of life in postmenopausal women (p<0.05). Moreover, Pap smear results showed that vaginal atrophy in vaginal Premarin group was lower than the other groups (p<0.001), and there was no significant difference between lubricant and royal jelly groups (p=0.89). Conclusion Administration of vaginal royal jelly was effective in quality-of-life improvement of postmenopausal women. Given to the various properties of royal jelly and its effectiveness on quality of life and vaginal atrophy in postmenopausal women, further studies are recommended for using =royal jelly in improving menopausal symptoms. Clinical trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT code: 2014112220043n1. Funding Shahrekord University of Medical Sciences supported this research (project no. 1440). PMID:28070251

  5. Mesh removal after vaginal surgery: what happens in the UK?

    PubMed

    Duckett, Jonathan; Morley, Roland; Monga, Ash; Hillard, Tim; Robinson, Dudley

    2017-07-01

    There is little objective evidence regarding complication rates for mesh procedures outside clinical trials. Current coding poorly collects complications of prolapse and continence surgery using mesh. This survey was designed to identify surgeons performing mesh removal and reporting patterns in the UK. An electronic questionnaire was sent to all members of the Royal College of Obstetricians and Gynaecologists and members of the Section of Female Neurological and Urodynamic Urology of the British Association of Urologists in the UK. The questionnaire aimed to identify the number of procedures performed for mesh complications and whether they were reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and the patterns of referral and treatment RESULTS: Referral to a colleague in the same hospital was common practice (69 %). Only 27 % of respondents stated that they reported all removals to the MHRA. The numbers of surgical procedures were low, with most respondents performing between one and three procedures each year and many not performing any surgery for a specific mesh complication in the previous year. Removal of exposed, eroded and/or painful vaginally inserted mesh is performed by many different surgeons in a variety of hospital settings in the UK.

  6. `Normal' vaginal microbiology of women of childbearing age in relation to the use of oral contraceptives and vaginal tampons

    PubMed Central

    Morris, C. A.; Morris, Delia F.

    1967-01-01

    The vaginal microbiology of women attending a family planning clinic was found to be unrelated to the use of oral contraceptives and vaginal tampons. Beta haemolytic streptococci isolated from this `normal' population were compared with those from 1,104 women attending general practitioners complaining of vaginal discharge. There is a caution regarding the indications for antibiotic therapy. Observations were made on the effects of contamination of vaginal swabs with yeasts and β-haemolytic streptococci from the vulva. The persistent character of the vaginal flora over a six-month period is described. PMID:5602581

  7. Vaginal Dose Is Associated With Toxicity in Image Guided Tandem Ring or Ovoid-Based Brachytherapy.

    PubMed

    Susko, Matthew; Craciunescu, Oana; Meltsner, Sheridan; Yang, Yun; Steffey, Beverly; Cai, Jing; Chino, Junzo

    2016-04-01

    To calculate vaginal doses during image guided brachytherapy with volume-based metrics and correlate with long-term vaginal toxicity. In this institutional review board-approved study, institutional databases were searched to identify women undergoing computed tomography and/or magnetic resonance-guided brachytherapy at the Duke Cancer Center from 2009 to 2015. All insertions were contoured to include the vagina as a 3-dimensional structure. All contouring was performed on computed tomography or magnetic resonance imaging and used a 0.4-cm fixed brush to outline the applicator and/or packing, expanded to include any grossly visible vagina. The surface of the cervix was specifically excluded from the contour. High-dose-rate (HDR) and low-dose-rate (LDR) doses were converted to the equivalent dose in 2-Gy fractions using an α/β of 3 for late effects. The parameters D0.1cc, D1cc, and D2cc were calculated for all insertions and summed with prior external beam therapy. Late and subacute toxicity to the vagina were determined by the Common Terminology Criteria for Adverse Events version 4.0 and compared by the median and 4th quartile doses, via the log-rank test. Univariate and multivariate hazard ratios were calculated via Cox regression. A total of 258 insertions in 62 women who underwent definitive radiation therapy including brachytherapy for cervical (n=48) and uterine cancer (n=14) were identified. Twenty HDR tandem and ovoid, 32 HDR tandem and ring, and 10 LDR tandem and ovoid insertions were contoured. The median values (interquartile ranges) for vaginal D0.1cc, D1cc, and D2cc were 157.9 (134.4-196.53) Gy, 112.6 (96.7-124.6) Gy, and 100.5 (86.8-108.4) Gy, respectively. At the 4th quartile cutoff of 108 Gy for D2cc, the rate of late grade 1 toxicity at 2 years was 61.2% (95% confidence interval [CI] 43.0%-79.4%) below 108 Gy and 83.9% (63.9%-100%) above (P=.018); grade 2 or greater toxicity was 36.2% (95% CI 15.8%-56.6%) below 108 Gy and 70.7% (95% CI 45

  8. Fetal presentation and successful twin vaginal delivery.

    PubMed

    Easter, Sarah Rae; Lieberman, Ellice; Carusi, Daniela

    2016-01-01

    Despite the demonstrated safety of a trial of labor for pregnancies with a vertex-presenting twin and clinical guidelines in support of this plan, the rate of planned cesarean delivery for twin pregnancies remains high. This high rate, as well as variation in cesarean rates for twin pregnancies across providers, may be influenced strongly by concern about delivery of the second twin, particularly when it is in a nonvertex presentation. There are limited data in the literature that has examined the impact of the position of the nonpresenting twin on successful vaginal delivery or maternal/neonatal morbidity. We hypothesized that nonvertex presentation of the second twin would be associated with lower rates of successful vaginal birth for those patients attempting labor. This institutional review board-approved, retrospective cohort study of women who labored with twin pregnancies in a single urban hospital from 2007-2011. We included women with vertex-presenting first twins at >32 weeks gestation without a contraindication to labor and excluded those with uterine scar or lethal fetal anomaly. Vaginal delivery rates were evaluated according to vertex or nonvertex presentation of the second twin at admission and again at delivery. Maternal and neonatal morbidities were evaluated separately. Logistic regression was used to control for multiple confounders. Seven hundred sixteen patients met the inclusion criteria; 349 patients (49%) underwent a trial of labor. This included 73% (296/406) of eligible vertex/vertex twins and 17% (53/310) eligible vertex/nonvertex twins (P < .01). When compared with laboring patients with vertex/vertex-presenting twins, those with vertex/nonvertex twins were younger (median age, 32 vs 33 years; P = .05), were more often multiparous (60% vs 43%; P = .02), and were less likely to have hypertension (13% vs 27%; P = .03). Eighty-five percent of patients with nonvertex second twins at admission delivered vaginally, compared with 70% of

  9. Women's preferences for vaginal antimicrobial contraceptives. III. Choice of a formulation, applicator, and packaging.

    PubMed

    Hardy, E; Jiménez, A L; de Pádua, K S; Zaneveld, L J

    1998-10-01

    Novel vaginal formulations are under development to combat the increasing incidence of sexually transmitted diseases, including AIDS, and also unplanned pregnancies. A study was performed to determine women's preferences for different dosage forms (gel, cream, ovule/suppository, film, foam, tablet), width, length, and color of an applicator, and various types of packages. The study was conducted in Campinas, Brazil. A total of 635 women were interviewed, including both adolescents and adults and low and middle-high socioeconomic groups. The large majority of the women preferred a gel over a cream; both were preferred over the other methods. When asked which method they would not use, the film was most frequently identified, followed by the tablet and ovule. The primary reasons for selecting a particular dosage form were ease of use, absence of odor or the presence of a pleasant one, absence of color, and insertion with an applicator. The major reasons for not using a method were discomfort, "plastic" appearance, distrust of effectiveness, difficulty with insertion, messiness, and rigidity/hardness. The majority of the women liked the applicator shown. The prefilled single dose applicator was by far the preferred packaging. This information should aid in the development of consumer-friendly, vaginal formulations.

  10. A randomized controlled trial comparing vaginal misoprostol versus Foley catheter plus oxytocin for labor induction.

    PubMed

    Moraes Filho, Olimpio B; Albuquerque, Rivaldo M; Cecatti, José G

    2010-08-01

    To compare effectiveness and safety of 25 microg vaginal misoprostol versus Foley catheter and oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. Randomized controlled trial. A public maternity in Recife, Brazil. A total of 240 pregnant women. Women with a term or post-term, live, singleton fetus in cephalic presentation, intact membranes, Bishop score <6, not in labor, medically indicated for labor induction. They were randomly divided in Group 1, where 119 women received 25 microg of intravaginal misoprostol every 6 hours for a maximum of four doses; and Group 2, where 121 women had a 14-F Foley catheter inserted into their cervical canal. Once past the internal os, the balloon was inflated. Intravenous oxytocin was initiated after the balloon was spontaneously extruded from the cervix or after 24 hours. There were no significant differences between the groups regarding baseline characteristics. Misoprostol was more effective in inducing labor than Foley catheter and oxytocin. Mean induction-to-vaginal delivery time with misoprostol was shorter (17.3 vs. 20.2 hours, p = 0.016). There were more vaginal deliveries in the misoprostol group at 12 (p < 0.001) and 18 (p = 0.007) hours, but the difference was no longer statistically significant at 24 and 48 hours. There were no significant differences in uterine contraction abnormalities, puerperal infection or neonatal outcomes. Vaginal misoprostol is more effective than and as safe as Foley catheter and oxytocin for induction of labor in term and post-term pregnancy.

  11. Preclinical, Clinical, and Over-the-Counter Postmarketing Experience with a New Vaginal Cup: Menstrual Collection

    PubMed Central

    North, Barbara B.

    2011-01-01

    Abstract Background Menstrual cups have been available for decades, but their use is limited by bulky design and the need for multiple sizes. The Softcup® (Instead, Inc., San Diego, CA) is a simple single-size disposable over-the-counter (OTC) menstrual cup that compresses to tampon shape to facilitate insertion and can be worn during coitus. This report describes preclinical evaluation, clinical testing, and postmarketing monitoring of the Softcup. Methods Preclinical testing complied with U.S. Food and Drug Administration (FDA) guidelines and used standard United States Pharmacopoeia methodologies for assessment of potential toxicity. Clinical testing enrolled 406 women in seven U.S. centers. A detailed written questionnaire assessed safety, acceptability, and effectiveness for menstrual collection. Study safety parameters included pelvic examinations, Pap smears, colposcopy, urinalysis, vaginal pH, wet mounts, gram stain, and vaginal microflora cultures. Postmarketing surveillance of over 100 million Softcups has been conducted by the manufacturer and by the FDA Medwatch system. Results No toxicity or mutagenicity was observed in preclinical evaluations. In clinical testing, after three cycles of cup use, 37% of subjects rated the cup as better than, 29% as worse than, and 34% as equal to pads or tampons. The cup was preferred for comfort, dryness, and less odor. Cups received lower ratings for disposal and convenience. Eighty-one percent of enrolled women were able to insert and remove their first cup using only written instructions. Use difficulties resulting in study discontinuations included cramping (1%), leakage (1%), and improper fit (3%). No safety parameters were adversely affected. No significant health risks were reported during postmarketing surveillance. Conclusions These results demonstrate that a single-size vaginal device has no significant health risks and is acceptable to many women without the need for fitting or other medical services. PMID

  12. Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy.

    PubMed

    Ercan, Önder; Özer, Alev; Köstü, Bülent; Bakacak, Murat; Kıran, Gürkan; Avcı, Fazıl

    2016-01-01

    To compare vaginal length and sexual function after total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH), and vaginal hysterectomy (VH). The present cross-sectional study at a single center in Turkey compared vaginal length and sexual function among women who received TLH, TAH, VH, or no surgery (groups 1, 2, 3, and 0, respectively) between January 2011 and April 2014. All women underwent hysterectomy for benign reasons at least 3months before the study and were sexually active. Vaginal length was measured between the hymenal ring and vaginal apex. Sexual function was assessed via the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, short form (PISQ-12). Vaginal length in groups 0, 1, 2, and 3 was 10.9±1.5, 8.9±1.4, 8.5±1.2, and 8.1±0.7cm, respectively; it was significantly longer in the control group (P<0.001), and significantly shorter in group 3 than in group 1 (P=0.03). The mean PISQ-12 score in groups 0, 1, 2, and 3 was 18.6±5.2, 12.9±3.0, 13.8±4.4, and 11.5±4.4, respectively, and was significantly higher in group 0 (P<0.001). Total hysterectomy shortened vaginal length and compromised sexual function regardless of the technique used. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. The Comparison of Vaginal Cream of Mixing Yogurt, Honey and Clotrimazole on Symptoms of Vaginal Candidiasis

    PubMed Central

    Darvishi, Maryam; Jahdi, Fereshteh; Hamzegardeshi, Zeinab; Goodarzi, Saied; Vahedi, Mohsen

    2015-01-01

    Background: Vulvovaginal candidiasis is known as one of the most common fungal infection among women of reproductive age and considered as an important public health problem. In recent years, due to resistance to common antifungal medication, the use of traditional medicine of anti-fungal and herbal treatmentis increased. Therefore the objective of this study was to determine the effects of vaginal cream, mixture of yogurt and honey and comparing it with clotrimazole vaginal cream on symptoms of Vulvovaginal candidiasis in patients. Methods: In this randomized, triple blind clinical trial of 70 non-pregnant women infected with Candidalvulvovaginitis were placed in two groups of Vaginal cream mixed of yogurt and honey recipients (N = 35) and clotrimazole vaginal cream (N = 35). Both groups were treated for 7 days.At the beginning of study, Clinical and laboratory signs and symptoms were registered 7 and 14 days after treatment by questionnaire, observation formand secretions medium culture results. Data were analyzed by chi-square test, t test, McNemar tests through SPSS version 21. Significance level of 0.05 was considered. Results: The result of present study reveals the significant differences in symptom improvement of yogurt and honey, toward clotrimazole group (P < 0.05) and also Positive results of the first cultures (one week after treatment) in “yogurt and honey” and clotrimazole (20% versus 8.6%) and second time cultivation (14 days after treatment) (17.1% versus 8.6%) were similar and there was no significant differences between the two groups. (P > 0.05). Conclusion: This study indicated that the therapeutic effects of vaginal cream, yogurt and honey is not only similar with clotrimazole vaginal cream but is more effective in relieving some symptoms of vaginal candidiasis. Therefore, the use of this product can be suggested as an herbal remedy for candida infection treatment. PMID:26153168

  14. The impact of air pockets around the vaginal cylinder on vaginal vault brachytherapy

    PubMed Central

    Guler, O C; Dolek, Y

    2015-01-01

    Objective: To evaluate the incidence, size and predisposing factors for air pockets around the vaginal cylinder and their dosimetric effect on the vaginal mucosa. Methods: We investigated 174 patients with endometrial carcinoma treated with external radiotherapy (RT) and brachytherapy (BRT) (101 patients, 58%) or BRT alone (73 patients, 42%). The quantity, volume and dosimetric impact of the air pockets surrounding the vaginal cylinder were quantified. The proportions of patients with or without air pockets during application were stratified according to menopausal status, treatment modality and interval between surgery and RT. Results: Air pockets around the vaginal cylinder were seen in 75 patients (43%), while 99 patients (57%) had no air pockets. Only 11 patients (6.3%) received less than the prescribed dose (average 93.9% of prescribed dose; range, 79.0–99.2%). Air pockets were significantly fewer in pre-menopausal patients or in patients treated with the combination of external RT and BRT than in post-menopausal patients or patients treated with BRT alone. A significant correlation existed between the mucosal displacement of the air gap and the ratio of the measured dose at the surface of the air gap and prescribed dose (Pearson r = −0.775; p < 0.001). Conclusion: Air pockets were still a frequent problem during vaginal vault BRT, especially in post-menopausal patients or in patients treated with BRT alone, which may potentially cause dose reductions at the vaginal mucosa. Advances in knowledge: Air pockets around the vaginal cylinder remain a significant problem, which may potentially cause dose reduction in the target volume. PMID:25562767

  15. Vaginal replacement in children and young adults.

    PubMed

    Hensle, T W; Reiley, E A

    1998-03-01

    Absence of the vagina in the pediatric population most commonly results from congenital abnormalities, such as the Mayer-Rokitansky syndrome but it may also be seen after treatment for pelvic tumors, such as rhabdomyosarcoma, and in patients who have had previous gender reassignment. We review our experience using bowel for vaginal replacement in a group of children and young adults to assess outcome and satisfaction. From 1980 to 1996 we evaluated 31 patients 1 to 20 years old who required vaginal replacement. Presenting diagnoses included müllerian failure (the Mayer-Rokitansky syndrome) in 20 patients, androgen insensitivity syndrome in 5, rhabdomyosarcoma in 3, penile agenesis in 1, cloacal exstrophy in 1 and 1 previously separated conjoint twin. A questionnaire was given to 26 of the 31 patients to assess postoperative sexual function and satisfaction. A total of 33 bowel segments in 31 patients were used for vaginal reconstruction, including sigmoid colon in 20, ileum in 8 and cecum in 5. Of the 31 patients 20 were sexually active, 8 were married and 3 had been previously married and divorced. Only 1 patient described chronic dyspareunia. Three patients were on chronic home dilation, while 4 required sanitary pads for vaginal secretions. There were 8 complications in the 31 patients, including stenosis of the bowel segment in 6. Three patients required a second procedure after total stenosis of the small bowel vagina (2) and prolapse of the neovagina (1), which required retroperitoneal fixation. Experience with this group of patients leads us to believe that isolated bowel segments provide excellent tissue for vaginal replacement. Furthermore, we believe that colon segments, particularly sigmoid, are preferable to small bowel for creation of the neovagina. In many instances the small bowel mesentery may be too short to provide an adequate, tension-free anastomosis in the perineum, particularly in obese patients. Our results would also suggest that sexual

  16. The vaginal microflora in relation to gingivitis

    PubMed Central

    2009-01-01

    Background Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. Methods Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites. Results A Nugent score of 0–3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p < 0.001) for 38/74 species in BV+ in comparison to BV- women. Counts of four lactobacilli species were higher in BV- women (p < 0.001). Independent of BV diagnosis, women with gingivitis had higher counts of Prevotella bivia (p < 0.001), and Prevotella disiens (p < 0.001). P. bivia, P. disiens, M. curtisii and M. mulieris (all at the p < 0.01 level) were found at higher levels in the BV+/G+ group than in the BV+/G- group. The sum of bacterial load (74 species) was higher in the BV+/G+ group than in the BV+/G- group (p < 0.05). The highest odds ratio for the presence of bacteria in vaginal samples (> 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p < 0.001) and 3.6 for P. disiens (95%CI: 1.8–7.5, p < 0.001), and a diagnosis of BV for P. bivia (odds ratio: 5.3, 95%CI: 2.6 to 10.4, p < 0.001) and P. disiens (odds ratio: 4.4, 95% CI: 2.2 to 8.8, p < 0.001). Conclusion Higher vaginal bacterial counts can be found in women with BV and gingivitis in comparison to women with BV but not gingivitis. P

  17. Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies

    PubMed Central

    2014-01-01

    Background Purpose of this study was to identify predictors of vaginal ulcer after CT based three-dimensional image-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for gynecologic malignancies. Methods Records were reviewed for 44 female (14 with primary disease and 30 with recurrence) with gynecological malignancies treated with HDR-ISBT with or without external beam radiation therapy. The HDR-ISBT applicator insertion was performed with image guidance by trans-rectal ultrasound and CT. Results The median clinical target volume was 35.5 ml (2.4-142.1 ml) and the median delivered dose in equivalent dose in 2 Gy fractions (EQD2) for target volume D90 was 67.7 Gy (48.8-94.2 Gy, doses of external-beam radiation therapy and brachytherapy were combined). For re-irradiation patients, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 91.1 Gy, 100.9 Gy, 260.3 Gy, 212.3 Gy, 170.1 Gy, 117.1 Gy, 105.2 Gy, and 94.7 Gy, respectively. For those without prior radiation therapy, median EQD2 of D2cc for rectum and bladder, D0.5cc, D1cc, D2cc, D4cc, D6cc and D8cc for vaginal wall was 56.3 Gy, 54.3 Gy, 147.4 Gy, 126.2 Gy, 108.0 Gy, 103.5 Gy, 94.7 Gy, and 80.7 Gy, respectively. Among five patients with vaginal ulcer, three had prior pelvic radiation therapy in their initial treatment and three consequently suffered from fistula formation. On univariate analysis, re-irradiation and vaginal wall D2cc in EQD2 was the clinical predictors of vaginal ulcer (p = 0.035 and p = 0.025, respectively). The ROC analysis revealed that vaginal wall D2cc is the best predictor of vaginal ulcer. The 2-year incidence rates of vaginal ulcer in the patients with vaginal wall D2cc in EQD2 equal to or less than 145 Gy and over 145 Gy were 3.7% and 23.5%, respectively, with a statistically significant difference (p = 0.026). Conclusions Re-irradiation and vaginal D2cc is a significant predictor of vaginal ulcer after HDR-ISBT for

  18. Vaginal tolerance of CT based image-guided high-dose rate interstitial brachytherapy for gynecological malignancies.

    PubMed

    Murakami, Naoya; Kasamatsu, Takahiro; Sumi, Minako; Yoshimura, Ryoichi; Harada, Ken; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Itami, Jun

    2014-01-23

    Purpose of this study was to identify predictors of vaginal ulcer after CT based three-dimensional image-guided high-dose-rate interstitial brachytherapy (HDR-ISBT) for gynecologic malignancies. Records were reviewed for 44 female (14 with primary disease and 30 with recurrence) with gynecological malignancies treated with HDR-ISBT with or without external beam radiation therapy. The HDR-ISBT applicator insertion was performed with image guidance by trans-rectal ultrasound and CT. The median clinical target volume was 35.5 ml (2.4-142.1 ml) and the median delivered dose in equivalent dose in 2 Gy fractions (EQD2) for target volume D90 was 67.7 Gy (48.8-94.2 Gy, doses of external-beam radiation therapy and brachytherapy were combined). For re-irradiation patients, median EQD2 of D(2cc) for rectum and bladder, D0.5cc, D(1cc), D(2cc), D(4cc), D(6cc) and D(8cc) for vaginal wall was 91.1 Gy, 100.9 Gy, 260.3 Gy, 212.3 Gy, 170.1 Gy, 117.1 Gy, 105.2 Gy, and 94.7 Gy, respectively. For those without prior radiation therapy, median EQD2 of D(2cc) for rectum and bladder, D(0.5cc), D(1cc), D(2cc), D(4cc), D(6cc) and D(8cc) for vaginal wall was 56.3 Gy, 54.3 Gy, 147.4 Gy, 126.2 Gy, 108.0 Gy, 103.5 Gy, 94.7 Gy, and 80.7 Gy, respectively. Among five patients with vaginal ulcer, three had prior pelvic radiation therapy in their initial treatment and three consequently suffered from fistula formation. On univariate analysis, re-irradiation and vaginal wall D(2cc) in EQD2 was the clinical predictors of vaginal ulcer (p = 0.035 and p = 0.025, respectively). The ROC analysis revealed that vaginal wall D(2cc) is the best predictor of vaginal ulcer. The 2-year incidence rates of vaginal ulcer in the patients with vaginal wall D(2cc) in EQD2 equal to or less than 145 Gy and over 145 Gy were 3.7% and 23.5%, respectively, with a statistically significant difference (p = 0.026). Re-irradiation and vaginal D(2cc) is a significant predictor of vaginal ulcer after HDR-ISBT for gynecologic

  19. MELFI Urine Sample First Insertion

    NASA Image and Video Library

    2009-04-11

    ISS019-E-005715 (11 April 2009) --- Astronaut Michael Barratt, Expedition 19/20 flight engineer, performs an insertion of urine samples into the Minus Eighty Degree Laboratory Freezer for ISS (MELFI) as part of the Nutritional Status Assessment (NUTRITION) study in the Japanese Kibo laboratory of the International Space Station.

  20. Laparoscopic urethrolysis followed by trans-obturator tape sling insertion for long standing voiding dysfunction after Burch colposuspension.

    PubMed

    Ismail, Sharif I M F

    2014-04-01

    This case report describes laparoscopic urethrolysis followed by trans-obturator tape sling insertion for voiding dysfunction after colposuspension. A 50-year-old patient presented with predominant stress incontinence of urine 14 after Burch colposuspension. There was no anterior vaginal wall prolapse on examination and urodynamic assessment confirmed voiding dysfunction in the absence of urodynamic stress incontinence. Clean intermittent self-catheterisation was tried, but failed to improve the patient's symptoms. Laparoscopic urethrolysis was carried out, leading to the relief of voiding dysfunction, but was followed by recurrence of stress incontinence. A trans-obturator tape sling was subsequently inserted with significant improvement in stress incontinence and the patient was discharged.

  1. Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: a randomized controlled trial.

    PubMed

    Lee, Yoo-Kyung; Chung, Hyun Hoon; Kim, Jae Weon; Park, Noh-Hyun; Song, Yong-Sang; Kang, Soon-Beom

    2011-04-01

    To estimate the effects of vaginal pH-balanced gel on vaginal symptoms and atrophy in breast cancer survivors treated with chemotherapy or endocrine therapy. This was a randomized, double-blind, placebo-controlled study. Breast cancer survivors who experienced menopause after chemotherapy or endocrine therapy were voluntarily enrolled and randomly administered vaginal topical pH-balanced gel or placebo three times per week for 12 weeks. Vaginal dryness and dyspareunia were measured by visual analog scale, vaginal health index, and vaginal pH. The endometrium and ovary were evaluated by transvaginal ultrasonography. Among 98 enrolled women, 86 completed the treatment (n=44 and n=42 for the pH-balanced gel group and placebo group, respectively). Vaginal dryness and dyspareunia improved more in the pH-balanced gel group than in the placebo group (baseline mean 8.20 compared with end-point mean 4.23 [P=.001] and 8.23 compared with 5.48 [P=.040], respectively). Vaginal pH-balanced gel reduced the vaginal pH (gel: baseline mean 6.49 compared with end-point mean 5.00; placebo: 6.22 compared with 5.69 [P<.001]), and enhanced vaginal maturation index (gel: 45.5 compared with 51.2; placebo: 46.4 compared with 47.9 [P<.001]) and vaginal health index (gel: 15.8 compared with 21.1; placebo 14.3 compared with 16.98 [P=.002]). There was no significant difference in adverse effects between the two groups except for mild irritation at the early time of pH-balanced gel administration. Vaginal pH-balanced gel could relieve vaginal symptoms and improve vaginal health in breast cancer survivors who have experienced menopause after cancer treatment. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00607295. I.

  2. Secretory Aspartyl Proteinases Cause Vaginitis and Can Mediate Vaginitis Caused by Candida albicans in Mice.

    PubMed

    Pericolini, Eva; Gabrielli, Elena; Amacker, Mario; Kasper, Lydia; Roselletti, Elena; Luciano, Eugenio; Sabbatini, Samuele; Kaeser, Matthias; Moser, Christian; Hube, Bernhard; Vecchiarelli, Anna; Cassone, Antonio

    2015-06-02

    Vaginal inflammation (vaginitis) is the most common disease caused by the human-pathogenic fungus Candida albicans. Secretory aspartyl proteinases (Sap) are major virulence traits of C. albicans that have been suggested to play a role in vaginitis. To dissect the mechanisms by which Sap play this role, Sap2, a dominantly expressed member of the Sap family and a putative constituent of an anti-Candida vaccine, was used. Injection of full-length Sap2 into the mouse vagina caused local neutrophil influx and accumulation of the inflammasome-dependent interleukin-1β (IL-1β) but not of inflammasome-independent tumor necrosis factor alpha. Sap2 could be replaced by other Sap, while no inflammation was induced by the vaccine antigen, the N-terminal-truncated, enzymatically inactive tSap2. Anti-Sap2 antibodies, in particular Fab from a human combinatorial antibody library, inhibited or abolished the inflammatory response, provided the antibodies were able, like the Sap inhibitor Pepstatin A, to inhibit Sap enzyme activity. The same antibodies and Pepstatin A also inhibited neutrophil influx and cytokine production stimulated by C. albicans intravaginal injection, and a mutant strain lacking SAP1, SAP2, and SAP3 was unable to cause vaginal inflammation. Sap2 induced expression of activated caspase-1 in murine and human vaginal epithelial cells. Caspase-1 inhibition downregulated IL-1β and IL-18 production by vaginal epithelial cells, and blockade of the IL-1β receptor strongly reduced neutrophil influx. Overall, the data suggest that some Sap, particularly Sap2, are proinflammatory proteins in vivo and can mediate the inflammasome-dependent, acute inflammatory response of vaginal epithelial cells to C. albicans. These findings support the notion that vaccine-induced or passively administered anti-Sap antibodies could contribute to control vaginitis. Candidal vaginitis is an acute inflammatory disease that affects many women of fertile age, with no definitive cure and, in

  3. Association of vaginal dysbiosis and biofilm with contraceptive vaginal ring biomass in African women.

    PubMed

    Hardy, Liselotte; Jespers, Vicky; De Baetselier, Irith; Buyze, Jozefien; Mwambarangwe, Lambert; Musengamana, Viateur; van de Wijgert, Janneke; Crucitti, Tania

    2017-01-01

    We investigated the presence, density and bacterial composition of contraceptive vaginal ring biomass and its association with the vaginal microbiome. Of 415 rings worn by 120 Rwandese women for three weeks, the biomass density was assessed with crystal violet and the bacterial composition of biomass eluates was assessed with quantitative polymerase chain reaction (qPCR). The biomass was visualised after fluorescence in situ hybridisation (FISH) and with scanning electron microscopy (SEM). The vaginal microbiome was assessed with Nugent scoring and vaginal biofilm was visualised after FISH. All vaginal rings were covered with biomass (mean optical density (OD) of 3.36; standard deviation (SD) 0.64). Lactobacilli were present on 93% of the rings, Gardnerella vaginalis on 57%, and Atopobium vaginae on 37%. The ring biomass density was associated with the concentration of A. vaginae (OD +0.03; 95% confidence interval (CI) 0.01-0.05 for one log increase; p = 0.002) and of G. vaginalis (OD +0.03; (95% CI 0.01-0.05; p = 0.013). The density also correlated with Nugent score: rings worn by women with a BV Nugent score (mean OD +0.26), and intermediate score (mean OD +0.09) had a denser biomass compared to rings worn by participants with a normal score (p = 0.002). Furthermore, presence of vaginal biofilm containing G. vaginalis (p = 0.001) and A. vaginae (p = 0.005) correlated with a denser ring biomass (mean OD +0.24 and +0.22 respectively). With SEM we observed either a loose network of elongated bacteria or a dense biofilm. We found a correlation between vaginal dysbiosis and the density and composition of the ring biomass, and further research is needed to determine if these relationships are causal. As multipurpose vaginal rings to prevent pregnancy, HIV, and other sexually transmitted diseases are being developed, the potential impact of ring biomass on the vaginal microbiota and the release of active pharmaceutical ingredients should be researched in depth.

  4. Patterns of cetacean vaginal folds yield insights into functionality

    PubMed Central

    Orbach, Dara N.; Marshall, Christopher D.; Mesnick, Sarah L.; Würsig, Bernd

    2017-01-01

    Complex foldings of the vaginal wall are unique to some cetaceans and artiodactyls and are of unknown function(s). The patterns of vaginal length and cumulative vaginal fold length were assessed in relation to body length and to each other in a phylogenetic context to derive insights into functionality. The reproductive tracts of 59 female cetaceans (20 species, 6 families) were dissected. Phylogenetically-controlled reduced major axis regressions were used to establish a scaling trend for the female genitalia of cetaceans. An unparalleled level of vaginal diversity within a mammalian order was found. Vaginal folds varied in number and size across species, and vaginal fold length was positively allometric with body length. Vaginal length was not a significant predictor of vaginal fold length. Functional hypotheses regarding the role of vaginal folds and the potential selection pressures that could lead to evolution of these structures are discussed. Vaginal folds may present physical barriers, which obscure the pathway of seawater and/or sperm travelling through the vagina. This study contributes broad insights to the evolution of reproductive morphology and aquatic adaptations and lays the foundation for future functional morphology analyses. PMID:28362830

  5. Aromatase inhibitors affect vaginal proliferation and steroid hormone receptors.

    PubMed

    Kallak, Theodora Kunovac; Baumgart, Juliane; Göransson, Emma; Nilsson, Kerstin; Poromaa, Inger Sundström; Stavreus-Evers, Anneli

    2014-04-01

    Women with breast cancer who are treated with aromatase inhibitors often experience vaginal atrophy symptoms and sexual dysfunction. This work aims to study proliferation and the presence and distribution of steroid hormone receptors in vaginal biopsies in relation to vaginal atrophy and vaginal pH in women with breast cancer who are on adjuvant endocrine treatment and in healthy postmenopausal women. This is a cross-sectional study that compares postmenopausal aromatase inhibitor-treated women with breast cancer (n = 15) with tamoxifen-treated women with breast cancer (n = 16) and age-matched postmenopausal women without treatment (n = 19) or with vaginal estrogen therapy (n = 16). Immunohistochemistry was used to study proliferation and steroid hormone receptor staining intensity. Data was correlated with estrogen and androgen levels, vaginal atrophy scores, and vaginal pH. Aromatase inhibitor-treated women had a lower grade of proliferation, weaker progesterone receptor staining, and stronger androgen receptor staining, which correlated with plasma estrone levels, vaginal atrophy scores, and vaginal pH. Women with aromatase inhibitor-treated breast cancer exhibit reduced proliferation and altered steroid hormone receptor staining intensity in the vagina, which are related to clinical signs of vaginal atrophy. Although these effects are most probably attributable to estrogen suppression, a possible local inhibition of aromatase cannot be ruled out.

  6. Patterns of cetacean vaginal folds yield insights into functionality.

    PubMed

    Orbach, Dara N; Marshall, Christopher D; Mesnick, Sarah L; Würsig, Bernd

    2017-01-01

    Complex foldings of the vaginal wall are unique to some cetaceans and artiodactyls and are of unknown function(s). The patterns of vaginal length and cumulative vaginal fold length were assessed in relation to body length and to each other in a phylogenetic context to derive insights into functionality. The reproductive tracts of 59 female cetaceans (20 species, 6 families) were dissected. Phylogenetically-controlled reduced major axis regressions were used to establish a scaling trend for the female genitalia of cetaceans. An unparalleled level of vaginal diversity within a mammalian order was found. Vaginal folds varied in number and size across species, and vaginal fold length was positively allometric with body length. Vaginal length was not a significant predictor of vaginal fold length. Functional hypotheses regarding the role of vaginal folds and the potential selection pressures that could lead to evolution of these structures are discussed. Vaginal folds may present physical barriers, which obscure the pathway of seawater and/or sperm travelling through the vagina. This study contributes broad insights to the evolution of reproductive morphology and aquatic adaptations and lays the foundation for future functional morphology analyses.

  7. Vaginal Evisceration: An Unexpected Complication of Conization

    PubMed Central

    Ghassani, Ali; Andre, Benoit; Simon-Toulza, Caroline; Tanguy le Gac, Yann; Martinez, Alejandra; Vidal, Fabien

    2014-01-01

    Background. Large loop excision of the transformation zone (LLETZ) is routinely performed for the management of high grade intracervical neoplasia (CIN). Several uncommon complications have been described, including postoperative peritonitis, pseudoaneurysm of uterine artery, and bowel fistula. We report a unique case of postoperative vaginal evisceration and the subsequent management. Case. A 73-years-old woman underwent LLETZ for high grade CIN. On postoperative day 3, she was admitted for small bowel evisceration through the vagina. Surgical management was based on combined laparoscopic and transvaginal approach and consisted in bowel inspection and reinstatement, peritoneal washing, and dehiscence repair. Conclusions. Vaginal evisceration is a rare but potentially serious complication of pelvic surgery. This case report is to make clinicians aware of such complication following LLETZ and its management. PMID:25506010

  8. Biofilms of vaginal Lactobacillus in vitro test.

    PubMed

    Wei, Xiao-Yu; Zhang, Rui; Xiao, Bing-Bing; Liao, Qin-Ping

    2017-01-01

    This paper focuses on biofilms of Lactobacillus spp. - a type of normal flora isolated from healthy human vaginas of women of childbearing age; thereupon, it broadens the research scope of investigation of vaginal normal flora. The static slide culture method was adopted to foster biofilms, marked by specific fluorescence staining. Laser scanning confocal and scanning electron microscopy were used to observe the microstructure of the biofilms. Photographs taken from the microstructure were analysed to calculate the density of the biofilms. The body of Lactobacillus spp., though red, turned yellow when interacting with the green extracellular polysaccharides. The structure of the biofilm and aquaporin within the biofilm were imaged. Lactobacillus density increases over time. This study provides convincing evidence that Lactobacillus can form biofilms and grow over time in vitro. This finding establishes an important and necessary condition for selecting proper strains for the pharmaceutics of vaginal ecology.

  9. Spectrum of vaginal discharge in a tertiary care setting

    PubMed Central

    Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S

    2013-01-01

    Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998

  10. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    PubMed Central

    Pereira, Vanessa S.; Hirakawa, Humberto S.; Oliveira, Ana B.; Driusso, Patricia

    2014-01-01

    Background: The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05). Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively). Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment. PMID:25372005

  11. Development and evaluation of acid-buffering bioadhesive vaginal tablet for mixed vaginal infections.

    PubMed

    Alam, Mohd Aftab; Ahmad, Farhan Jalees; Khan, Zeenat Iqbal; Khar, Roop Krishen; Ali, Mushir

    2007-12-14

    An acid-buffering bioadhesive vaginal tablet was developed for the treatment of genitourinary tract infections. From the bioadhesion experiment and release studies it was found that polycarbophil and sodium carboxymethylcellulose is a good combination for an acid-buffering bioadhesive vaginal tablet. Sodium monocitrate was used as a buffering agent to provide acidic pH (4.4), which is an attribute of a healthy vagina. The effervescent mixture (citric acid and sodium bicarbonate) along with a superdisintegrant (Ac-Di-sol) was used to enhance the swellability of the bioadhesive tablet. The drugs clotrimazole (antifungal) and metronidazole (antiprotozoal as well as an antibacterial) were used in the formulation along with Lactobacillus acidophilus spores to treat mixed vaginal infections. From the ex vivo retention study it was found that the bioadhesive polymers hold the tablet for more than 24 hours inside the vaginal tube. The hardness of the acid-buffering bioadhesive vaginal tablet was optimized, at 4 to 5 kg hardness the swelling was found to be good and the cumulative release profile of the developed tablet was matched with a marketed conventional tablet (Infa-V). The in vitro spreadability of the swelled tablet was comparable to the marketed gel. In the in vitro antimicrobial study it was found that the acid-buffering bioadhesive tablet produces better antimicrobial action than marketed intravaginal drug delivery systems (Infa-V, Candid-V and Canesten 1).

  12. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles.

    PubMed

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-01-01

    The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05). There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively). This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.

  13. Women's vaginal responses during REM Sleep.

    PubMed

    Abel, G G; Murphy, W D; Becker, J V; Bitar, A

    1979-01-01

    Eight female subjects underwent vaginal photoplethysmographic recordings while asleep. Results demonstrated consistent findings of decreases in relative blood volume and increases in relative pulse pressure within the vagina during REM periods. Thes vascular changes indicate that females undergo phasic shifts in vascular blood flow in the vagina during REM sleep, similar to the phasic shifts of blood flow in the male's penis during REM sleep.

  14. [Saforelle - a new approach to treat vaginitis].

    PubMed

    Karamisheva, V; Nachev, A

    2015-01-01

    Infections of the vulva and vagina are one of the most common gynecological diseases. They can be determined by a variety of physical, chemical and biological factors. The main risk factors contributing to vaginitis are aerobic and anaerobic bacterias, fungal and viral infections, and irritants. Subjective complaints are pruritus, vulvar and/or perivulvar erytema and different in volume and characterization discharge. Excepting etiological treatment in most cases it is necessary to use additional agents, for example Saforelle.

  15. Urinary Tract Infection/Vaginitis Protocol

    PubMed Central

    Conte, John E.

    1978-01-01

    A process, outcome and salary-cost analysis was made of the use of a urinary tract infection/vaginitis protocol. Three nurse practitioners, in a university-based, walk-in clinic, cared for 128 women presenting with complaints of dysuria or vaginal discharge, or both. There were no significant differences among the nurse practitioners in data collection, diagnostic accuracy or patient outcome. The diagnoses were correct in 92 percent, incorrect in 6 percent and indeterminate in 2 percent of the patients. Incorrect diagnoses were due to presumption of urinary tract infection in patients with the urethral syndrome or vaginitis. Of the patients, 78 percent were actually sent home without seeing a physician. Concordance with the nurse practitioners' physical examination was 100 percent in those patients examined by a physician. In 82 percent of the patients there was alleviation of symptoms. Patient satisfaction with this method of care was extraordinary, with 98 percent of the patients giving favorable reports. True physician extension was achieved with a reduction in physician time per patient from 20 minutes to 6 minutes. In contrast to previously reported data, only a modest reduction in salary cost savings (10 percent) could be shown. The author concludes that nurse practitioners working in an acute care clinic or emergency department can see the patients defined in the study and provide high-quality care at a reasonable cost. PMID:706355

  16. Antibiotic Susceptibility of Potentially Probiotic Vaginal Lactobacilli

    PubMed Central

    Ocaña, Virginia; Silva, Clara; Nader-Macías, María Elena

    2006-01-01

    Objective. To study the antimicrobial susceptibility of six vaginal probiotic lactobacilli. Methods. The disc diffusion method in Müeller Hinton, LAPTg and MRS agars by the NCCLS (National Committee for Clinical Laboratory Standards) procedure was performed. Due to the absence of a Lactobacillus reference strains, the results were compared to those of Staphylococcus aureus ATCC29213. Minimal Inhibitory Concentration (MIC) with 21 different antibiotics in LAPTg agar and broth was also determined. Results. LAPTg and MRS agars are suitable media to study antimicrobial susceptibility of lactobacilli. However, the NCCLS procedure needs to be standardized for this genus. The MICs have shown that all Lactobacillus strains grew at concentrations above 10 μg/mL of chloramphenicol, aztreonam, norfloxacin, ciprofloxacin, ceftazidime, ceftriaxone, streptomycin and kanamycin. Four lactobacilli were sensitive to 1 μg/mL vancomycin and all of them were resistant to 1000 μg/mL of metronidazole. Sensitivity to other antibiotics depended on each particular strain. Conclusions. The NCCLS method needs to be standardized in an appropriate medium to determine the antimicrobial susceptibility of Lactobacillus. Vaginal probiotic lactobacilli do not display uniform susceptibility to antibiotics. Resistance to high concentrations of metronidazole suggests that lactobacilli could be simultaneously used with a bacterial vaginosis treatment to restore the vaginal normal flora. PMID:17485797

  17. Synthetic vaginal mesh for pelvic organ prolapse.

    PubMed

    Iglesia, Cheryl B

    2011-10-01

    The purpose of this review is to summarize recently published comparative trials on synthetic vaginal mesh versus traditional native tissue repairs for pelvic organ prolapse. Although studies suggest benefit from the use of synthetic vaginal mesh for anterior compartment prolapse, data are limited on the use of mesh for posterior and apical prolapse when compared with native tissue repair. The benefits of a more durable repair must be weighed against risks such as the development of de-novo stress incontinence, visceral injury, dyspareunia, pelvic pain and mesh contraction, exposure and extrusion requiring reoperation. Furthermore, the success rates of native tissue repairs are higher than previously considered using updated validated composite outcomes that incorporate both subjective relief of bulge and objective cure defined as prolapse above the hymenal ring. Surgeons placing synthetic mesh for pelvic organ prolapse should counsel patients regarding the potential benefits, risks, and alternatives including native tissue repairs. Level 1 evidence suggests anterior synthetic mesh may be superior to anterior repair. Expert opinion suggests potential benefit of vaginal mesh for recurrences, hysteropexy, and advanced prolapse in patients with medical co-morbidities precluding invasive open and endoscopic sacrocolpopexies; however, comparative clinical trials with long-term data are needed. (C) 2011 Lippincott Williams & Wilkins, Inc.

  18. Vaginal drug delivery systems for HIV prevention.

    PubMed

    Rohan, Lisa Cencia; Sassi, Alexandra B

    2009-03-01

    Microbicides have become a principal focus for HIV prevention strategies. The successful design of drug delivery systems for vaginal microbicide drug candidates brings with it a multitude of challenges. It is imperative that the chemical and physical characteristics of the drug candidate and its mechanism of action be clearly understood and considered to successfully deliver and target drug candidates efficiently. In addition, an understanding of the dynamic nature of the vaginal environment, the tissue and innate barriers present, as well as patient preferences are critical considerations in the design of effective microbicide products. Although the majority of drug candidates clinically evaluated to date have been delivered using conventional semisolid aqueous-based gel dosage forms, drug delivery system design has recently been extended to include advanced delivery systems such as vaginal rings, quick-dissolve films, and tablets. Ultimately, it may be necessary to develop multiple dosage platforms for a single active agent to provide users with options that can be used within the constraints of their social environment, personal choice, and environmental conditions.

  19. Chronic fungal vaginitis: the value of cultures.

    PubMed

    Nyirjesy, P; Seeney, S M; Grody, M H; Jordan, C A; Buckley, H R

    1995-09-01

    Our purpose was to examine the importance of fungal cultures in evaluating patients with symptoms of chronic vaginitis by assessing the relative contribution of various yeast species and by comparing infections caused by Candida albicans with those caused by other species. A prospective observational study of patients referred with chronic vaginal symptoms was undertaken. In addition to a standard evaluation of symptoms, cultures for yeast were performed on modified Sabouraud agar plates. Seventy-seven isolates were obtained from 74 patients. A total of 68% were Candida albicans; 32% were other species. The clinical syndromes caused by non-Candida albicans isolates were indistinguishable from Candida albicans infections. Fluconazole gave a short-term mycologic cure in all Candida albicans but only 25% of non-Candida albicans cases (p < 0.001). In non-Candida albicans infections, boric acid suppositories achieved the best mycologic cure rate (85%). Because non-Candida albicans species are responsible for a significant number of chronic fungal vaginal infections and are more resistant to therapy with fluconazole, fungal cultures are a valuable aid in confirming the diagnosis and selecting appropriate therapy.

  20. Safety and Pharmacokinetics of Quick-Dissolving Polymeric Vaginal Films Delivering the Antiretroviral IQP-0528 for Preexposure Prophylaxis.

    PubMed

    Srinivasan, Priya; Zhang, Jining; Martin, Amy; Kelley, Kristin; McNicholl, Janet M; Buckheit, Robert W; Smith, James M; Ham, Anthony S

    2016-07-01

    For human immunodeficiency virus (HIV) prevention, microbicides or drugs delivered as quick-dissolving films may be more acceptable to women than gels because of their compact size, minimal waste, lack of an applicator, and easier storage and transport. This has the potential to improve adherence to promising products for preexposure prophylaxis. Vaginal films containing IQP-0528, a nonnucleoside reverse transcriptase inhibitor, were evaluated for their pharmacokinetics in pigtailed macaques. Polymeric films (22 by 44 by 0.1 mm; providing 75% of a human dose) containing IQP-0528 (1.5%, wt/wt) with and without poly(lactic-co-glycolic acid) (PLGA) nanoparticle encapsulation were inserted vaginally into pigtailed macaques in a crossover study design (n = 6). With unencapsulated drug, the median (range) vaginal fluid concentrations of IQP-0528 were 160.97 (2.73 to 2,104), 181.79 (1.86 to 15,800), and 484.50 (8.26 to 4,045) μg/ml at 1, 4, and 24 h after film application, respectively. Median vaginal tissue IQP-0528 concentrations at 24 h were 3.10 (0.03 to 222.58) μg/g. The values were similar at locations proximal, medial, and distal to the cervix. The IQP-0528 nanoparticle-formulated films delivered IQP-0528 in vaginal tissue and secretions at levels similar to those obtained with the unencapsulated formulation. A single application of either formulation did not disturb the vaginal microflora or the pH (7.24 ± 0.84 [mean ± standard deviation]). The high mucosal IQP-0528 levels delivered by both vaginal film formulations were between 1 and 5 log higher than the in vitro 90% inhibitory concentration (IC90) of 0.146 μg/ml. The excellent coverage and high mucosal levels of IQP-0528, well above the IC90, suggest that the films may be protective and warrant further evaluation in a vaginal repeated low dose simian-human immunodeficiency virus (SHIV) transmission study in macaques and clinically in women. Copyright © 2016, American Society for Microbiology. All Rights

  1. Safety and Pharmacokinetics of Quick-Dissolving Polymeric Vaginal Films Delivering the Antiretroviral IQP-0528 for Preexposure Prophylaxis

    PubMed Central

    Srinivasan, Priya; Zhang, Jining; Martin, Amy; Kelley, Kristin; McNicholl, Janet M.; Buckheit, Robert W.; Smith, James M.

    2016-01-01

    For human immunodeficiency virus (HIV) prevention, microbicides or drugs delivered as quick-dissolving films may be more acceptable to women than gels because of their compact size, minimal waste, lack of an applicator, and easier storage and transport. This has the potential to improve adherence to promising products for preexposure prophylaxis. Vaginal films containing IQP-0528, a nonnucleoside reverse transcriptase inhibitor, were evaluated for their pharmacokinetics in pigtailed macaques. Polymeric films (22 by 44 by 0.1 mm; providing 75% of a human dose) containing IQP-0528 (1.5%, wt/wt) with and without poly(lactic-co-glycolic acid) (PLGA) nanoparticle encapsulation were inserted vaginally into pigtailed macaques in a crossover study design (n = 6). With unencapsulated drug, the median (range) vaginal fluid concentrations of IQP-0528 were 160.97 (2.73 to 2,104), 181.79 (1.86 to 15,800), and 484.50 (8.26 to 4,045) μg/ml at 1, 4, and 24 h after film application, respectively. Median vaginal tissue IQP-0528 concentrations at 24 h were 3.10 (0.03 to 222.58) μg/g. The values were similar at locations proximal, medial, and distal to the cervix. The IQP-0528 nanoparticle-formulated films delivered IQP-0528 in vaginal tissue and secretions at levels similar to those obtained with the unencapsulated formulation. A single application of either formulation did not disturb the vaginal microflora or the pH (7.24 ± 0.84 [mean ± standard deviation]). The high mucosal IQP-0528 levels delivered by both vaginal film formulations were between 1 and 5 log higher than the in vitro 90% inhibitory concentration (IC90) of 0.146 μg/ml. The excellent coverage and high mucosal levels of IQP-0528, well above the IC90, suggest that the films may be protective and warrant further evaluation in a vaginal repeated low dose simian-human immunodeficiency virus (SHIV) transmission study in macaques and clinically in women. PMID:27139475

  2. Firmness Perception Influences Women’s Preferences for Vaginal Suppositories

    PubMed Central

    Zaveri, Toral; Primrose, Rachel J.; Surapaneni, Lahari; Ziegler, Gregory R.; Hayes, John E.

    2014-01-01

    Microbicides are being actively researched and developed as woman-initiated means to prevent HIV transmission during unprotected coitus. Along with safety and efficacy, assessing and improving compliance is a major area of research in microbicide development. We have developed carrageenan-based semisoft vaginal suppositories and have previously evaluated how physical properties such as firmness, size and shape influence women’s willingness to try them. Firmness has previously been quantified in terms of small-strain storage modulus, G’, however large-strain properties of the gels may also play a role in the firmness perception. In the current study we prepared two sets of suppositories with the same G’ but different elongation properties at four different G’ values (250, 2500, 12,500, 25,000 Pa): For convenience we refer to these as “brittle” and “elastic”, although these terms were never provided to study participants. In the first of two tests conducted to assess preference, women compared pairs of brittle and elastic suppositories and indicated their preference. We observed an interaction, as women preferred brittle suppositories at lower G’ (250, 2500 Pa) and elastic ones at a higher G’ (25,000 Pa). In the second test, women evaluated samples across different G’, rated the ease-of-insertion and willingness-to-try and ranked the samples in order of preference. Brittle suppositories at G’ of 12,500 Pa were most preferred. In vitro studies were also conducted to measure the softening of the suppositories in contact with vaginal simulant fluid (VSF). Release of antiretroviral drug tenofovir in VSF was quantified for the brittle and elastic suppositories at G’ of 12,500 Pa to determine the effect of suppository type on release. The initial rate of release was 20% slower with elastic suppositories as compared to brittle suppositories. Understanding how different physical properties simultaneously affect women’s preferences and

  3. Strength of Preference for Vaginal Birth as a Predictor of Delivery Mode Among Women who Attempt a Vaginal Delivery

    PubMed Central

    WU, Erica; KAIMAL, Anjali; HOUSTON, Kathryn; YEE, Lynn; NAKAGAWA, Sanae; KUPPERMANN, Miriam

    2014-01-01

    OBJECTIVE To assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode. STUDY DESIGN We conducted a longitudinal study of mode of delivery preferences among women who were less than 36 weeks pregnant. Participants completed a sociodemographic and clinical questionnaire and were asked if they preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode was obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery. RESULTS Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (IQR 0.50–0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (aOR 0.08, CI 0.02–0.39) or who delivered an infant ≥4000 grams (aOR 0.04, CI 0.01–0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR 1.54, CI 1.01–2.34 for every 0.2 increase on the 0-to-1 scale). CONCLUSION Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone. PMID:24246523

  4. Effect of Vaginal or Systemic Estrogen on Dynamics of Collagen Assembly in the Rat Vaginal Wall1

    PubMed Central

    Montoya, T. Ignacio; Maldonado, P. Antonio; Acevedo, Jesus F.; Word, R. Ann

    2014-01-01

    ABSTRACT The objective of this study was to compare the effects of systemic and local estrogen treatment on collagen assembly and biomechanical properties of the vaginal wall. Ovariectomized nulliparous rats were treated with estradiol or conjugated equine estrogens (CEEs) either systemically, vaginal CEE, or vaginal placebo cream for 4 wk. Low-dose local CEE treatment resulted in increased vaginal epithelial thickness and significant vaginal growth without uterine hyperplasia. Furthermore, vaginal wall distensibility increased without compromise of maximal force at failure. Systemic estradiol resulted in modest increases in collagen type I with no change in collagen type III mRNA. Low-dose vaginal treatment, however, resulted in dramatic increases in both collagen subtypes whereas moderate and high dose local therapies were less effective. Consistent with the mRNA results, low-dose vaginal estrogen resulted in increased total and cross-linked collagen content. The inverse relationship between vaginal dose and collagen expression may be explained in part by progressive downregulation of estrogen receptor-alpha mRNA with increasing estrogen dose. We conclude that, in this menopausal rat model, local estrogen treatment increased total and cross-linked collagen content and markedly stimulated collagen mRNA expression in an inverse dose-effect relationship. High-dose vaginal estrogen resulted in downregulation of estrogen receptor-alpha and loss of estrogen-induced increases in vaginal collagen. These results may have important clinical implications regarding the use of local vaginal estrogen therapy and its role as an adjunctive treatment in women with loss of vaginal support. PMID:25537371

  5. Triapine, Cisplatin, and Radiation Therapy in Treating Patients With Cervical Cancer or Vaginal Cancer

    ClinicalTrials.gov

    2014-04-21

    Recurrent Cervical Cancer; Recurrent Vaginal Cancer; Stage IB Cervical Cancer; Stage II Vaginal Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Vaginal Cancer; Stage IVA Cervical Cancer; Stage IVA Vaginal Cancer; Stage IVB Cervical Cancer; Stage IVB Vaginal Cancer; Therapy-related Toxicity

  6. Filled Prescriptions for Opioids After Vaginal Delivery.

    PubMed

    Jarlenski, Marian; Bodnar, Lisa M; Kim, Joo Yeon; Donohue, Julie; Krans, Elizabeth E; Bogen, Debra L

    2017-03-01

    To estimate the prevalence of filled opioid prescriptions after vaginal delivery. We conducted a retrospective cohort study of 164,720 Medicaid-enrolled women in Pennsylvania who delivered a liveborn neonate vaginally from 2008 to 2013, excluding women who used opioids during pregnancy or who had an opioid use disorder. We assessed overall filled prescriptions as well as filled prescriptions in the presence or absence of the following pain-inducing conditions: bilateral tubal ligation, perineal laceration, or episiotomy. Outcomes included a binary measure of whether a woman had any opioid prescription fill 5 days or less after delivery and, among those women, a second opioid prescription fill 6-60 days after delivery. Among women with no coded pain-inducing conditions at delivery, we used multivariable logistic regression with standard errors clustered to account for within-hospital correlation to assess the association between patient characteristics and odds of a filled opioid prescription. Twelve percent of women (n=18,131) filled an outpatient opioid prescription 5 days or less after vaginal delivery; among those women, 14% (n=2,592, or 1.6% of the total) filled a second opioid prescription 6-60 days after delivery. Of the former, 5,110 (28.2%) had one or more pain-inducing conditions. Predictors of filled opioid prescriptions with no observed pain-inducing condition at delivery included tobacco use (adjusted odds ratio [OR] 1.3, 95% confidence interval [CI] 1.2-1.4) and a mental health condition (adjusted OR 1.3, 95% CI 1.2-1.4). Having a diagnosis of substance use disorder other than opioid use disorder was not associated with filling an opioid prescription 5 days or less after delivery, but was associated with having a second opioid prescription 6-60 days after delivery (adjusted OR 1.4, 95% CI 1.2-1.6). More than 1 in 10 Medicaid-enrolled women fill an outpatient opioid prescription after vaginal delivery. National opioid-prescribing recommendations for

  7. Antibiotic prophylaxis for operative vaginal delivery.

    PubMed

    Liabsuetrakul, T; Choobun, T; Peeyananjarassri, K; Islam, M

    2004-01-01

    Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics are prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum and/or forceps deliveries. We searched the Cochrane Pregnancy and Childbirth Group trials register (November 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003) and MEDLINE (1966 to November 2003). All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. Four reviewers assessed trial eligibility and methodological quality. Two reviewers extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all reviewers. We assessed methodological quality of the included trial using the standard Cochrane criteria and the CONSORT statement of randomised controlled trials. We calculated the relative risks using a fixed effect model and all the reviewers interpreted and discussed the results. One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine

  8. Predictors of vaginal delivery in nulliparous mothers.

    PubMed

    Adeyemi, Adewale Samson; Adekanle, Daniel Adebode; Afolabi, Adeola Folasade

    2014-01-01

    Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae. A prospective cross-sectional study was done on 286 eligible booked nulliparae in labor, to determine factors associated with vaginal delivery. Information about each patient's social demographic factors, and physical characteristics such as height and weight, events in labor and mode of delivery were recorded in the data sheet. Bivariate analysis was done using Chi square, while multivariate analysis was done using logistic regression. Level of significance was put at P < 0.05. Of a total of 944 primigravidae delivered in the unit during the study period, 286 (30.3%) were eligible for the study. Vaginal delivery was achieved in 214 (74.8%) of the eligible parturient, while 72 (25.2%) had emergency caesarean delivery. Indications for the caesarean delivery were: failure to progress (46; 63.9%), fetal distress (20; 27.8%), maternal distress (5; 8.0%), and rapidly developing pre-eclampsia in labor (1, 0.3%). The birth weight of the baby ranged between 2.0 and 4.5 kg with mean weight of 3.1 ± 0.4 kg. Birth weight (odd ratio [OR] = 0.40, 95% confidence interval [CI] = 0.21-0.78), fetal head engagement in early labor (OR = 10.30, 95% CI = 1.35-78.69), and maternal body mass index (BMI) (odd ratio [OR] = 2.08, 95% confidence interval [CI] = 1.03-4.20) were found to be predictors of vaginal delivery. Normal range of maternal BMI, fetal head engagement and normal range of fetal birth weight were found to be the factors associated with vaginal delivery in nulliparae. Variations in these three factors may be the underlying reason for failure to progress, which is the most common indication for caesarean section among this population of parturient.

  9. Insertion device calculations with mathematica

    SciTech Connect

    Carr, R.; Lidia, S.

    1995-02-01

    The design of accelerator insertion devices such as wigglers and undulators has usually been aided by numerical modeling on digital computers, using code in high level languages like Fortran. In the present era, there are higher level programming environments like IDL{reg_sign}, MatLab{reg_sign}, and Mathematica{reg_sign} in which these calculations may be performed by writing much less code, and in which standard mathematical techniques are very easily used. The authors present a suite of standard insertion device modeling routines in Mathematica to illustrate the new techniques. These routines include a simple way to generate magnetic fields using blocks of CSEM materials, trajectory solutions from the Lorentz force equations for given magnetic fields, Bessel function calculations of radiation for wigglers and undulators and general radiation calculations for undulators.

  10. Ultrasound guided spine needle insertion

    NASA Astrophysics Data System (ADS)

    Chen, Elvis C. S.; Mousavi, Parvin; Gill, Sean; Fichtinger, Gabor; Abolmaesumi, Purang

    2010-02-01

    An ultrasound (US) guided, CT augmented, spine needle insertion navigational system is introduced. The system consists of an electromagnetic (EM) sensor, an US machine, and a preoperative CT volume of the patient anatomy. Three-dimensional (3D) US volume is reconstructed intraoperatively from a set of two-dimensional (2D) freehand US slices, and is coregistered with the preoperative CT. This allows the preoperative CT volume to be used in the intraoperative clinical coordinate. The spatial relationship between the patient anatomy, surgical tools, and the US transducer are tracked using the EM sensor, and are displayed with respect to the CT volume. The pose of the US transducer is used to interpolate the CT volume, providing the physician with a 2D "x-ray vision" to guide the needle insertion. Many of the system software components are GPU-accelerated, allowing real-time performance of the guidance system in a clinical setting.

  11. Vaginal evisceration related to genital prolapse in premenopausal woman

    PubMed Central

    Schreiner, Lucas; dos Santos, Thais Guimarães; Nygaard, Christiana Campani; Oliveira, Daniele Sparemberger

    2017-01-01

    ABSTRACT Background Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Case Report A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases. PMID:28128916

  12. Urinary tract infection in vaginitis: a condition often overlooked.

    PubMed

    Amatya, R; Bhattarai, S; Mandal, P K; Tuladhar, H; Karki, B M S

    2013-03-01

    Despite the differences between the organisms that cause vaginitis and urinary tract infections (UTI), it is possible that women with vaginitis develop UTI. The main objective of the study was to find the association of the common types of infectious vaginitis with UTI. Cross sectional study was conducted for six months in a referral hospital at Lalitpur, Nepal. Three hundred and sixmid-stream urine samples and high vaginal swabs (HVS) collected from non pregnant women were investigated by standard microbiological techniques. Among the women with bacterial vaginosis (BV), 75% also had UTI. Similarly, 46% and 13% of those with vaginal candidiasis and trichomoniasis respectively had concurrent UTI. Considering this strong association of UTI and vaginitis, women with either of these conditions should be tested for the other.

  13. Liposomes containing drugs for treatment of vaginal infections.

    PubMed

    Pavelić, Z; Skalko-Basnet, N; Jalsenjak, I

    1999-08-01

    To develop a novel vaginal delivery system, able to effectively deliver entrapped drugs during an extended period of time at the site of action, liposomes made of phosphatidylcholine were prepared by two different methods, namely the polyol dilution method and the proliposome method. Liposomes containing three commonly applied drugs in the treatment of vaginal infections: clotrimazole, metronidazole and chloramphenicol were tested for in vitro stability (in buffers at pH 4.5 and 5.9 representing pre- and postmenopausal vaginal pH). In situ stability (in the presence of cow vaginal mucosa) showed that after 6 h incubation (at 37 degrees C), liposomes retained more than 40% of originally entrapped clotrimazole, 28% of entrapped metronidazole or 37% of entrapped chloramphenicol. In vitro and in situ stability studies confirmed the applicability of liposomes as a carrier system for vaginal delivery. Even after 24 h of incubation in the presence of vaginal mucosa liposomes retained sufficient amounts of entrapped drugs.

  14. Inserting Agility in System Development

    DTIC Science & Technology

    2012-07-01

    Agile IT Acquisition, IT Box, Scrum Inserting Agility in System Development Matthew R. Kennedy and Lt Col Dan Ward, USAF With the fast-paced nature...1,700 individuals and 71 countries, found Scrum and eXtreme Programming to be the most widely followed method- ologies (VersionOne, 2007). Other...University http://www.dau.mil 259 Defense ARJ, July 2012, Vol. 19 No. 3 : 249–264 Scrum Scrum is a framework used for project management, which is

  15. Effects of a One Year Reusable Contraceptive Vaginal Ring on Vaginal Microflora and the Risk of Vaginal Infection: An Open-Label Prospective Evaluation.

    PubMed

    Huang, Yongmei; Merkatz, Ruth B; Hillier, Sharon L; Roberts, Kevin; Blithe, Diana L; Sitruk-Ware, Régine; Creinin, Mitchell D

    2015-01-01

    A contraceptive vaginal ring (CVR) containing Nestorone® (NES) and ethinyl estradiol (EE) that is reusable for 1- year (13 cycles) is under development. This study assessed effects of this investigational CVR on the incidence of vaginal infections and change in vaginal microflora. There were 120 women enrolled into a NES/EE CVR Phase III trial and a microbiology sub-study for up to 1- year of cyclic product use. Gynecological examinations were conducted at baseline, the first week of cycle 6 and last week of cycle 13 (or during early discontinuation visits). Vaginal swabs were obtained for wet mount microscopy, Gram stain and culture. The CVR was removed from the vagina at the last study visit and cultured. Semi-quantitative cultures for Lactobacillus, Gardnerella vaginalis, Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, anaerobic gram negative rods (GNRs), Candida albicans and other yeasts were performed on vaginal and CVR samples. Vaginal infections were documented throughout the study. Over 1- year of use, 3.3% of subjects were clinically diagnosed with bacterial vaginosis, 15.0% with vulvovaginal candidiasis, and 0.8% with trichomoniasis. The detection rate of these three infections did not change significantly from baseline to either Cycle 6 or 13. Nugent scores remained stable. H2O2-positive Lactobacillus dominated vaginal flora with a non-significant prevalence increase from 76.7% at baseline to 82.7% at cycle 6 and 90.2% at cycle 13, and a median concentration of 107 colony forming units (cfu) per gram. Although anaerobic GNRs prevalence increased significantly, the median concentration decreased slightly (104 to 103cfu per gram). There were no significant changes in frequency or concentrations of other pathogens. High levels of agreement between vaginal and ring surface microbiota were observed. Sustained use of the NES/EE CVR did not increase the risk of vaginal infection and was not disruptive to the vaginal ecosystem. Clinical

  16. Relationship between lactobacilli and opportunistic bacterial pathogens associated with vaginitis

    PubMed Central

    Razzak, Mohammad Sabri A.; Al-Charrakh, Alaa H.; AL-Greitty, Bara Hamid

    2011-01-01

    Background: Vaginitis, is an infectious inflammation of the vaginal mucosa, which sometimes involves the vulva. The balance of the vaginal flora is maintained by the Lactobacilli and its protective and probiotic role in treating and preventing vaginal infection by producing antagonizing compounds which are regarded as safe for humans. Aim: The aim of this study was to evaluate the protective role of Lactobacilli against common bacterial opportunistic pathogens in vaginitis and study the effects of some antibiotics on Lactobacilli isolates. Materials and Methods: In this study (110) vaginal swabs were obtained from women suffering from vaginitis who admitted to Babylon Hospital of Maternity and Paediatrics in Babylon province, Iraq. The study involved the role of intrauterine device among married women with vaginitis and also involved isolation of opportunistic bacterial isolates among pregnant and non pregnant women. This study also involved studying probiotic role of Lactobacilli by production of some defense factors like hydrogen peroxide, bacteriocin, and lactic acid. Results: Results revealed that a total of 130 bacterial isolates were obtained. Intrauterine device was a predisposing factor for vaginitis. The most common opportunistic bacterial isolates were Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae, and Klebsiella pneumoniae. All Lactobacilli were hydrogen peroxide producers while some isolates were bacteriocin producers that inhibited some of opportunistic pathogens (S. aureus, E. coli). Lactobacilli were sensitive to erythromycin while 93.3% of them were resistant to ciprofloxacin and (40%, 53.3%) of them were resistant to amoxicillin and gentamycin respectively. Results revealed that there was an inverse relationship between Lactobacilli presence and organisms causing vaginitis. This may be attributed to the production of defense factors by Lactobacilli. Conclusion: The types of antibiotics used to treat vaginitis must be very

  17. Relationship between lactobacilli and opportunistic bacterial pathogens associated with vaginitis.

    PubMed

    Razzak, Mohammad Sabri A; Al-Charrakh, Alaa H; Al-Greitty, Bara Hamid

    2011-04-01

    Vaginitis, is an infectious inflammation of the vaginal mucosa, which sometimes involves the vulva. The balance of the vaginal flora is maintained by the Lactobacilli and its protective and probiotic role in treating and preventing vaginal infection by producing antagonizing compounds which are regarded as safe for humans. The aim of this study was to evaluate the protective role of Lactobacilli against common bacterial opportunistic pathogens in vaginitis and study the effects of some antibiotics on Lactobacilli isolates. In this study (110) vaginal swabs were obtained from women suffering from vaginitis who admitted to Babylon Hospital of Maternity and Paediatrics in Babylon province, Iraq. The study involved the role of intrauterine device among married women with vaginitis and also involved isolation of opportunistic bacterial isolates among pregnant and non pregnant women. This study also involved studying probiotic role of Lactobacilli by production of some defense factors like hydrogen peroxide, bacteriocin, and lactic acid. Results revealed that a total of 130 bacterial isolates were obtained. Intrauterine device was a predisposing factor for vaginitis. The most common opportunistic bacterial isolates were Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae, and Klebsiella pneumoniae. All Lactobacilli were hydrogen peroxide producers while some isolates were bacteriocin producers that inhibited some of opportunistic pathogens (S. aureus, E. coli). Lactobacilli were sensitive to erythromycin while 93.3% of them were resistant to ciprofloxacin and (40%, 53.3%) of them were resistant to amoxicillin and gentamycin respectively. Results revealed that there was an inverse relationship between Lactobacilli presence and organisms causing vaginitis. This may be attributed to the production of defense factors by Lactobacilli. The types of antibiotics used to treat vaginitis must be very selective in order not to kill the beneficial bacteria

  18. Treatment of vaginal stenosis with fasciocutaneous Singapore flap.

    PubMed

    Clifton, Marisa M; Gurunluoglu, Raffi; Pizarro-Berdichevsky, Javier; Baker, Todd; Vasavada, Sandip P

    2017-03-01

    Vaginal stenosis is an unfortunate complication that can occur after pelvic radiation therapy for gynecologic or colorectal malignancies. Treatment is challenging and can require significant reconstructive surgery. The objective of this video is to present a case of vaginal stenosis after radiation and describe vaginal reconstruction with a fasciocutaneous Singapore flap. We describe the case of a 42-year-old woman with a history of stage 3 colorectal cancer who underwent partial colectomy, chemotherapy, and pelvic radiation. She subsequently developed a rectovaginal fistula requiring repair with a right-sided gracilis flap. When her stenosis recurred, she underwent vaginal reconstruction with a medial thigh flap. The Singapore flap is a pudendal thigh flap centered on the labial crural fold with a base at the perineal body. As the cutaneous innervation is spared, this flap is sensate. This technique is one option for patients with complex vaginal stenosis who have failed conservative management. However, it is imperative the patient perform vaginal dilation postoperatively and maintain close follow-up with her surgeon, as vaginal stenosis can recur. Postradiation vaginal stenosis is a complex condition to treat; however, vaginal reconstruction with a thigh flap can provide excellent cosmetic and functional results.

  19. Laparoscopic Management of Bleeding After Laparoscopic or Vaginal Hysterectomy

    PubMed Central

    Jabor, Antonin

    2004-01-01

    Objective: To assess the results and contributions of laparoscopy in the management of postoperative bleeding following laparoscopic (LH) or vaginal hysterectomy (VH). Methods: A retrospective study of a 5-year period was carried out on 1167 women who underwent laparoscopic or vaginal hysterectomy. Ten women with postoperative bleeding following laparoscopic or vaginal hysterectomy were identified. Results: The overall incidence of bleeding after laparoscopic or vaginal hysterectomy was 0.85% (10 of 1167). Over the 5-year study period, the incidence fluctuated between 1.1% and 0.4%. Surgical revision was primarily vaginal in 1 woman, followed by laparoscopic control. In 6 patients, laparoscopy was performed immediately. The patients profited from the prompt laparoscopic treatment, because intraabdominal hemorrhage was found and stopped. Of 6 cases of intraperitoneal bleeding, 1 resulted from a blood disorder. The collagen-fibrin agent TachoComb was applied locally, and the patient was postoperatively treated with blood products and coagulation factors. Only bipolar coagulation, TachoComb, and Foley catheter were used to achieve local hemostasis during laparoscopy. The remaining 3 cases where the vaginal cuff was bleeding were managed by vaginal repair and packing without laparoscopy. Conclusion: The laparoscopic approach to postoperative bleeding following laparoscopic or vaginal hysterectomy is an attractive alternative to the abdominal surgical approach. Bleeding following laparoscopic or vaginal hysterectomy can be managed by laparoscopy in the majority of patients. Because the abdominal incision is avoided, the recovery time is reduced. PMID:15347110

  20. Laparoscopic management of bleeding after laparoscopic or vaginal hysterectomy.

    PubMed

    Holub, Zdenek; Jabor, Antonin

    2004-01-01

    To assess the results and contributions of laparoscopy in the management of postoperative bleeding following laparoscopic (LH) or vaginal hysterectomy (VH). A retrospective study of a 5-year period was carried out on 1167 women who underwent laparoscopic or vaginal hysterectomy. Ten women with postoperative bleeding following laparoscopic or vaginal hysterectomy were identified. The overall incidence of bleeding after laparoscopic or vaginal hysterectomy was 0.85% (10 of 1167). Over the 5-year study period, the incidence fluctuated between 1.1% and 0.4%. Surgical revision was primarily vaginal in 1 woman, followed by laparoscopic control. In 6 patients, laparoscopy was performed immediately. The patients profited from the prompt laparoscopic treatment, because intraabdominal hemorrhage was found and stopped. Of 6 cases of intraperitoneal bleeding, 1 resulted from a blood disorder. The collagen-fibrin agent TachoComb was applied locally, and the patient was postoperatively treated with blood products and coagulation factors. Only bipolar coagulation, TachoComb, and Foley catheter were used to achieve local hemostasis during laparoscopy. The remaining 3 cases where the vaginal cuff was bleeding were managed by vaginal repair and packing without laparoscopy. The laparoscopic approach to postoperative bleeding following laparoscopic or vaginal hysterectomy is an attractive alternative to the abdominal surgical approach. Bleeding following laparoscopic or vaginal hysterectomy can be managed by laparoscopy in the majority of patients. Because the abdominal incision is avoided, the recovery time is reduced.

  1. Systemic Effects of Vaginally Administered Estrogen Therapy: A Review

    PubMed Central

    Krause, Megan; Wheeler, Thomas L.; Richter, Holly E.; Snyder, Thomas E.

    2015-01-01

    Hormone Therapy (HT) was considered the standard of care prior to the publication of the Women’s Health Initiative (WHI). After the study was published, the use of systemic HT dramatically decreased resulting in an increased incidence of menopausal symptoms such as hot flashes, vaginal dryness and dyspareunia experienced by women. Use of vaginal estrogen offers women a unique alternative for relief of these symptoms. This article reviews the systemic effects of vaginally administered estrogen. Effects on serum hormone levels, vasomotor symptoms, lipid profiles and use in women with breast cancer are reviewed. An accompanying review examines the local effects of vaginally administered estrogen. PMID:22453284

  2. Immediate postplacental insertion of a copper intrauterine device: a pilot study to evaluate expulsion rate by mode of delivery.

    PubMed

    Sucak, Ayhan; Ozcan, Sarp; Çelen, Şevki; Çağlar, Turhan; Göksu, Gonca; Danışman, Nuri

    2015-09-02

    The present study aimed to investigate risk factors for expulsion in immediate postplacental IUD insertion. We specifically sought to determine whether cesarean delivery before or during labor have an impact on IUD expulsion. The study included 160 pregnant women for immediate IUD insertion following vaginal or cesarean delivery. Three groups of patients were recruited: Patients who underwent pre-planned cesarean delivery (group 1, n: 51), patients who underwent cesarean delivery during active labor (group 2, n: 47), patients who delivered vaginally (group 3, n: 62). The cumulative expulsion rates were similar with a frequency of 8.7, 8.9 and 11.3% respectively in groups 1 to 3 (p > 0.05 in all pairwise comparisons). The rate of patients who had the IUD removed at 12th month was 4,3, 6.7 and 11.3% for groups 1, 2 and 3 respectively (p > 0.05 in all pairwise comparisons). Multiparity increased the risk of cumulative expulsion within 12 months by 2.1 fold (95% 1,03-4,37) in the logistic regression model. Previous vaginal deliveries or IUD use did not have an impact on the expulsion of the IUD. The risk of spontaneous expulsion was similar in patients whose IUD was placed after cesarean in the active and latent phase or after spontaneous vaginal delivery. The rates of IUD expulsion are similar in patients who underwent cesarean section before and during labor and who delivered vaginally. Parity was the only factor independently associated with IUD expulsion.

  3. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique

    PubMed Central

    Gani, Johan; Chee, Justin

    2016-01-01

    Purpose To present a novel modification of surgical technique to treat female urethral stricture (FUS) by a vaginal-sparing ventral buccal mucosal urethroplasty. Recurrent FUS represents an uncommon, though difficult clinical scenario to manage definitively. A variety of surgical techniques have been described to date, yet a lack of consensus on the optimal procedure persists. Materials and Methods We present a 51-year-old female with urethral stricture involving the entire urethra. Suspected etiology was iatrogenic from cystoscopy 17 years prior. Since then, the patient had undergone at least 25 formal urethral dilations and periods of self-dilation. In lithotomy position, the urethra was dilated to accommodate forceps, and ventral urethrotomy carried out sharply, exposing a bed of periurethral tissue. Buccal mucosa was harvested, and a ventral inlay technique facilitated by a nasal speculum, was used to place the graft from the proximal urethra/bladder neck to urethral meatus without a vaginal incision. Graft was sutured into place, and urethral Foley catheter inserted. Results The vaginal-sparing ventral buccal mucosal graft urethroplasty was deemed successful as of last follow-up. Flexible cystoscopy demonstrated patency of the repair at 6 months. At 10 months of follow-up, the patient was voiding well, with no urinary incontinence. No further interventions have been required. Conclusions This case describes a novel modification of surgical technique for performing buccal mucosal urethroplasty for FUS. By avoiding incision of the vaginal mucosa, benefits may include reduced: morbidity, urinary incontinence, and wound complications including urethro-vaginal fistula. PMID:27437540

  4. 78 FR 19271 - Draft Guidance for Industry on Bioequivalence Recommendations for Metronidazole Vaginal Gel...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-29

    ... Recommendations for Metronidazole Vaginal Gel; Availability AGENCY: Food and Drug Administration, HHS. ACTION... guidance for industry entitled ``Bioequivalence Recommendations for Metronidazole Vaginal Gel.'' The... abbreviated new drug applications (ANDAs) for metronidazole vaginal gel. DATES: Although you can comment on...

  5. Field errors in hybrid insertion devices

    SciTech Connect

    Schlueter, R.D.

    1995-02-01

    Hybrid magnet theory as applied to the error analyses used in the design of Advanced Light Source (ALS) insertion devices is reviewed. Sources of field errors in hybrid insertion devices are discussed.

  6. Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study.

    PubMed

    Biglia, Nicoletta; Peano, Elisa; Sgandurra, Paola; Moggio, Giulia; Panuccio, Enrico; Migliardi, Marco; Ravarino, Nicoletta; Ponzone, Riccardo; Sismondi, Piero

    2010-06-01

    The study aim is to evaluate the efficacy and safety of two low-dose vaginal estrogen treatments (ETs) and of a non-hormonal vaginal moisturizer in postmenopausal breast cancer survivors with urogenital atrophy. Eighteen patients receiving estriol cream 0.25 mg (n = 10) or estradiol tablets 12.5 microg (n = 8) twice/week for 12 weeks were evaluated and compared with eight patients treated with polycarbophil-based moisturizer 2.5 g twice/week. Severity of vaginal atrophy was assessed using subjective [Vaginal Symptoms Score (VSS), Profile of Female Sexual Function (PFSF)] and objective [Vaginal Health Index (VHI), Karyopycnotic Index (KI)] evaluations, while safety by measuring endometrial thickness and serum sex hormones levels. After 4 weeks, VSS and VHI were significantly improved by both vaginal ETs, with further improvement after 12 weeks. PFSF improved significantly only in estriol group (p = 0.02). Safety measurements did not significantly change. Vaginal moisturizer improved VSS at week 4 (p = 0.01), but score returned to pre-treatment values at week 12; no significant modification of VHI, KI, PFSF was recorded. Both low-dose vaginal ET are effective for relieving urogenital atrophy, while non-hormonal moisturizer only provides transient benefit. The increase of serum estrogens levels during treatment with vaginal estrogen at these dosages is minimal.

  7. Adenocarcinoma arising from vaginal stump: unusual vaginal carcinogenesis 7 years after hysterectomy due to cervical intraepithelial neoplasia.

    PubMed

    Shibata, Takashi; Ikura, Yoshihiro; Iwai, Yasuhiro; Tokuda, Hisato; Cho, Yuka; Morimoto, Noriyuki; Nakago, Satoshi; Oishi, Tetsuya

    2013-11-01

    Primary vaginal adenocarcinomas are one of the rarest malignant neoplasms, which develop in the female genital tract. Because of the extremely low incidence, their clinical and pathologic characteristics are still obscure. Recently, we experienced a case of vaginal adenocarcinoma that appeared 7 yr after hysterectomy because of cervical intraepithelial neoplasia. The patient, a 65-yr-old obese woman, was diagnosed as having adenocarcinoma in the vaginal stump and was treated by simple tumor excision and radiation. Immunohistochemical and molecular biologic examinations indicated a potential association with human papilloma virus infection in the development of the vaginal adenocarcinoma. There has been no evidence of recurrence for 3 yr after the operation.

  8. What can we do to reduce the associated costs in induction of labour of intrauterine growth restriction foetuses at term? A cost-analysis study.

    PubMed

    Duro-Gómez, Jorge; Garrido-Oyarzún, María Fernanda; Rodríguez-Marín, Ana Belén; de la Torre González, Antonio Jesús; Arjona-Berral, José Eduardo; Castelo-Branco, Camil

    2017-07-11

    To evaluate the costs associated with induction of labour in intrauterine growth restriction fetuses comparing different procedures. 150 pregnancies at term diagnosed with intrauterine growth restriction and indication for induction of labour were included. 24 were ripened with misoprostol 25 μg tablets, 24 with dinoprostone 10 mg vaginal insert, and 77 with Cook(®) cervical ripening balloon. To determine the costs of induction of labour, method of induction, intrapartum medication, epidural analgesia, type of delivery, and maternal and neonatal admissions were considered. Statistical analysis was performed using the G-Stat 2.0 free statistical software. ANOVA test was used for comparisons between quantitative parametric variables. Chi-squared test or Fisher test was used for qualitative variables. A value of p < 0.05 was considered statistically significant. Up to 70.83% women in dinoprostone group gave birth within the first 24 h compared to 42.66% in misoprostol group and 36.36% in CG (p < 0.01). Misoprostol tablets were cheaper (9.45 ± 1.52 US dollars) than dinoprostone or Cook(®) balloon (41.67 ± 0 and 59.85 ± 0 54.45 ± 0 US dollars, respectively) (p < 0.01). Costs related to maternal admissions were higher in CG (475.13 ± 146.95$) than dinoprostone group (475.13 ± 146.95$) or MG (427.97 ± 112.65$) (p = 0.03). Total costs in misoprostol group (2765.18 ± 495.38$) were lower than in the dinoprostone group (3075.774 ± 896.14$) or Cook(®) balloon group (3228.02 ± 902.06$) groups. Misoprostol for induction of labour had lower related costs than dinoprostone or Cook(®) balloon, with similar obstetrical and perinatal outcomes.

  9. Insert metering plates for gas turbine nozzles

    DOEpatents

    Burdgick, Steven S.; Itzel, Gary; Chopra, Sanjay; Abuaf, Nesim; Correia, Victor H.

    2004-05-11

    The invention comprises a metering plate which is assembled to an impingement insert for use in the nozzle of a gas turbine. The metering plate can have one or more metering holes and is used to balance the cooling flow within the nozzle. A metering plate with multiple holes reduces static pressure variations which result from the cooling airflow through the metering plate. The metering plate can be assembled to the insert before or after the insert is inserted into the nozzle.

  10. Partial Cervical Agenesis and Complete Vaginal Atresia.

    PubMed

    Kimble, Rebecca; Molloy, Genevieve; Sutton, Bridget

    2016-06-01

    The objective of this study was to report 2 cases of the combined congenital anomalies of complete vaginal atresia and partial cervical agenesis, and highlight the limitations of magnetic resonance imaging for definitive initial diagnosis, and consequently the importance of early definitive management, to avoid life-threatening sepsis. Herein we provide a retrospective case audit of two patients with congenital abnormalities between 2005 and 2013 who were treated in a quaternary statewide pediatric and adolescent gynecology center. Two patients with the combined congenital anomalies of complete vaginal agenesis and partial cervical agenesis highlight the difficulties encountered with the limitations of magnetic resonance imaging in accuracy of diagnosis, as well as development of life-threatening sepsis that requires hysterectomy. Both patients were initially imaged as having distended endometrial cavities and cervical canals with what was thought to be an obstructive upper vaginal septum and absent lower vagina. Both required initial neovagina creation, however the cervices were never clinically or surgically visualized. Partial cervical agenesis is a relatively rare form of Müllerian abnormality which, if not diagnosed and definitively treated early, can have significant morbidity and mortality. Although magnetic resonance imaging is the diagnostic imaging gold standard for Müllerian abnormalities, it is important to recognize the limitations of this modality, the potential sequelae of these limitations, and to appreciate the importance of early accurate diagnosis and treatment of this condition. Importantly, if the imaging diagnosis does not completely correlate with the clinical and surgical findings, then a high suspicion of complete or partial cervical agenesis is prudent, because the consequences of nondefinitive early treatment can be life-threatening and potentially fatal. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  11. Alternative therapies in women with chronic vaginitis.

    PubMed

    Nyirjesy, Paul; Robinson, Jennifer; Mathew, Leny; Lev-Sagie, Ahinoam; Reyes, Ingrid; Culhane, Jennifer F

    2011-04-01

    To describe the use of complementary alternative medicines in women with chronic vaginitis and to evaluate epidemiologic factors associated with these treatments. In this prospective cohort study, patients with chronic vaginitis completed a questionnaire about past diagnoses and treatments. Information regarding demographics, medical and social history, perceived mental and emotional stress, and current symptoms was collected. All patients underwent a standard physical examination and laboratory testing and were assigned a specific diagnosis. A total of 481 women were enrolled; 64.9% used complementary alternative medicines. The most common treatments were yogurt and acidophilus pills. In univariate analysis, compared with nonusers, users of complementary alternative medicines were younger (83.4% younger than 50 compared with 73.1%; P=.032), not African American (11.9% compared with 21.3%; P=.018), had increased measures of perceived stress (P=.008), and reported that their symptoms interfered with both work (59.1% compared with 40.6%; P=.001) and social lives (57.9% compared with 40.2%; P=.001). Patients using complementary alternative medicines had seen more doctors (median 2 compared with 1; P<.001) and were more likely to report a history of vulvovaginal candidiasis (98.4% compared with 90.5%; P<.001) or bacterial vaginosis (34.3% compared with 22.8%; P=.007). In the multivariable analysis, interference with social life, higher number of doctors seen, symptoms of itching or burning, and previous diagnoses of yeast infection remained associated with alternative medicine use. A current diagnosis of vulvovaginal candidiasis was not associated with alternative medicine use. Complementary alternative medicine use is common in women with chronic vaginitis, particularly in those who are young, have more disruptive symptoms, and report greater stress. II.

  12. Vaginal retention of locally administered clindamycin.

    PubMed

    Eriksson, Katarina; Larsson, Per-Göran; Nilsson, Maud; Forsum, Urban

    2011-06-01

    Since bacterial vaginosis (BV) is characterized by a lack of, or very few, lactobacilli and high numbers of small, mostly anaerobic bacteria, an obvious treatment modality would be eradication of the BV-associated bacterial flora followed by reintroduction of lactobacilli vaginally. As probiotic treatment with lactobacilli is one tool for improving the cure rate when treating BV, it is necessary to know the length of time after treatment that clindamycin can be found in the vagina and if this could interfere with the growth of the probiotic lactobacilli. We evaluated the vaginal concentration of clindamycin in 12 women for 8 days to obtain data on the concentration of clindamycin in the vagina after intravaginal treatment with the drug. The participants were examined five times between two menstrual periods: before treatment, the day after treatment was finished, and 3, 5 and 8 days post-treatment. The first day post-treatment clindamycin 0.46 × 10(-3) to 8.4 × 10(-3) g/g vaginal fluid (median 2.87 × 10(-3)) was found. Thereafter, the concentration of clindamycin decreased rapidly. In 10 patients clindamycin was found after 3 days. A very low concentration was still present 5 days after treatment in four patients. After 8 days no clindamycin was found. Clindamycin is rapidly eliminated from the vagina, within 3-8 days, after local administration. Our results indicate that treatment with probiotic lactobacilli could be problematic if carried out within 5 days after cessation of clindamycin treatment.

  13. Vaginal microbiome of reproductive-age women

    PubMed Central

    Ravel, Jacques; Gajer, Pawel; Abdo, Zaid; Schneider, G. Maria; Koenig, Sara S. K.; McCulle, Stacey L.; Karlebach, Shara; Gorle, Reshma; Russell, Jennifer; Tacket, Carol O.; Brotman, Rebecca M.; Davis, Catherine C.; Ault, Kevin; Peralta, Ligia; Forney, Larry J.

    2011-01-01

    The means by which vaginal microbiomes help prevent urogenital diseases in women and maintain health are poorly understood. To gain insight into this, the vaginal bacterial communities of 396 asymptomatic North American women who represented four ethnic groups (white, black, Hispanic, and Asian) were sampled and the species composition characterized by pyrosequencing of barcoded 16S rRNA genes. The communities clustered into five groups: four were dominated by Lactobacillus iners, L. crispatus, L. gasseri, or L. jensenii, whereas the fifth had lower proportions of lactic acid bacteria and higher proportions of strictly anaerobic organisms, indicating that a potential key ecological function, the production of lactic acid, seems to be conserved in all communities. The proportions of each community group varied among the four ethnic groups, and these differences were statistically significant [χ2(10) = 36.8, P < 0.0001]. Moreover, the vaginal pH of women in different ethnic groups also differed and was higher in Hispanic (pH 5.0 ± 0.59) and black (pH 4.7 ± 1.04) women as compared with Asian (pH 4.4 ± 0.59) and white (pH 4.2 ± 0.3) women. Phylotypes with correlated relative abundances were found in all communities, and these patterns were associated with either high or low Nugent scores, which are used as a factor for the diagnosis of bacterial vaginosis. The inherent differences within and between women in different ethnic groups strongly argues for a more refined definition of the kinds of bacterial communities normally found in healthy women and the need to appreciate differences between individuals so they can be taken into account in risk assessment and disease diagnosis. PMID:20534435

  14. Optimisation techniques in vaginal cuff brachytherapy.

    PubMed

    Tuncel, N; Garipagaoglu, M; Kizildag, A U; Andic, F; Toy, A

    2009-11-01

    The aim of this study was to explore whether an in-house dosimetry protocol and optimisation method are able to produce a homogeneous dose distribution in the target volume, and how often optimisation is required in vaginal cuff brachytherapy. Treatment planning was carried out for 109 fractions in 33 patients who underwent high dose rate iridium-192 (Ir(192)) brachytherapy using Fletcher ovoids. Dose prescription and normalisation were performed to catheter-oriented lateral dose points (dps) within a range of 90-110% of the prescribed dose. The in-house vaginal apex point (Vk), alternative vaginal apex point (Vk'), International Commission on Radiation Units and Measurements (ICRU) rectal point (Rg) and bladder point (Bl) doses were calculated. Time-position optimisations were made considering dps, Vk and Rg doses. Keeping the Vk dose higher than 95% and the Rg dose less than 85% of the prescribed dose was intended. Target dose homogeneity, optimisation frequency and the relationship between prescribed dose, Vk, Vk', Rg and ovoid diameter were investigated. The mean target dose was 99+/-7.4% of the prescription dose. Optimisation was required in 92 out of 109 (83%) fractions. Ovoid diameter had a significant effect on Rg (p = 0.002), Vk (p = 0.018), Vk' (p = 0.034), minimum dps (p = 0.021) and maximum dps (p<0.001). Rg, Vk and Vk' doses with 2.5 cm diameter ovoids were significantly higher than with 2 cm and 1.5 cm ovoids. Catheter-oriented dose point normalisation provided a homogeneous dose distribution with a 99+/-7.4% mean dose within the target volume, requiring time-position optimisation.

  15. Ketamine improves nasogastric tube insertion.

    PubMed

    Nejati, Amir; Golshani, Keihan; Moradi Lakeh, Maziar; Khashayar, Patricia; Moharari, Reza Shariat

    2010-08-01

    Nasogastric (NG) intubation is one of the most common procedures performed in the emergency department (ED) and other hospital settings. The aim of this study was to compare the level of pain during NG tube insertion in groups receiving local ketamine plus water-soluble lubricating gel and water-soluble lubricating gel alone (the latter is the common practice in our hospital). It was hypothesised that ketamine has local anaesthetic effects in reducing the pain of NG tube insertion in the ED. This prospective double-blind randomised clinical trial was performed on alert haemodynamically stable subjects aged >18 years who required NG tube placement for diagnostic or therapeutic purposes in the ED of a teaching hospital during January and June 2008. The subjects were divided into two groups using randomised allocation software. The ketamine group received intranasal ketamine, while an equivalent volume of sterile water was instilled into the nasal cavity in the control group. The same amount of lubricating gel was used in both groups. The pain of NG tube placement was measured using a standard 100 mm visual analogue scale (VAS). The physician was asked to evaluate the difficulty of the procedure using a 5-point Likert scale. Seventy-two subjects were enrolled in the study (36 subjects in each group). There was a significant difference between the pain score of the ketamine and control groups (19.03+/-3.56 vs 33.33+/-5.31), while the difficulty score was not statistically different between the two groups (2.39+/-1.25 vs 2.78+/-1.56). Intranasal ketamine is an effective agent in reducing pain during NG tube insertion among patients without serious underlying illness.

  16. Transverse vaginal septae: management and long-term outcomes.

    PubMed

    Williams, C E; Nakhal, R S; Hall-Craggs, M A; Wood, D; Cutner, A; Pattison, S H; Creighton, S M

    2014-12-01

    To examine the management and long-term outcomes of transverse vaginal septae. Observational study with cross-sectional and retrospective arms. Tertiary referral centre specialising in Müllerian anomalies. Forty-six girls and women with a transverse vaginal septum. Data from medical records of all cases (1998-2013) of transverse vaginal septae were collected and reviewed. Patients over 16 years of age also completed a questionnaire. Presentation, examination findings, investigations, surgery, and long-term reproductive outcomes. The septae in the study were described as follows: 61% (95% CI 0.46-0.74) were imperforate, and presented with obstructed menstruation; 39% (95% CI 0.26-0.54) were perforate, and presented with a variety of concerns; 72% (95% CI 0.57-0.83) were low, 22% (95% CI 0.12-0.36) were mid-vaginal, and 6% (95% CI 0.02-0.18) were high; 33% were managed via an abdominoperineal approach, 59% were managed via a vaginal approach, and 6% had laparoscopic resection (one patient did not have surgery); 11% (95% CI 0.05-0.23) of patients presented with reobstruction, all following abdominoperineal vaginoplasty; 7% presented with vaginal stenosis, two following vaginal resection and one following the abdominoperineal approach; 61% of questionnaires were returned. These results showed that 22/23 patients were menstruating and one had a hysterectomy, 74% had been sexually active, 35% had dyspareunia, and 36% complained of dysmenorrhoea. There were seven pregnancies, with one termination and six live births, all following the vaginal excision of a transverse vaginal septum. Transverse vaginal septae resected vaginally or laparoscopically have low complication rates and good long-term outcomes. Complex septae require more extensive surgery, with an increased risk of complications. © 2014 Royal College of Obstetricians and Gynaecologists.

  17. Simple strategies for vaginal health promotion in cancer survivors.

    PubMed

    Carter, Jeanne; Goldfrank, Deborah; Schover, Leslie R

    2011-02-01

    With the population of cancer survivors nearing 12 million, an ever-increasing number of women will face vaginal health issues related to their disease and/or treatment. Abrupt menopause triggered by cancer treatment, for example, can cause intense and prolonged estrogen deprivation symptoms, including vaginal dryness and discomfort. Simple strategies to promote vaginal health are available. To provide a comprehensive overview of vaginal health issues caused by estrogen deprivation in female cancer patients/survivors and provide recommendations to identify, treat, and promote vaginal health. We describe a treatment algorithm, based on scientific literature and supported by clinical experience, found to be effective in treating these patients at two major cancer centers. We also provide examples of handouts for patient education on vaginal health promotion. Evidence-based medicine and psychosocial literature, in addition to clinical experience at two major cancer centers. Simple, non-hormonal interventions for sexual dysfunction are often overlooked. Several studies show that education on vaginal lubricants, moisturizers, and dilator use (as needed) can decrease the morbidity of vaginal atrophy. These studies also provide support for our clinical treatment recommendations. Our goal in this article is to increase awareness of these strategies and to provide assistance to general gynecologists and oncologists caring for cancer patients and survivors. Dedicating a small amount of time to educate female cancer survivors about methods to promote vaginal health can result in the reduction or elimination of vaginal discomfort. Non-hormonal vaginal health strategies often appear sufficient to remedy these issues. However, large randomized trials are needed, varying the format and components of the treatment program and exploring efficacy in various groups of female cancer survivors. © 2010 International Society for Sexual Medicine.

  18. Syndromic Diagnosis in Evaluation of Women with Symptoms of Vaginitis.

    PubMed

    Nwankwo, Theophilus Ogochukwu; Aniebue, Uzochukwu Uzoma; Umeh, Uchenna Anthony

    2017-01-01

    This review aims to determine the effectiveness of the use of syndrome diagnosis in the evaluation of vaginitis and to make suggestions based on the review findings. Vaginal discharge as the main symptom of vaginitis is unspecific. A randomized study of symptom-based diagnosis and treatment of vaginitis in the USA favored symptoms used for treatment; however, this was only a pilot study. Hence, a population-based study is necessary to validate these findings. Most of the study that assessed treatment of vaginitis in pregnancy reported low diagnostic sensitivity and specificity for bacterial vaginosis and vaginal candidiasis and a wide range for trichomonas vaginalis reflecting ineffectiveness of syndrome-based treatment in pregnancy. A systematic review of the web for relevant literature was made, and appropriate articles were extracted and reviewed. Sensitivity, specificity, and positive values were used, where applicable to determine effectiveness. Forty-three full articles and abstracts were reviewed. Studies that validated or applied WHO algorithm for treatment of vaginitis reported high sensitivity (91.5-100%) but moderate to low specificity (0-27.5%) among women with vaginal symptoms. Studies that focused on symptoms for diagnosis of the three main etiologic agents of vaginitis reported low sensitivity and specificity, while such studies in pregnancy reported sensitivity and specificity ranging from 35.4 to 54% for TV, 11 to 100% for BV, and 0 to 56.2% for trichomonas vaginalis, bacterial vaginosis, and vaginal candidiasis, respectively. Studies that added point of care test reported higher sensitivity and specificity and positive predictive value. The use of WHO syndrome-based algorithm or its modification for treatment of vaginitis though moderately effective has the potential for overtreatment and physician error. Point of care testing and laboratory investigation are essential for productive intervention especially in pregnancy.

  19. The case for extrathymic development of vaginal T lymphocytes.

    PubMed

    Hamad, Mawieh

    2008-04-01

    The vaginal tract mucosa is populated by a small, yet phenotypically diverse and functionally significant, subset of T cells that plays a major role in local cell-mediated immunity. Although phenotypic and functional characteristics of vaginal T cells have received some attention in recent years, little is known about the development of this cell population. In this mini review, the developmental origins of vaginal T cells are traced from published work related to vaginal T cells, the vaginal mucosa environment and vaginal tract infection animal models. A CD3(+)TCR(+)CD2(+)CD5(+)B220(-) (CD3(+)B220(-)) subpopulation, which is mostly CD4(+), makes up 30-40% of vaginal T lymphocytes. This population consists of a TCRalphabeta(+) subset and TCRgammadelta(+) subset. While CD3(+)B220(-)TCRalphabeta(+) vaginal T cells exhibit phenotypic and functional properties consistent with that of peripheral T cells, CD3(+)B220(-)TCRgammadelta(+) vaginal T cells exhibit unique phenotypic and functional features that set them apart from other TCRgammadelta(+) T cell subsets populating the periphery or other mucosal areas. The vaginal mucosa is populated also by CD3(+)TCRalphabeta(+)CD4(-)/8(-)B220(+)CD2(-)CD5(-) T cells (CD3(+)B220(+)) whose relative predominance increases significantly in systemic T cell deficiency. This subset is generally unresponsive to TCR-mediated stimuli and expresses high levels of CD25, perhaps indicative of a regulatory role. Current data suggest that, while CD3(+)B220(-) vaginal T cells are mostly thymic in origin, CD3(+)TCRalphabeta(+)B220(+) cells are exclusively extrathymic.

  20. Vaginal Cuff Dehiscence in Robotic-Assisted Total Hysterectomy

    PubMed Central

    Kashani, Shabnam; Gallo, Taryn; Sargent, Anita; ElSahwi, Karim; Silasi, Dan-Arin

    2012-01-01

    Study Objective: The aim of this study was to estimate the cumulative incidence of vaginal cuff dehiscence in robotic-assisted total hysterectomies in our patients and to provide recommendations to decrease the incidence of vaginal cuff dehiscence. Methods: This was an observational case series, Canadian Task Force Classification II-3 conducted at an academic and community teaching hospital. A total of 654 patients underwent robotic-assisted total laparoscopic hysterectomy for both malignant and benign reasons from September 1, 2006 to March 1, 2011 performed by a single surgeon. The da Vinci Surgical System was used for robotic-assisted total laparoscopic hysterectomy. Results: There were 3 cases of vaginal cuff dehiscence among 654 robotic-assisted total laparoscopic hysterectomies, making our cumulative incidence of vaginal cuff dehiscence 0.4%. The mean time between the procedures and vaginal cuff dehiscence was 44.3 d (6.3 wk). All patients were followed up twice after surgery, at 3 to 4 wk and 12 to 16 wk. Conclusion: In our study, the incidence of vaginal cuff dehiscence after robotic-assisted total laparoscopic hysterectomy compares favorably to that of total abdominal and vaginal hysterectomy. Our study suggests that the incidence of vaginal cuff dehiscence is more likely related to the technique of colpotomy and vaginal cuff suturing than to robotic-assisted total hysterectomy per se. With proper technique and patient education, our vaginal dehiscence rate has been 0.4%, which is 2.5 to 10 times less than the previously reported vaginal cuff dehiscence rate in the literature. PMID:23484559

  1. Rationale and Safety Assessment of a Novel Intravaginal Drug-Delivery System with Sustained DL-Lactic Acid Release, Intended for Long-Term Protection of the Vaginal Microbiome.

    PubMed

    Verstraelen, Hans; Vervaet, Chris; Remon, Jean-Paul

    2016-01-01

    Bacterial vaginosis is a prevalent state of dysbiosis of the vaginal microbiota with wide-ranging impact on human reproductive health. Based on recent insights in community ecology of the vaginal microbiome, we hypothesize that sustained vaginal DL-lactic acid enrichment will enhance the recruitment of lactobacilli, while counteracting bacterial vaginosis-associated bacteria. We therefore aimed to develop an intravaginal device that would be easy to insert and remove, while providing sustained DL-lactic acid release into the vaginal lumen. The final prototype selected is a vaginal ring matrix system consisting of a mixture of ethylene vinyl acetate and methacrylic acid-methyl methacrylate copolymer loaded with 150 mg DL-lactic acid with an L/D-lactic acid ratio of 1:1. Preclinical safety assessment was performed by use of the Slug Mucosal Irritation test, a non-vertebrate assay to evaluate vaginal mucosal irritation, which revealed no irritation. Clinical safety was evaluated in a phase I trial with six healthy nulliparous premenopausal volunteering women, with the investigational drug left in place for 7 days. Colposcopic monitoring according to the WHO/CONRAD guidelines for the evaluation of vaginal products, revealed no visible cervicovaginal mucosal changes. No adverse events related to the investigational product occurred. Total release from the intravaginal ring over 7 days was estimated through high performance liquid chromatography at 37.1 (standard deviation 0.9) mg DL-lactic acid. Semisolid lactic acid formulations have been studied to a limited extent in the past and typically consist of a large volume of excipients and very high doses of lactic acid, which is of major concern to mucosal safety. We have documented the feasability of enriching the vaginal environment with pure DL-lactic acid with a prototype intravaginal ring. Though the efficacy of this platform remains to be established possibly requiring further development, this approach may offer a

  2. Radiation-induced vaginal stenosis: current perspectives

    PubMed Central

    Morris, Lucinda; Do, Viet; Chard, Jennifer; Brand, Alison H

    2017-01-01

    Treatment of gynecological cancer commonly involves pelvic radiation therapy (RT) and/or brachytherapy. A commonly observed side effect of such treatment is radiation-induced vaginal stenosis (VS). This review analyzed the incidence, pathogenesis, clinical manifestation(s) and assessment and grading of radiation-induced VS. In addition, risk factors, prevention and treatment options and follow-up schedules are also discussed. The limited available literature on many of these aspects suggests that additional studies are required to more precisely determine the best management strategy of this prevalent group after RT. PMID:28496367

  3. Supracervical hysterectomy – the vaginal route

    PubMed Central

    Cieślak, Jarosław; Malinowski, Andrzej

    2014-01-01

    Removal of the cervix during hysterectomy is not mandatory. There has been no irrefutable evidence so far that total hysterectomy is more beneficial to patients in terms of pelvic organ function. The procedure that leaves the cervix intact is called a subtotal hysterectomy. Traditional approaches to this surgery include laparoscopic and abdominal routes. Vaginal total hysterectomy has been proven to present many advantages over the other approaches. Therefore, it seems that this route should also be applied in the case of subtotal hysterectomy. We present 9 cases of patients who underwent subtotal hysterectomy performed through the vagina for benign gynecological diseases. PMID:25097688

  4. [Vaginal birth after cesarean delivery: update 2010].

    PubMed

    Jastrow, N; Cantero, P; Boulvain, M; Irion, O

    2010-10-27

    Uterine rupture is a rare, but potentially catastrophic complication of a trial of vaginal birth after cesarean (VBAC). In part because of concerns about this complication, the rate of cesarean deliveries continue to raise in developed countries. However, multiple repeat cesarean deliveries are associated with a greater risk of complications during surgery and of abnormal placentation in a subsequent pregnancy. VBAC should be proposed to women with good prognosis of VBAC success and low risk of uterine rupture. We aimed to review antepartum and intrapartum factors that are required for a safe VBAC.

  5. JT/LJT connector insert material evaluation

    SciTech Connect

    Baca, J.R.F.

    1991-10-01

    Different insert (insulator) materials are undergoing evaluation to replace the Fiberite E-3938 BE96 material currently used. Also being evaluated is the reconfiguration of the insert and metal shell-edge geometries for the purpose of reducing the alleged interference principally responsible for insert damage.

  6. Insert earphone depth and the occlusion effect.

    PubMed

    Dean, M S; Martin, F N

    2000-12-01

    Twenty individuals were tested to determine the occlusion effect caused by supraaural earphones and by insert earphones with shallow and deep insertion of its foam eartip. The bone-conduction oscillator was placed both on the forehead and the mastoid. It was concluded that using deeply inserted earphones is the most practical way in which to carry out clinical bone-conduction measurements.

  7. Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race.

    PubMed

    Subramaniam, Akila; Kumar, Ranjit; Cliver, Suzanne P; Zhi, Degui; Szychowski, Jeff M; Abramovici, Adi; Biggio, Joseph R; Lefkowitz, Elliot J; Morrow, Casey; Edwards, Rodney K

    2016-03-01

    This study aims to evaluate vaginal microbiota differences by bacterial vaginosis (BV), birth timing, and race, and to estimate parameters to power future vaginal microbiome studies. Previously, vaginal swabs were collected at 21 to 25 weeks (stored at -80°C), and vaginal smears evaluated for BV (Nugent criteria). In a blinded fashion, 40 samples were selected, creating 8 equal-sized groups stratified by race (black/white), BV (present/absent), and birth timing (preterm/term). Samples were thawed, DNA extracted, and prepared. Polymerase chain reaction (PCR) with primers targeting the 16S rDNA V4 region was used to prepare an amplicon library. PCR products were sequenced and analyzed using quantitative insight into microbial ecology; taxonomy was assigned using ribosomal database program classifier (threshold 0.8) against the modified Greengenes database. After quality control, 97,720 sequences (mean) per sample, single-end 250 base-reads, were analyzed. BV samples had greater microbiota diversity (p < 0.05)-with BVAB1, Prevotella, and unclassified genus, Bifidobacteriaceae family (all p < 0.001) more abundant; there was minimal content of Gardnerella or Mobiluncus. Microbiota did not differ by race or birth timing, but there was an association between certain microbial clusters and preterm birth (p = 0.07). To evaluate this difference, 159 patients per group are needed. There are differences in the vaginal microbiota between patients with and without BV. Larger studies should assess the relationship between microbiota composition and preterm birth. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Vaginal Microbiota in Pregnancy: Evaluation Based on Vaginal Flora, Birth Outcome, and Race

    PubMed Central

    Subramaniam, Akila; Kumar, Ranjit; Cliver, Suzanne P.; Zhi, Degui; Szychowski, Jeff M.; Abramovici, Adi; Biggio, Joseph R.; Lefkowitz, Elliot J.; Morrow, Casey; Edwards, Rodney K.

    2016-01-01

    Objective This study aims to evaluate vaginal microbiota differences by bacterial vaginosis (BV), birth timing, and race, and to estimate parameters to power future vaginal microbiome studies. Methods Previously, vaginal swabs were collected at 21 to 25 weeks (stored at −80°C), and vaginal smears evaluated for BV (Nugent criteria). In a blinded fashion, 40 samples were selected, creating 8 equal-sized groups stratified by race (black/white), BV (present/absent), and birth timing (preterm/term). Samples were thawed, DNA extracted, and prepared. Polymerase chain reaction (PCR) with primers targeting the 16S rDNA V4 region was used to prepare an amplicon library. PCR products were sequenced and analyzed using quantitative insight into microbial ecology; taxonomy was assigned using ribosomal database program classifier (threshold 0.8) against the modified Greengenes database. Results After quality control, 97,720 sequences (mean) per sample, single-end 250 base-reads, were analyzed. BV samples had greater microbiota diversity (p < 0.05)—with BVAB1, Prevotella, and unclassified genus, Bifidobacteriaceae family (all p < 0.001) more abundant; there was minimal content of Gardnerella or Mobiluncus. Microbiota did not differ by race or birth timing, but there was an association between certain microbial clusters and preterm birth (p = 0.07). To evaluate this difference, 159 patients per group are needed. Conclusions There are differences in the vaginal microbiota between patients with and without BV. Larger studies should assess the relationship between microbiota composition and preterm birth. PMID:26479170

  9. Clinical Outcome of Postplacental Copper T 380A Insertion in Women Delivering by Caesarean Section

    PubMed Central

    Singal, Sunita; Dewan, Rupali; Divya; Dabral, Anjali; Batra, Achla; Sharma, Manjula; Mittal, Pratima

    2014-01-01

    Introduction: Short interconception period after caesarean section and its associated risk of increased morbidity, mortality and surgical interventions could be avoided by postplacental IUCD insertion during the procedure. Despite the safety reports on intracaesarean IUCD insertion, obstetricians are still hesitant to extend the benefit of this long acting reversible contraception to women undergoing operative delivery. Objective: To study the clinical outcome (safety, efficacy, expulsion and continuation rates) of postplacental Copper T 380A insertion in primiparous women undergoing caesarean section. Materials and Methods: This study was a prospective observational study, carried out in the Department of Obstetrics and Gynaecology, Safdarjung hospital, which is a tertiary care hospital of Northern India. Primiparous women who delivered by caesarean section over a period of six months (July 2012 to December 2012), willing for postplacental intracaesarean IUCD insertion, and willing to comply with the study protocol, were recruited for the study. All these subjects fulfilled the WHO Standard Medical Criteria for PPIUCD insertion; follow up visits were scheduled at 1, 3, 6 and 12 months. Results: A total of 300 primiparous women underwent postpartum intracaesarean insertion of Copper T 380A. The mean age of women included in the study was 23.12 ± 2.42 years. Most common postinsertion complication observed in the immediate postoperative period was febrile morbidity (2%). Majority of women (94.33%) had hospital stay of less than 4 days. The common adverse events observed during follow-up of 12 months were menstrual complaints, excessive vaginal discharge and persistent pelvic pain. At the end of one year, there were 16 expulsions, 21 removals, and 2 pregnancies with gross cumulative expulsion, removal, failure and continuation rates of 5.33%, 7%, 0.67% and 91%, respectively. Conclusion: Postplacental intracaesarean Copper T 380A insertion in primiparous women is a

  10. Immediate versus delayed postpartum insertion of contraceptive implant for contraception.

    PubMed

    Sothornwit, Jen; Werawatakul, Yuthapong; Kaewrudee, Srinaree; Lumbiganon, Pisake; Laopaiboon, Malinee

    2017-04-22

    inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision.Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence).There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence)Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence).It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy

  11. Dosimetric comparison of interstitial brachytherapy with multi-channel vaginal cylinder plans in patients with vaginal tumors.

    PubMed

    Mendez, Lucas C; Paudel, Moti; Wronski, Matt; Ravi, Ananth; Barbera, Lisa; Leung, Eric

    2017-05-18

    To evaluate the dosimetric performance of multi-channel vaginal cylinder (MCVC) against interstitial brachytherapy (ISBT) for the treatment of vaginal tumors. Vaginal tumors with extension of > 0.5 cm and ≤ 2 cm from the lateral vaginal wall and/or ≤ 1 cm in height above the vaginal vault were retrospectively selected from a ISBT registry trial database. The selected patients were treated with ISBT and targets included the intermediate (IRCTV) or high-risk (HRCTV) clinical target volumes. For technique comparison, a 35 mm MCVC was registered with the interstitial intra-vaginal cylinder. Bladder and rectum contours were transferred from the ISBT to the MCVC-BT plans. Vaginal mucosa was achieved by 3 mm uniform expansion from cylinder surface. Both the ISBT and MCVC-BT plans were optimized using the Inverse Planning Simulated Annealing optimization algorithm. After normalizing target D90 to 700 cGy, dose to organs at risk were measured and compared between ISBT and MCVC plans. Six interstitial patient plans met the inclusion criteria for this study. Four patients had vaginal primaries and two recurrent cancers in the vagina. Lower doses to bladder and rectum were seen with ISBT plans. In half of the MCVC plans, the rectal dose met the recommended constraints. For plans in which the rectal constraint was not met, the target volumes were abutting the rectum and had a cranial-caudal length ≥ 5 cm. Dose to vaginal mucosa was lower in ISBT plans directed to the HRCTVs, although no difference was seen in circumferential IRCTVs. Overall, ISBT results in decreased dose to OARs as compared to MCVC. However, MCVC BT results in acceptable doses to OARs with possible improvement in vaginal doses for circumferential targets. Careful consideration to tumor geometry and location may help guide optimal techniques in vaginal tumor brachytherapy.

  12. Nasal and vaginal vaccinations have differential effects on antibody responses in vaginal and cervical secretions in humans.

    PubMed

    Johansson, E L; Wassén, L; Holmgren, J; Jertborn, M; Rudin, A

    2001-12-01

    Sexually transmitted diseases are a major health problem worldwide, but there is still a lack of knowledge about how to induce an optimal immune response in the genital tract of humans. In this study we vaccinated 21 volunteers nasally or vaginally with the model mucosal antigen cholera toxin B subunit and determined the level of specific immunoglobulin A (IgA) and IgG antibodies in vaginal and cervical secretions as well as in serum. To assess the hormonal influence on the induction of antibody responses after vaginal vaccination, we administered the vaccine either independently of the stage in the menstrual cycle or on days 10 and 24 in the cycle in different groups of subjects. Vaginal and nasal vaccinations both resulted in significant IgA and IgG anti-cholera toxin B subunit responses in serum in the majority of the volunteers in the various vaccination groups. Only vaginal vaccination given on days 10 and 24 in the cycle induced strong specific antibody responses in the cervix with 58-fold IgA and 16-fold IgG increases. In contrast, modest responses were seen after nasal vaccination and in the other vaginally vaccinated group. Nasal vaccination was superior in inducing a specific IgA response in vaginal secretions, giving a 35-fold increase, while vaginal vaccination induced only a 5-fold IgA increase. We conclude that a combination of nasal and vaginal vaccination might be the best vaccination strategy for inducing protective antibody responses in both cervical and vaginal secretions, provided that the vaginal vaccination is given on optimal time points in the cycle.

  13. Genome Sequences of 11 Human Vaginal Actinobacteria Strains

    PubMed Central

    Deitzler, Grace E.; Ruiz, Maria J.; Weimer, Cory; Park, SoEun; Robinson, Lloyd S.; Hallsworth-Pepin, Kymberlie; Wollam, Aye; Mitreva, Makedonka

    2016-01-01

    The composition of the vaginal microbiota is an important health determinant. Several members of the phylum Actinobacteria have been implicated in bacterial vaginosis, a condition associated with many negative health outcomes. Here, we present 11 strains of vaginal Actinobacteria (now available through BEI Resources) along with draft genome sequences. PMID:27688328

  14. Evaluation of vaginal implant transmitters in elk (Cervus elaphus nelsoni).

    Treesearch

    Bruce K. Johnson; Terrance McCoy; Christopher O. Kochanny; Rachel C. Cook

    2006-01-01

    The effects of vaginal implant transmitters for tissue damage after 11 wk in 13 captive adult elk (Cervus elaphus nelsoni) and subsequent reproductive performance in 38 free-ranging elk were evaluated. Vaginal implant transmitters are designed to be shed at parturition and are used to locate birth sites of wild ungulates; however, potential adverse...

  15. Women's Psychological Adjustment Following Emergency Cesarean versus Vaginal Delivery.

    ERIC Educational Resources Information Center

    Padawer, Jill A.; And Others

    1988-01-01

    Investigated psychological adjustment and satisfaction in women who had given birth vaginally or by cesarean section. Cesarean mothers reported significantly less satisfaction with the delivery than did vaginal mothers; however no differences were found in postpartum psychological adjustment as measured by depression, anxiety, and confidence in…

  16. Ulcerative Vaginitis Due to Torulopsis Glabrata: A Case Report

    PubMed Central

    Clark, John F. J.; Faggett, Timothy; Peters, Barbara; Sampson, Calvin C.

    1978-01-01

    A patient with ulcerative vaginitis is presented. The differential diagnosis included malignant ulcer, chancroid, and granuloma venereum. Torulopsis glabrata vaginitis, which was subsequently proven, responded successfully to clotrimazole suppositories. Predisposing and related factors and isolation and identification procedures are discussed. PMID:569709

  17. Nano-sized platforms for vaginal drug delivery.

    PubMed

    El-Hammadi, Mazen M; Arias, Jose L

    2015-01-01

    Nano-sized systems have shown promise for efficient vaginal drug delivery providing sustained drug release and enhanced permeation. In parallel with advancements in drug discovery of new vaginal therapeutic agents, such as peptides, proteins, nucleic material, antigens, hormones, and microbicides, nanoplatforms are gaining momentum as prospective vectors for these agents. Thus far, extensive research in this arena has been focused on local delivery to the mucus vagina. However, an improved understanding of vaginal route, advantages offered by the vaginal route including being non-invasive and bypassing hepatic first-effect metabolism, and recent success achieved by vaginal drug nanocarriers may open the door for extensive nanotechnology- based research to explore the viability of systemic administration via this route. The review analyzes the possibilities given by nanoplatform-based delivery systems in the vaginal delivery of active agents. Special insight is given to the most important aspects to be considered during nanomedicine development and preclinical evaluation, i.e., the anatomy and physiology of the vagina, advantages of vaginal route of drug administration, and barriers to vaginal drug delivery. Finally, an updated analysis of the recent advancements of nanomedicine technologies and their potential progress into the clinic is compiled in this work.

  18. Two cases of vaginal bleeding in pet rats

    PubMed Central

    Sadar, Miranda J.; Parker, Dennilyn L.; Burgess, Hilary; Wojnarowicz, Chris

    2011-01-01

    Two unrelated rats were presented to the Western College of Veterinary Medicine emergency service for vaginal bleeding. Each was taken to surgery due to marked blood loss and suspicion of uterine pathology. Despite similar clinical presentation, gross and histopathologic examination revealed 2 different underlying disease processes, uterine dilatation with mild endometritis and vaginal polyp. PMID:22210942

  19. Genome Sequences of 11 Human Vaginal Actinobacteria Strains.

    PubMed

    Lewis, Amanda L; Deitzler, Grace E; Ruiz, Maria J; Weimer, Cory; Park, SoEun; Robinson, Lloyd S; Hallsworth-Pepin, Kymberlie; Wollam, Aye; Mitreva, Makedonka; Lewis, Warren G

    2016-09-29

    The composition of the vaginal microbiota is an important health determinant. Several members of the phylum Actinobacteria have been implicated in bacterial vaginosis, a condition associated with many negative health outcomes. Here, we present 11 strains of vaginal Actinobacteria (now available through BEI Resources) along with draft genome sequences.

  20. Analysis of inserts in prokaryote genomes

    NASA Astrophysics Data System (ADS)

    Cristea, Paul Dan; Tuduce, Rodica Aurora

    2008-02-01

    Nucleotide genomic signals satisfy regularities that reveal restrictions in the distribution of nucleotides and pairs of nucleotides along DNA sequences. Structurally, a chromosome appears to be more than a plain text, by satisfying symmetry constrains that evoke the rhythm and rhyme in poems. These regularities make it easy to identify exogenous inserts in the genomes of prokaryotes, because such inserts obey different regularities than the background sequence. The paper presents instances of inserts found in the genomes of Bacillus subtilis, Mycobacterium tuberculosis and other prokaryotes. Inserts of exogenous material are frequently accompanied by complementary inserts tending to restore the original constrains.

  1. An alternative approach for the treatment of vaginal atrophy.

    PubMed

    Quaranta, L; Ottolina, J; Parma, M; Chionna, R; Sileo, F; Dindelli, M; Origoni, M; Candiani, M; Salvatore, S

    2014-08-01

    The aim of this study was to determine the efficacy of a new topic non-hormonal treatment for postmenopausal women complaining of symptoms of vaginal atrophy. Patients included in the study were prescribed Sinecol gel (AM PHARMA Srl, Vimercate, Monza and Brianza, Italy) application once a day for 20 consecutive days. Sinecol gel is a topic compound for vaginal atrophy containing hyaluronic acid, that is known to improve vaginal elasticity, lactoperoxidase, Xantham gum and glucose oxidase, which have protective and antibacterial action. We evaluated each patient before and after treatment, both subjectively with the "Visual Analogical Scale" (VAS) and objectively with the "Vaginal Health Index" (VHI). We observed a significant clinical improvement of the subjective and objective assessment of symptoms severity with a p value <0.001 at the end of the treatment compared to baseline. Sinecol gel appears to be an effective and valid non-hormonal alternative to the estrogen therapy for vaginal atrophy.

  2. The role of fomites in the transmission of vaginitis.

    PubMed Central

    Andrew, D. E.; Bumstead, E.; Kempton, A. G.

    1975-01-01

    A role for fomites such as toilet seats in the transmission of vaginitis has never been proved or disproved. A compilation of clinical data from a university community showed that the organisms found in vaginal cultures of patients with vaginitis were, in order of frequency. Candida albicans, Escherichia coli, beta-hemolytic streptococci, Hemophilus vaginalis and Trichomonas vaginalis. In a concurrent bacteriologic survey of washroom fixtures, staphylococci and other micrococci were isolated most frequently. The overt pathogens associated with vaginitis were never found, and gram-negative organisms appeared to be suppressed by the disinfectant used by the cleaning staff. It is clear that fomites are not an important mode of transmission in vaginitis, although a search for specific pathogens on toilets is to be continued. PMID:1092449

  3. Transabdominal sonography to measure the total vaginal and mucosal thicknesses.

    PubMed

    Balica, Adrian; Schertz, Katherine; Wald-Spielman, Daniella; Egan, Susan; Bachmann, Gloria

    2017-10-01

    Transabdominal and transvaginal sonography are used to measure bladder wall and detrusor thickness. Only transvaginal sonography has been used to measure the vaginal wall thickness. We describe the use of transabdominal sonography to measure the total vaginal wall thickness and total vaginal mucosal thickness at the bladder trigone. The mean bladder wall thickness and SD from published data were within the 95% confidence interval of our data. Total vaginal and mucosal thicknesses are reliable measurements, which require specific evaluation in a postmenopausal population. They could be used to quantify vaginal atrophy and could correlate to symptoms of atrophy and response to treatment. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:461-464, 2017. © 2017 Wiley Periodicals, Inc.

  4. Local Effects of Vaginally Administered Estrogen Therapy: A Review

    PubMed Central

    Krause, Megan; Wheeler, Thomas L.; Snyder, Thomas E.; Richter, Holly E.

    2011-01-01

    The results of the Women’s Health Initiative (WHI) led to a distinct decline in the routine use of estrogen as preventive therapy for vasomotor symptoms, osteoporosis, and cardiovascular disease in postmenopausal women. Without estrogen replacement, one third of women experience symptoms of atrophic vaginitis including dryness, irritation, itching and or dyspareunia. Local application of estrogen has been shown to relieve these symptoms and improve quality of life for these women. In addition, local estrogen therapy may have a favorable effect on sexuality, urinary tract infections, vaginal surgery, and incontinence. This review examines the effects of vaginally applied estrogen on the vaginal epithelium, urethra and endometrium. An accompanying review examines the systemic effects of vaginally applied estrogen. PMID:22229022

  5. Quench Module Insert (QMI) and the Diffusion Module Insert (DMI) Furnace Development

    NASA Technical Reports Server (NTRS)

    Crouch, Myscha; Carswell, William; Farmer, Jeff; Rose, Fred; Tidwell, Paul

    2000-01-01

    This paper presents, in viewgraph form, QMI (Quench Module Insert) and DMI (Diffusion Module Insert) furnace development. The topics include: 1) Furnace Module in Rack; 2) Quench Module Insert; 3) QMI in MSL Core; 4) Diffusion Module Insert; 5) QMI; and 6) QMI Development and Testing.

  6. Diclofenac plus lidocaine gel for pain relief during intrauterine device insertion. A randomized, double-blinded, placebo-controlled study.

    PubMed

    Fouda, Usama M; Salah Eldin, Noha M; Elsetohy, Khaled A; Tolba, Hoda A; Shaban, Mona M; Sobh, Sherin M

    2016-06-01

    To determine the effectiveness of diclofenac potassium combined with 2% lidocaine gel in reducing the pain of intrauterine device (IUD) insertion. We randomized 90 parous women requesting copper T380A IUD insertion in a 1:1 ratio to active or placebo treatment. Active treatment included administration of two 50-mg diclofenac potassium tablets 1h before IUD insertion, application of 3mL of 2% lidocaine gel on the anterior cervical lip 3min before IUD insertion and placement of a cotton swab soaked in 2% lidocaine gel in the cervical canal 3min before IUD insertion. Women in the placebo group received placebo tablets and gel. Participants assessed pain intensity using a 10-cm visual analog scale (VAS). We considered a 2-cm difference in VAS pain score between both groups during IUD insertion to be a clinically significant difference. Subjects receiving active treatment, as compared to placebo, experienced less pain during tenaculum placement (1.66±0.85 vs. 2.33±1.19, p=.003) and IUD insertion (3.14±0.92 vs. 3.94±1.3, p=.001). Women who delivered only by cesarean section had higher pain scores with IUD insertion compared with women with previous vaginal deliveries (4.41±1.24 vs. 3.29±1.05, p=.001). Diclofenac potassium combined with 2% lidocaine gel slightly reduced pain scores during tenaculum application and copper IUD insertion in parous women; however, the reduction in pain scores lacked clinical significance. Although we found a statistically significant lowering of pain scores with pretreatment with diclofenac potassium and lidocaine gel in parous women having copper IUD placement, the reduction is not clinically relevant. These findings may be more relevant for nulliparous women who experience more pain than parous women with IUD insertion and support studies of diclofenac potassium and lidocaine gel in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Aerobic vaginitis: no longer a stranger.

    PubMed

    Donders, Gilbert G G; Bellen, Gert; Grinceviciene, Svitrigaile; Ruban, Kateryna; Vieira-Baptista, Pedro

    2017-05-11

    Aerobic vaginitis (AV) is the name given in 2002 to a vaginal infectious entity which was not recognized as such before. It is characterized by abnormal (dysbiotic) vaginal microflora containing aerobic, enteric bacteria, variable levels of vaginal inflammation and deficient epithelial maturation. Although AV and bacterial vaginosis (BV) share some characteristics, such as a diminished number or absence of lactobacilli, increased discharge (fishy smelling in BV, while in severe forms of AV, a foul, rather rotten smell may be present) and increased pH (often more pronounced in AV), there are also striking differences between the two. There is no inflammation in women with BV, whereas the vagina of women with AV often appears red and edematous, and may even display small erosions or ulcerations. The color of the discharge in BV is usually whitish or gray and of a watery consistency, whereas in AV it is yellow to green and rather thick and mucoid. Women with BV do not have dyspareunia, while some women with severe AV do. Finally, the microscopic appearance differs in various aspects, such as the presence of leucocytes and parabasal or immature epithelial cells in AV and the absence of the granular aspect of the microflora, typical of BV. Despite all these differences, the distinction between AV and BV was not recognized in many former studies, leading to incomplete and imprecise diagnostic workouts and erroneous management of patients in both clinical and research settings. The prevalence of AV ranges between 7 and 12%, and is therefore less prevalent than BV. Although still largely undiagnosed, many researchers and clinicians increasingly take it into account as a cause of symptomatic vaginitis. AV can co-occur with other entities, such as BV and candidiasis. It can be associated with dyspareunia, sexually transmitted infections (such as human papilloma virus, human immunodeficiency virus, Trichomonas vaginalis and Chlamydia trachomatis), chorioamnionitis, fetal

  8. Attitudes among Toronto obstetricians towards vaginal breech delivery.

    PubMed

    Devarajan, Karthika; Seaward, P Gareth; Farine, Dan

    2011-05-01

    The recent SOGC guidelines allow for selective vaginal delivery of breech presentations, following an eight-year period during which vaginal breech delivery was discouraged based on the results of the Term Breech Trial (TBT). We sought to determine the effect of publication of this guideline on the acceptance of vaginal breech delivery by obstetricians and to correlate obstetricians' attitudes with actual practice. A survey was sent to all obstetricians practising in five teaching hospitals in Toronto exploring their attitudes towards, and comfort with, vaginal breech delivery in various clinical situations. We correlated these with their graduation year in relation to the publication of the TBT. We also reviewed the obstetrical database of the largest teaching hospital in Toronto to see if these attitudes correlated with actual practice. The vaginal breech delivery rate, which was declining prior to publication of the TBT, plummeted after it. Our survey found that most practitioners (50% to 80%) would be willing to provide vaginal breech delivery in defined conditions, with more experienced obstetricians being more comfortable with offering vaginal breech delivery. However, despite these attitudes, the vaginal breech delivery rate during the period surveyed was only 3% (6/195). In the eight years between publication of the TBT and the new guidelines, very few vaginal breech deliveries were performed. Our survey indicates that most obstetricians have accepted the new guidelines; however, it seems that actual practice is lagging behind. The recent SOGC guidelines seem to have changed attitudes, but without changes in training and practical support, it seems unlikely that the trend for very few vaginal breech deliveries to be performed will be reversed.

  9. Vaginal breech delivery: results of a prospective registration study

    PubMed Central

    2013-01-01

    Background Most countries recommend planned cesarean section in breech deliveries, which is considered safer than vaginal delivery. As one of few countries in the western world Norway has continued to practice planned vaginal delivery in selected women. The aim of this study is to evaluate prospectively registered neonatal and maternal outcomes in term singleton breech deliveries in a Norwegian hospital during a ten years period. We aim to compare maternal and neonatal outcomes in term breech pregnancies subjected either to planned vaginal or elective cesarean section. Methods A prospective registration study including 568 women with term breech deliveries (>37 weeks) consecutively registered at Sorlandet Hospital Kristiansand between 2001 and 2011. Fetal and maternal outcomes were compared according to delivery method; planned vaginal delivery versus planned cesarean section. Results Of 568 women, elective cesarean section was planned in 279 (49%) cases and vaginal delivery was planned in 289 (51%) cases. Acute cesarean section was performed in 104 of the planned vaginal deliveries (36.3%). There were no neonatal deaths. Two cases of serious neonatal morbidity were reported in the planned vaginal group. One infant had seizures, brachial plexus injury, and cephalhematoma. The other infant had 5-minutes Apgar < 4. Twenty-nine in the planned vaginal group (10.0%) and eight in the planned cesarean section group (2.9%) (p < 0.001) were transferred to the neonatal intensive care unit. However, only one infant was admitted for ≥4 days. According to follow-up data (median six years) none of these infants had long-term sequelae. Regarding maternal morbidity, blood loss was the only variable that was significantly higher in the planned cesarean section group versus in the vaginal delivery group (p < 0.001). Conclusions Strict guidelines were followed in all cases. There were no neonatal deaths. Two infants had serious neonatal morbidity in the planned

  10. Bacterial vaginosis, vaginal flora patterns and vaginal hygiene practices in patients presenting with vaginal discharge syndrome in The Gambia, West Africa.

    PubMed

    Demba, Edward; Morison, Linda; van der Loeff, Maarten Schim; Awasana, Akum A; Gooding, Euphemia; Bailey, Robin; Mayaud, Philippe; West, Beryl

    2005-03-09

    Bacterial vaginosis (BV) - a syndrome characterised by a shift in vaginal flora - appears to be particularly common in sub-Saharan Africa, but little is known of the pattern of vaginal flora associated with BV in Africa. We conducted a study aimed at determining the prevalence of BV and patterns of BV-associated vaginal micro-flora among women with vaginal discharge syndrome (VDS) in The Gambia, West Africa. We enrolled 227 women with VDS from a large genito-urinary medicine clinic in Fajara, The Gambia. BV was diagnosed by the Nugent's score and Amsel's clinical criteria. Vaginal swabs were collected for T vaginalis and vaginal flora microscopy, and for Lactobacillus spp, aerobic organisms, Candida spp and BV-associated bacteria (Gardnerella vaginalis, anaerobic bacteria, and Mycoplasma spp) cultures; and cervical swabs were collected for N gonorrhoeae culture and C trachomatis PCR. Sera were tested for HIV-1 and HIV-2 antibodies. Sexual health history including details on sexual hygiene were obtained by standardised questionnaire. BV prevalence was 47.6% by Nugent's score and 30.8% by Amsel's clinical criteria. Lactobacillus spp were isolated in 37.8% of women, and 70% of the isolates were hydrogen-peroxide (H202)-producing strains. Prevalence of BV-associated bacteria were: G vaginalis 44.4%; Bacteroides 16.7%; Prevotella 15.2%; Peptostretococcus 1.5%; Mobiluncus 0%; other anaerobes 3.1%; and Mycoplasma hominis 21.4%. BV was positively associated with isolation of G vaginalis (odds-ratio [OR] 19.42, 95%CI 7.91 - 47.6) and anaerobes (P = 0.001 [OR] could not be calculated), but not with M hominis. BV was negatively associated with presence of Lactobacillus (OR 0.07, 95%CI 0.03 - 0.15), and H2O2-producing lactobacilli (OR 0.12, 95% CI 0.05 - 0.28). Presence of H2O2-producing lactobacilli was associated with significantly lower prevalence of G vaginalis, anaerobes and C trachomatis. HIV prevalence was 12.8%. Overall, there was no association between BV and HIV, and

  11. Vaginal microbial flora analysis by next generation sequencing and microarrays; can microbes indicate vaginal origin in a forensic context?

    PubMed

    Benschop, Corina C G; Quaak, Frederike C A; Boon, Mathilde E; Sijen, Titia; Kuiper, Irene

    2012-03-01

    Forensic analysis of biological traces generally encompasses the investigation of both the person who contributed to the trace and the body site(s) from which the trace originates. For instance, for sexual assault cases, it can be beneficial to distinguish vaginal samples from skin or saliva samples. In this study, we explored the use of microbial flora to indicate vaginal origin. First, we explored the vaginal microbiome for a large set of clinical vaginal samples (n = 240) by next generation sequencing (n = 338,184 sequence reads) and found 1,619 different sequences. Next, we selected 389 candidate probes targeting genera or species and designed a microarray, with which we analysed a diverse set of samples; 43 DNA extracts from vaginal samples and 25 DNA extracts from samples from other body sites, including sites in close proximity of or in contact with the vagina. Finally, we used the microarray results and next generation sequencing dataset to assess the potential for a future approach that uses microbial markers to indicate vaginal origin. Since no candidate genera/species were found to positively identify all vaginal DNA extracts on their own, while excluding all non-vaginal DNA extracts, we deduce that a reliable statement about the cellular origin of a biological trace should be based on the detection of multiple species within various genera. Microarray analysis of a sample will then render a microbial flora pattern that is probably best analysed in a probabilistic approach.

  12. Beneficial effects of a Coriolus versicolor-based vaginal gel on cervical epithelization, vaginal microbiota and vaginal health: a pilot study in asymptomatic women.

    PubMed

    Palacios, Santiago; Losa, Fernando; Dexeus, Damián; Cortés, Javier

    2017-03-16

    To assess the effect of a 12-day treatment using a vaginal gel based on niosomes containing hyaluronic acid, ß-glucan, alpha-glucan oligosaccharide, Coriolus versicolor, Asian centella, Azadirachta indica and Aloe vera on vaginal microbiota, cervical epithelization and vaginal health. Open-label, prospective pilot study conducted in asymptomatic women in daily practice. Cervical epithelization was evaluated by colposcopy using an ectopy epithelization score (from 5: no ectopy to 1: severe ectopy and bleeding), vaginal microbiota using the VaginaStatus-Diagnostic test (Instiüt für Mikroökologie, Herborn, Germany) and further rated by the investigator using a 5-point Liker scale (from 5: normal to 1: very severe deterioration in which all evaluated species were altered), and vaginal health using the Vaginal Health Index. In 21 women, a positive effect to improve epithelization of the cervical mucosa, with a mean score of 4.42 at the final visit as compared to 3.09 at baseline (P < 0.0001) (43% improvement). In 10 women, there was a trend of improving of vaginal microbiota status, with a mean score of 4.0 at the final visit vs. 3.3 at baseline (P = NS) (21.2% improvement). In 11 women, the Vaginal Health Index increased from 19.0 at baseline to 22.3 at the final visit (P = 0.007). The concentration of Lactobacillus spp. increased 54.5% of women and pH decreased from 4.32 to 4.09. These encouraging preliminary results provide the basis for designing a randomized controlled study, and for potential use in human papilloma virus infection. ISRCTN77955077 . Registration date: February 15, 2017. Retrospectively registered.

  13. Mars Observer Orbit Insertion Briefing

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Steve Wall is the host of this video entitled, "Return to the Red Planet". Live animation of the Mars Observer orbiting Mars is presented. Steve Wall explains the spacecraft insertion maneuver and also explains the purpose for the Mars Observer launch. Live coverage of the Cape Canaveral launch of the Mars Observer is also presented. Suzanne Dodd, Chief of the Mission Planning team describes the burn start and how the spacecraft will be captured by Mars' gravity. Glenn Cunningham, Mars Observer Project Manager, gives background information on the Mars Observer and describes the organizations behind the Mars Observer Spacecraft, such as the Deep Space Network, the Mission Operation Support Office, Science Investigators, the Flight Engineering Office, Operations Office, and the Ground Data System Office. Dr. William Piotrowski, Acting Director, Solar System Exploration Division, NASA, talks about the purpose of the Mars Pathfinder which is to develop the technology and systems for landing small science packages on Mars. Mr. Roger Gibbs, Former Mars Observer Spacecraft Systems Engineer, tells us how the Mars Observer was built and describes the structural elements on the Mars Observer. The 11-month cruise period for the spacecraft is given by Joseph Beerer, Manager of the Engineering office. The thrust for the Mars Orbit Insertion is described by Ronald Klemetson, Technical Manager, Propulsion Subsystem Jet Propulsion Laboratory (JPL). George Chen, Lead Engineer Attitude and Articulation Subsystem Spacecraft Team, explains the importance of the attitude control engines on the Spacecraft. Marvin Traxler, Manager of Tracking and Data Acquisition, describes how searching for a signal from the Mars Observer works. See NONP-NASA-VT-2000081555 for a continuation of this discussion with Marvin Traxler.

  14. [Vaginal citology. Prevention and good health. Survey].

    PubMed

    Ordonez Gomez, M

    1995-06-01

    A 1993 survey of knowledge, attitudes and practices related to sexually transmitted diseases and other conditions included a series of questions for women on vaginal cytology. The survey was based on a subsample of the PROFAMILIA master sample. 15,080 persons were interviewed, including 6949 women 18-69 years old. The section on vaginal cytology began with a description of the procedure before the questions were asked. Among the total sample, 66.2% reported having undergone cervical cytology while 33.8% had not. 4.8% did not request the results. For the 61.4% of the sample that requested the results, 49.4% were normal, 11.1% were abnormal, and 0.9% did not know or were not given their results. Of those with abnormal results, 9.3% returned for another consultation and 1.8% did not. The proportion of women having cervical cytology exceeded 80% for women 30-49 years old. 69.9% of urban and 54.2% of rural women had been tested. 28.9% underwent the most recent test due to a personal decision, 24.7% on medical recommendation, 23.2% because of symptoms, 12.0% to prevent cancer, 3.2% for safety, 2.0% because a year had passed since the last test, 2.0% in response to a campaign, 1.6% because a friend suggested it, and 1.1% because they had never had it done. The symptoms that motivated the test were a discharge for 31.4%, pain for 30.0%, bleeding for 11.8%, itching for 5.5%, postpartum problems for 2.8%, burning for 2.5%, and cyst for 1.9%. Abnormal results were obtained in 40% of the women who had the test because of symptoms. The average number of times in the past 5 years that the test was done was 2.8. 9% of respondents had not had a test in the past 5 years, 26% had 1, 18% had 2, 12% had 3, 7% had 4, 16% had 5, and 11% had 6 or more. 64.4% of women under 25 and 39% over 60 had never had vaginal cytology. Rural women and the less educated were less likely to have had the procedure.

  15. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration.

    PubMed

    Chen, Beatrice A; Reeves, Matthew F; Creinin, Mitchell D; Schwarz, E Bimla

    2011-11-01

    The objective of this study was to assess the effect of timing of postpartum levonorgestrel-releasing intrauterine device (IUD) insertion on breast-feeding continuation. Women interested in using a levonorgestrel IUD postpartum were randomized to immediate postplacental insertion (postplacental group) or insertion 6-8 weeks after vaginal delivery (delayed group). Duration and exclusivity of breast-feeding were assessed at 6-8 weeks, 3 months, and 6 months postpartum. Only women who received an IUD were included in this analysis. Breast-feeding was initiated by 32 (64%) of 50 of women receiving a postplacental IUD and 27 (58.7%) of 46 of women receiving a delayed IUD (p=.59). More women in the delayed group compared with the postplacental group continued to breast-feed at 6-8 weeks (16/46 vs. 15/50, p=.62), 3 months (13/46 vs. 7/50, p=.13), and 6 months postpartum (11/46 vs. 3/50, p=.02). The results did not differ when only women who initiated breast-feeding or only primiparous women with no prior breast-feeding experience were analyzed. Immediate postplacental insertion of the levonorgestrel IUD is associated with shorter duration of breast-feeding and less exclusive breast-feeding. Further studies on the effects of early initiation of progestin-only methods on women's lactation experience are needed. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Peripherally Inserted Central Catheters and Hemodialysis Outcomes.

    PubMed

    McGill, Rita L; Ruthazer, Robin; Meyer, Klemens B; Miskulin, Dana C; Weiner, Daniel E

    2016-08-08

    Use of peripherally inserted central catheters has expanded rapidly, but the consequences for patients who eventually require hemodialysis are undefined. Our national, population-based analysis included 33,918 adult Medicare beneficiaries from the US Renal Data System who initiated hemodialysis with central venous catheters as their sole vascular access in 2010 and 2011. We used linked Medicare claims to identify peripherally inserted central catheter exposures and evaluate the associations of peripherally inserted central catheter placement with transition to working arteriovenous fistulas or grafts and patient survival using a Cox model with time-dependent variables. Among 33,918 individuals initiating hemodialysis with a catheter as sole access, 12.6% had received at least one peripherally inserted central catheter. Median follow-up was 404 days (interquartile range, 103-680 days). Among 6487 peripherally inserted central catheters placed, 3435 (53%) were placed within the 2 years before hemodialysis initiation, and 3052 (47%) were placed afterward. Multiple peripherally inserted central catheters were placed in 30% of patients exposed to peripherally inserted central catheters. Recipients of peripherally inserted central catheters were more likely to be women and have comorbid diagnoses and less likely to have received predialysis nephrology care. After adjustment for clinical and demographic factors, peripherally inserted central catheters placed before or after hemodialysis initiation were independently associated with lower likelihoods of transition to any working fistula or graft (hazard ratio for prehemodialysis peripherally inserted central catheter, 0.85; 95% confidence interval, 0.79 to 0.91; hazard ratio for posthemodialysis peripherally inserted central catheter, 0.81; 95% confidence interval, 0.73 to 0.89). Peripherally inserted central catheter placement was common and associated with adverse vascular access outcomes. Recognition of potential long

  17. [Isolation, identification and serotyping of yeasts obtained from the vaginal fluid in patients with clinical vaginitis].

    PubMed

    Mendoza, M; González, I; Bellorin, E J; Salazar, W; Mendoza, L; Zambrano, E A; de Albornoz, M C

    1999-03-01

    A study was carried out to determine the presence of Candida in 105 patients with clinical vaginitis who consulted in the Infectious Disease Unit of the Vargas Hospital after referral from Gynecology Service. Yeasts were detected in 23 cases (24%), and identified as C. albicans (12), C. tropicalis (5), C. guilliermondii (3), C. glabrata (2) and C. parapsilosis (1). The presence of hyphae was observed in 50% of the direct examinations, in which the isolated species was C. albicans. These structures were not observed in infections with other species of Candida. In this study, there was relatively little difference between the percentages of serotypes A and B, 58 % and 42, respectively. This is in contrast with previous studies reported in clinical material from Venezuela and other countries, in which serotype A presented a greater incidence than serotype B. Our observations suggest an increase in serotype B C. albicans in vaginal candidiasis.

  18. Vaginal intratubal insemination (VITI) and vaginal GIFT, endosonographic technique: early experience.

    PubMed

    Lucena, E; Ruiz, J A; Mendoza, J C; Ortiz, J A; Lucena, C; Gomez, M; Arango, A

    1989-08-01

    A new technique for vaginal intratubal insemination (VITI) and transvaginal gamete intra-Fallopian transfer (TV-GIFT) using endosonography has been developed. A total of 47 infertile couples were treated using a K-JITS 1000-1100 catheter (William Cook, Australia; Jansen Anderson Intratubal Transfer Set) introduced by Jansen and Anderson in Sydney, Australia, and endosonographic control with a Kretz Combison 310 echograph and a 5/7.5 MHz vaginal sectorial transducer. In 40 couples, the VITI technique was used, and in the other seven couples, TV-GIFT was used. Fifteen pregnancies (37.5%) were obtained in 63 VITI cycles (23.8% per treatment cycle) and three with TV-GIFT (42% per treatment cycle). A review is also presented of the migration--sedimentation technique used for management of male factor in an artificial insemination programme.

  19. Timing of insertion of levonorgestrel-releasing intrauterine system: a randomised controlled trial.

    PubMed

    van der Heijden, Pahh; Geomini, Pmaj; Herman, M C; Veersema, S; Bongers, M Y

    2017-01-01

    The objective was to assess whether patient-perceived pain during the insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS) depends on the timing during the menstrual cycle. A stratified two-armed non-inferiority randomised controlled trial. Large teaching hospital in Veldhoven, the Netherlands. From October 2013 to May 2014, 60 nulliparous and 60 multiparous women were randomised. Eight women withdrew after randomisation and before insertion took place: therefore, data from 112 women were collected and analysed. Women were randomised to the groups 'during menstruation' (i.e. days 1-7 of menstruation) or 'outside menstruation' (i.e. any day of the cycle after menstruation without the presence of vaginal blood loss) in a ratio of 1 : 1. The primary outcome was pain during insertion, measured by the visual analogue scale (VAS, 0-100 mm). Second, we analysed ease of insertion, bleeding pattern, satisfaction, pregnancy, and expulsion rate. The follow-up time was 3 months. The mean VAS score for nulliparous women was 74 mm (95% confidence interval, 95% CI 67-81) in the 'during menstruation' group, compared with 66 mm (95% CI 59-74) in the 'outside menstruation' group (P = 0.14). The mean VAS score for multiparous women was 30 mm (95% CI 20-40) in the 'during menstruation group', compared with 43 mm (95% CI 32-53) in the 'outside menstruation' group (P = 0.08). There was no difference between the stratified 'during menstruation' group and the 'outside menstruation' group with regards to ease of insertion, satisfaction, bleeding pattern, and median spotting and bleeding days for the use of the LNG-IUS 3 months after insertion. As we did not find that the level of pain perceived during insertion was higher during menstruation, compared with outside menstruation, we conclude that the LNG-IUS can be inserted at any time during the menstrual cycle, especially in the case of nulliparous women. We conducted an RCT on time of insertion of

  20. IUD in first-trimester abortion: immediate intrauterine contraceptive devices insertion vs delayed insertion following the next menstruation bleeding.

    PubMed

    Tsikouras, Panagiotis; Vrachnis, Nikolaos; Grapsa, Anastasia; Tsagias, Nikolaos; Pinidis, Petros; Liberis, Anastasios; Ammari, Alexandros; Grapsas, Xenofon; Galazios, Georgios; Liberis, Vasileios

    2014-07-01

    Approximately 21 days after an abortion, ovulation occurs in 50 % of women. Installation of an IUD directly after induced or spontaneous abortion offers immediate contraceptive protection. The purpose of the present study was to weigh up contraceptive safety and adverse reactions of IUD inserted directly after first-trimester abortion under general or paracervical anesthesia as against the fitting of IUD in the days of the next menstrual cycle without anesthesia. During the period May 1987 to October 2010, 73 women (Group A) underwent an immediate post-abortion insertion IUD after a first-trimester spontaneous or induced abortion under general or local paracervical anesthesia and 69 participants (Group B) received IUD during the next menstrual cycle without anesthesia. Questionnaires were completed by all the women of the study with respect to the effects of IUD. The women were examined every 3 months for 1 year after the fitting of the IUD in the out-patient department of the University Obstetrics Gynecological Department of Alexandroupolis, Democritus University of Thrace, Greece. The demographic characteristics of the women of the two groups were similar. The age of the women ranged between 19 and 44 years, while 61.98 % were women with one or two children and 38.02 % were women with three or more children. During the first menstrual cycles, with the exception of vaginal hemorrhages (5 %) and adnexitis (1 %), no serious adverse reactions were noted. During the transvaginal ultrasonography checks in both groups, no observation was made of any dislocation of the IUD, except for two cases in the subgroup of those women with paracervical anesthesia and one case in the women of Group B. As concerns the questionnaire with regard to the women's subjective evaluation of IUD, satisfactory answers were given. There were no differences between the two groups either with respect to the security of the supplied contraceptive methods or to the development of side effects.

  1. Mucus-penetrating nanoparticles for vaginal and gastrointestinal drug delivery

    NASA Astrophysics Data System (ADS)

    Ensign-Hodges, Laura

    A method that could provide more uniform and longer-lasting drug delivery to mucosal surfaces holds the potential to greatly improve the effectiveness of prophylactic and therapeutic approaches for numerous diseases and conditions, including sexually transmitted infections and inflammatory bowel disease. However, the body's natural defenses, including adhesive, rapidly cleared mucus linings coating nearly all entry points to the body not covered by skin, has limited the effectiveness of drug and gene delivery by nanoscale delivery systems. Here, we investigate the use of muco-inert mucus-penetrating nanoparticles (MPP) for improving vaginal and gastrointestinal drug delivery. Conventional hydrophobic nanoparticles strongly adhere to mucus, facilitating rapid clearance from the body. Here, we demonstrate that mucoadhesive polystyrene nanoparticles (conventional nanoparticles, CP) become mucus-penetrating in human cervicovaginal mucus (CVM) after pretreatment with sufficient concentrations of Pluronic F127. Importantly, the diffusion rate of large MPP did not change in F127 pretreated CVM, implying there is no affect on the native pore structure of CVM. Additionally, there was no increase in inflammatory cytokine release in the vaginal tract of mice after daily application of 1% F127 for one week. Importantly, HSV virus remains adherent in F127-pretreated CVM. Mucosal epithelia use osmotic gradients for fluid absorption and secretion. We hypothesized that hypotonically-induced fluid uptake could be advantageous for rapidly delivering drugs through mucus to the vaginal epithelium. We evaluated hypotonic formulations for delivering water-soluble drugs and for drug delivery with MPP. Hypotonic formulations markedly increased the rate at which drugs and MPP reached the epithelial surface. Additionally, hypotonic formulations greatly enhanced drug and MPP delivery to the entire epithelial surface, including deep into the vaginal folds (rugae) that isotonic formulations

  2. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy

    PubMed Central

    Kingsberg, SA; Kellogg, S; Krychman, M

    2010-01-01

    Vulvovaginal atrophy (VVA) and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms. PMID:21072280

  3. A simple procedure to prevent chronic vaginal colpotomy wound bleeding after laparoscopically assisted vaginal hysterectomy.

    PubMed

    Seow, Kok-Min; Lin, Yu-Hung; Hwang, Jiann-Loung; Huang, Lee-Wen; Pan, Ching-Pin

    2010-04-01

    To determine whether injecting the colpotomy wound with diluted vasopressin decreases vaginal bleeding after laparoscopically assisted vaginal hysterectomy (LAVH). In this prospective controlled study 100 patients who underwent LAVH from July 1, 2005 to June 30, 2007, were randomized to receive an injection of vasopressin (n=50) or normal saline (n=50) solution in the colpotomy wound. In the vasopressin group, bleeding from the colpotomy wound occurred for more than 7 days in 9 patients (18%), and none was bleeding after 1 month; in the control group, the corresponding values were 29 (58%) and 2 (4%). Compared with the study group, the control group had a significantly higher rate of chronic bleeding from the colpotomy wound for more than 7 days and for more than 14 days after LAVH (P<0.001 for both). Infiltrating the colpotomy wound with diluted vasopressin was found to prevent chronic vaginal bleeding, which frequently occurs following LAVH. Copyright 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Performing Vaginal Lavage, Crystal Violet Staining, and Vaginal Cytological Evaluation for Mouse Estrous Cycle Staging Identification

    PubMed Central

    McLean, Ashleigh C.; Valenzuela, Nicolas; Fai, Stephen; Bennett, Steffany A.L.

    2012-01-01

    A rapid means of assessing reproductive status in rodents is useful not only in the study of reproductive dysfunction but is also required for the production of new mouse models of disease and investigations into the hormonal regulation of tissue degeneration (or regeneration) following pathological challenge. The murine reproductive (or estrous) cycle is divided into 4 stages: proestrus, estrus, metestrus, and diestrus. Defined fluctuations in circulating levels of the ovarian steroids 17-β-estradiol and progesterone, the gonadotropins luteinizing and follicle stimulating hormones, and the luteotropic hormone prolactin signal transition through these reproductive stages. Changes in cell typology within the murine vaginal canal reflect these underlying endocrine events. Daily assessment of the relative ratio of nucleated epithelial cells, cornified squamous epithelial cells, and leukocytes present in vaginal smears can be used to identify murine estrous stages. The degree of invasiveness, however, employed in collecting these samples can alter reproductive status and elicit an inflammatory response that can confound cytological assessment of smears. Here, we describe a simple, non-invasive protocol that can be used to determine the stage of the estrous cycle of a female mouse without altering her reproductive cycle. We detail how to differentiate between the four stages of the estrous cycle by collection and analysis of predominant cell typology in vaginal smears and we show how these changes can be interpreted with respect to endocrine status. PMID:23007862

  5. Utility of anterior vaginal wall length measurement in vaginal reconstructive surgery.

    PubMed

    Collins, Amy F; Doyle, Paula J; Vilasagar, Smitha; Buchsbaum, Gunhilde M

    2017-08-01

    The pelvic organ prolapse quantification system (POP-Q) is the most commonly used method to quantify the extent of pelvic organ prolapse. However, it does not include assessment of anterior vaginal wall length (AVL). The objectives of this study were to characterize AVL and distance to the sacrospinous ligament (SSL), and to examine associations between total vaginal length (TVL), AVL, body mass index (BMI) and age. This was a retrospective chart review of 139 patients with cervix in situ presenting during an 8-month period for initial evaluation to the University of Rochester Medical Center Urogynecology practice. AVL, TVL and distance to the SSL were measured in addition to POP-Q measurements. Age, height, BMI, presenting complaint and prolapse stage were obtained from medical records. Simple linear regression was used to assess the relationship between TVL and AVL. Multivariate regression was used to test independent variables. The mean ± SD TVL, AVL and distance to the SSL were 9.4 ± 1.2 cm, 7.4 ± 0.9 cm and 7.2 ± 0.9 cm, respectively. All three measurements approached a normal distribution. TVL decreased slightly with age. No association was found between vaginal length and BMI or parity. AVL is a useful measurement that may aid in surgical decision-making. Providers should consider using AVL when planning sacrospinous hysteropexy.

  6. Polygynax in the treatment of fungal and non specific vaginitis.

    PubMed

    Goran, Dimitrov; Vesna, Antovska; Adela, Stefanija; Biljana, Trajkovska-Kiurcik; Snezana, Milenkova

    2004-01-01

    Polygynax is a product commercialized in the form of vaginal capsule, associating bactericidal antibiotics: Neomycin, Polymyxin B and Nystatin--an antifungal agent which is fungicidal and fungistatic in vitro and in vivo. The objectives of the study were to analyze the clinical and bacteriological efficacy of Polygynax in the treatment of bacterial vaginitis with one or more germs (mixed vaginitis) and Candida infections, and to investigate the correlation between the results of the initial clinical examination and bacteriological studies. The study covered 88 patients diagnosed with mixed vaginitis during initial screening of vaginal flora (direct Gram stains and standard microbiology laboratory methods for cultivation of vagina/ cervix smears with antibiotic susceptibility testing). The patients were treated with Polygynax, applied in form of vaginal capsules (during 12 days, application before retiring). After at least 30 days following last day of therapy, the same diagnostic swabs were repeated. In this period, averaging 38.4 days, sexual abstinence was recommended. The results showed that total clearance of present germs was found in 83/88 patients (94.3% of the cases), according to the repeated cervico- vaginal smears. Polygynax is a treatment of preference against fungal infections, with added advantage of having wide antibacterial spectrum.

  7. Characterisation of the vaginal Lactobacillus microbiota associated with preterm delivery.

    PubMed

    Petricevic, Ljubomir; Domig, Konrad J; Nierscher, Franz Josef; Sandhofer, Michael J; Fidesser, Maria; Krondorfer, Iris; Husslein, Peter; Kneifel, Wolfgang; Kiss, Herbert

    2014-05-30

    The presence of an abnormal vaginal microflora in early pregnancy is a risk factor for preterm delivery. There is no investigation on vaginal flora dominated by lactic acid bacteria and possible association with preterm delivery. We assessed the dominant vaginal Lactobacillus species in healthy pregnant women in early pregnancy in relation to pregnancy outcome. We observed 111 low risk pregnant women with a normal vaginal microflora 11 + 0 to 14 + 0 weeks of pregnancy without subjective complaints. Vaginal smears were taken for the identification of lactobacilli using denaturing gradient gel electrophoresis (DGGE). Pregnancy outcome was recorded as term or preterm delivery (limit 36 + 6 weeks of gestation). The diversity of Lactobacillus species in term vs. preterm was the main outcome measure. L. iners alone was detected in 11 from 13 (85%) women who delivered preterm. By contrast, L. iners alone was detected in only 16 from 98 (16%) women who delivered at term (p < 0.001). Fifty six percent women that delivered at term and 8% women that delivered preterm had two or more vaginal Lactobacillus spp. at the same time. This study suggests that dominating L. iners alone detected in vaginal smears of healthy women in early pregnancy might be associated with preterm delivery.

  8. Unraveling the Dynamics of the Human Vaginal Microbiome.

    PubMed

    Nunn, Kenetta L; Forney, Larry J

    2016-09-01

    Four Lactobacillus species, namely L. crispatus , L. iners, L. gasseri, and L. jensenii, commonly dominate the vaginal communities of most reproductive-age women. It is unclear why these particular species, and not others, are so prevalent. Historically, estrogen-induced glycogen production by the vaginal epithelium has been proffered as being key to supporting the proliferation of vaginal lactobacilli. However, the 'fly in the ointment' (that has been largely ignored) is that the species of Lactobacillus commonly found in the human vagina cannot directly metabolize glycogen. It would appear that this riddle has been solved as studies have demonstrated that vaginal lactobacilli can metabolize the products of glycogen depolymerization by α-amylase, and fortunately, amylase activity is found in vaginal secretions. These amylases are presumed to be host-derived, but we suggest that other bacterial populations in vaginal communities could also be sources of amylase in addition to (or instead of) the host. Here we briefly review what is known about human vaginal bacterial communities and discuss how glycogen-derived resources and resource competition might shape the composition and structure of these communities.

  9. The effect of pessaries on the vaginal microenvironment.

    PubMed

    Collins, Sarah; Beigi, Richard; Mellen, Colleen; O'Sullivan, David; Tulikangas, Paul

    2015-01-01

    The objective of the study was to evaluate the differences in vaginal culture, microscopy, and Gram stain between postmenopausal women who wear pessaries and those who do not to explain pessary-related, bothersome vaginal discharge. Postmenopausal women not using exogenous estrogen who had either been wearing a pessary for at least 3 months or who were undergoing their first pessary fittings were approached for enrollment. Symptoms were assessed, and vaginal fluid was collected for culture, microscopy, and Gram stain. A cross-sectional analysis was performed, comparing the new and return pessary wearers. The new pessary users were also sampled at 2 weeks, 3 months, and 6 months after fitting. Women who wore pessaries were more likely to be bothered by discharge (30.0% vs 2.1%, P < .001). They were also more likely to show microscopic evidence of vaginal inflammation and vaginitis. Prospective data showed that these changes developed during the first 2 weeks of pessary use. Aerobic and anaerobic organisms were nearly identical in women with and without bothersome vaginal discharge in the cross-sectional analysis and at all time points in the prospective analysis. Pessary-related, bothersome vaginal discharge develops early and may be due to an inflammatory process in the vagina. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis.

    PubMed

    Mitchell, Leia; King, Michelle; Brillhart, Heather; Goldstein, Andrew

    2017-09-01

    Desquamative inflammatory vaginitis is a poorly understood chronic vaginitis with an unknown etiology. Symptoms of desquamative inflammatory vaginitis include copious yellowish discharge, vulvovaginal discomfort, and dyspareunia. Cervical ectropion, the presence of glandular columnar cells on the ectocervix, has not been reported as a cause of desquamative inflammatory vaginitis. Although cervical ectropion can be a normal clinical finding, it has been reported to cause leukorrhea, metrorrhagia, dyspareunia, and vulvovaginal irritation. Patients with cervical ectropion and desquamative inflammatory vaginitis are frequently misdiagnosed with candidiasis or bacterial vaginosis and repeatedly treated without resolution of symptoms. We report the case of a 34-year-old woman with a 4-year history of profuse yellowish discharge and dyspareunia. Upon presentation, her symptoms and laboratory results met the criteria for desquamative inflammatory vaginitis, but the standard treatments did not provide long-lasting relief. As a last resort, cryotherapy (cryosurgery) of her cervix was performed for treatment of her cervical ectropion, which provided complete resolution of her symptoms. Mitchell L, King M, Brillhart H, Goldstein A. Cervical Ectropion May Be a Cause of Desquamative Inflammatory Vaginitis. Sex Med 2017;5:e212-e214. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  11. The vaginal microbiota, host defence and reproductive physiology.

    PubMed

    Smith, Steven B; Ravel, Jacques

    2017-01-15

    The interaction between the human host and the vaginal microbiota is highly dynamic. Major changes in the vaginal physiology and microbiota over a woman's lifetime are largely shaped by transitional periods such as puberty, menopause and pregnancy, while daily fluctuations in microbial composition observed through culture-independent studies are more likely to be the results of daily life activities and behaviours. The vaginal microbiota of reproductive-aged women is largely made up of at least five different community state types. Four of these community state types are dominated by lactic-acid producing Lactobacillus spp. while the fifth is commonly composed of anaerobes and strict anaerobes and is sometimes associated with vaginal symptoms. The production of lactic acid has been associated with contributing to the overall health of the vagina due to its direct and indirect effects on pathogens and host defence. Some species associated with non-Lactobacillus vaginal microbiota may trigger immune responses as well as degrade the host mucosa, processes that ultimately increase susceptibility to infections and contribute to negative reproductive outcomes such as infertility and preterm birth. Further studies are needed to better understand the functional underpinnings of how the vaginal microbiota affect host physiology but also how host physiology affects the vaginal microbiota. Understanding this fine-tuned interaction is key to maintaining women's reproductive health. © 2016 The Authors. The Journal of Physiology © 2016 The Physiological Society.

  12. Unraveling the Dynamics of the Human Vaginal Microbiome

    PubMed Central

    Nunn, Kenetta L.; Forney, Larry J.

    2016-01-01

    Four Lactobacillus species, namely L. crispatus, L. iners, L. gasseri, and L. jensenii, commonly dominate the vaginal communities of most reproductive-age women. It is unclear why these particular species, and not others, are so prevalent. Historically, estrogen-induced glycogen production by the vaginal epithelium has been proffered as being key to supporting the proliferation of vaginal lactobacilli. However, the ‘fly in the ointment’ (that has been largely ignored) is that the species of Lactobacillus commonly found in the human vagina cannot directly metabolize glycogen. It would appear that this riddle has been solved as studies have demonstrated that vaginal lactobacilli can metabolize the products of glycogen depolymerization by α-amylase, and fortunately, amylase activity is found in vaginal secretions. These amylases are presumed to be host-derived, but we suggest that other bacterial populations in vaginal communities could also be sources of amylase in addition to (or instead of) the host. Here we briefly review what is known about human vaginal bacterial communities and discuss how glycogen-derived resources and resource competition might shape the composition and structure of these communities. PMID:27698617

  13. Differential tissue-specific protein markers of vaginal carcinoma

    PubMed Central

    Hellman, K; Alaiya, A A; Becker, S; Lomnytska, M; Schedvins, K; Steinberg, W; Hellström, A-C; Andersson, S; Hellman, U; Auer, G

    2009-01-01

    The objective was to identify proteins differentially expressed in vaginal cancer to elucidate relevant cancer-related proteins. A total of 16 fresh-frozen tissue biopsies, consisting of 5 biopsies from normal vaginal epithelium, 6 from primary vaginal carcinomas and 5 from primary cervical carcinomas, were analysed using two-dimensional gel electrophoresis (2-DE) and MALDI-TOF mass spectrometry. Of the 43 proteins identified with significant alterations in protein expression between non-tumourous and tumourous tissue, 26 were upregulated and 17 were downregulated. Some were similarly altered in vaginal and cervical carcinoma, including cytoskeletal proteins, tumour suppressor proteins, oncoproteins implicated in apoptosis and proteins in the ubiquitin–proteasome pathway. Three proteins were uniquely altered in vaginal carcinoma (DDX48, erbB3-binding protein and biliverdin reductase) and five in cervical carcinoma (peroxiredoxin 2, annexin A2, sarcomeric tropomyosin kappa, human ribonuclease inhibitor and prolyl-4-hydrolase beta). The identified proteins imply involvement of multiple different cellular pathways in the carcinogenesis of vaginal carcinoma. Similar protein alterations were found between vaginal and cervical carcinoma suggesting common tumourigenesis. However, the expression level of some of these proteins markedly differs among the three tissue specimens indicating that they might be useful molecular markers. PMID:19367286

  14. Anaerobes and Gardnerella vaginalis in non-specific vaginitis.

    PubMed Central

    Hill, L V

    1985-01-01

    Clinical evidence of bacterial vaginosis was present in 25 (35%) of 72 patients attending a London venereology clinic and correlated significantly with abnormal organic acids in vaginal secretions (24/25), with Gardnerella vaginalis on culture (17/25), with complaints of vaginal malodour (15/25), and with a relative scarcity of white blood cells in vaginal secretions. Anaerobic vaginal flora were presumptively identified by gas-liquid chromatographic analysis of organic acids found in vaginal secretions. The clinical criteria used to diagnose bacterial vaginosis included the presence of at least three of the four following characteristics: (a) a vaginal pH greater than or equal to 4.5, vaginal secretions that (b) were homogeneous, (c) contained "clue" cells, and (d) released a "fishy" amine odour when mixed with 10% potassium hydroxide. Because 17 of the 25 patients with clinical bacterial vaginosis had both chromatographic bacterial vaginosis and G vaginalis, causative organisms were difficult to identify. None of the six patients who had G vaginalis but not chromatographic bacterial vaginosis had clinical bacterial vaginosis, but seven of the 10 women with chromatographic bacterial vaginosis but not G vaginalis had clinical bacterial vaginosis (p less than 0.02, chi 2 with Yates's correction). This finding supports the recent suggestions that anaerobes are important in the production of clinical signs of bacterial vaginosis. PMID:3872256

  15. A comparison of abdominal and vaginal hysterectomies in Benghazi, Libya.

    PubMed

    Agnaeber, K; Bodalal, Z

    2013-08-01

    We performed a comparative study between abdominal and vaginal hysterectomies using clinical data from Al-Jamhouria hospital (one of the largest maternity hospitals in Eastern Libya). Various parameters were taken into consideration: the rates of each type (and their subtypes); average age of patients; indications; causes; postoperative complications; and duration of stay in the hospital afterwards. Conclusions and recommendations were drawn from the results of this study. In light of the aforementioned parameters, it was found that: (1) abdominal hysterectomies were more common than vaginal hysterectomies (p < 0.001); (2) patients admitted for abdominal hysterectomies are younger than those admitted for vaginal hysterectomies (p < 0.001); (3) the most common indication for an abdominal hysterectomy was menstrual disturbances, while for vaginal hysterectomies it was vaginal prolapse; (4) the histopathological cause for abdominal and vaginal hysterectomies were observed and the most common were found to be leiomyomas and atrophic endometrium; (5) there was no significant difference between the two routes in terms of postoperative complications; (6) patients who were admitted for abdominal hysterectomies spent a longer amount of time in the hospital (p < 0.01). It was concluded that efforts should be made to further pursue vaginal and laparoscopic hysterectomies as a viable option to the more conventional abdominal route.

  16. Effects of a One Year Reusable Contraceptive Vaginal Ring on Vaginal Microflora and the Risk of Vaginal Infection: An Open-Label Prospective Evaluation

    PubMed Central

    Huang, Yongmei; Merkatz, Ruth B.; Hillier, Sharon L.; Roberts, Kevin; Blithe, Diana L.; Sitruk-Ware, Régine; Creinin, Mitchell D.

    2015-01-01

    Background A contraceptive vaginal ring (CVR) containing Nestorone® (NES) and ethinyl estradiol (EE) that is reusable for 1- year (13 cycles) is under development. This study assessed effects of this investigational CVR on the incidence of vaginal infections and change in vaginal microflora. Methods There were 120 women enrolled into a NES/EE CVR Phase III trial and a microbiology sub-study for up to 1- year of cyclic product use. Gynecological examinations were conducted at baseline, the first week of cycle 6 and last week of cycle 13 (or during early discontinuation visits). Vaginal swabs were obtained for wet mount microscopy, Gram stain and culture. The CVR was removed from the vagina at the last study visit and cultured. Semi-quantitative cultures for Lactobacillus, Gardnerella vaginalis, Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, anaerobic gram negative rods (GNRs), Candida albicans and other yeasts were performed on vaginal and CVR samples. Vaginal infections were documented throughout the study. Results Over 1- year of use, 3.3% of subjects were clinically diagnosed with bacterial vaginosis, 15.0% with vulvovaginal candidiasis, and 0.8% with trichomoniasis. The detection rate of these three infections did not change significantly from baseline to either Cycle 6 or 13. Nugent scores remained stable. H2O2-positive Lactobacillus dominated vaginal flora with a non-significant prevalence increase from 76.7% at baseline to 82.7% at cycle 6 and 90.2% at cycle 13, and a median concentration of 107 colony forming units (cfu) per gram. Although anaerobic GNRs prevalence increased significantly, the median concentration decreased slightly (104 to 103cfu per gram). There were no significant changes in frequency or concentrations of other pathogens. High levels of agreement between vaginal and ring surface microbiota were observed. Conclusion Sustained use of the NES/EE CVR did not increase the risk of vaginal infection and was not disruptive to

  17. Temporal Dynamics of the Human Vaginal Microbiota

    PubMed Central

    Gajer, Pawel; Brotman, Rebecca M.; Bai, Guoyun; Sakamoto, Joyce; Schütte, Ursel M.E.; Zhong, Xue; Koenig, Sara S.K.; Fu, Li; Ma, Zhanshan; Zhou, Xia; Abdo, Zaid; Forney, Larry J.; Ravel, Jacques

    2012-01-01

    Elucidating the factors that impinge on the stability of bacterial communities in the vagina may help in predicting the risk of diseases that affect women’s health. Here, we describe the temporal dynamics of the composition of vaginal bacterial communities in 32 reproductive age women over a 16-week period. The analysis revealed the dynamics of five major classes of bacterial communities and showed that some communities change markedly over short time periods, whereas others are relatively stable. Modeling community stability using new quantitative measures indicates that deviation from stability correlates with time in the menstrual cycle, bacterial community composition and sexual activity. The women studied are healthy, thus it appears that neither variation in community composition per se, nor higher levels of observed diversity (co-dominance) are necessarily indicative of dysbiosis, in which there is microbial imbalance accompanied by symptoms. PMID:22553250

  18. Vaginal agenesis, the hymen, and associated anomalies.

    PubMed

    Kimberley, N; Hutson, J M; Southwell, B R; Grover, S R

    2012-02-01

    Review anomalies in patients with vaginal agenesis. In particular, to clarify the impact of an absent hymen on the presence of other anomalies; on the success of creating a vagina with dilators; and on sexual function outcomes. Retrospective medical record review; questionnaire on sexual function. Gynecology service at a children's hospital and the practice of 1 gynecologist. All patients with vaginal agenesis were identified from the databases, as well as the subgroup in which hymenal status was known. Data regarding hymen, renal, skeletal, cardiac, and other anomalies; for women who had a neovagina, the technique used to create a functional vagina. Of 69 females (age range 2-70 years), renal tract anomalies (43.3%), vertebral anomalies (29%), cardiac anomalies (14.5%), and syndromes including Klippel-Feil (7%) and MURCS association (7%) were identified. Where hymenal status was known (n = 47), 31 were normal, and 16 had an absent hymen. Where the hymen was absent, renal agenesis was increased (odds ratio = 13.5, P < .001). There was no association between other anomalies and an absent hymen, or between the various anomalies. For women without a hymen, the likelihood of failing dilation therapy was increased (odds ratio = 21.7; P < .01]. An absent hymen makes renal agenesis more likely and increases the likelihood that dilator techniques will fail. This condition appears to be associated with reports of long-term problems with poor lubrication that are potentially related to the absence of the peri-hymenal Bartholin's glands. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  19. Perineal lacerations during spontaneous vaginal delivery.

    PubMed

    Bodner, K; Bodner-Adler, B; Wagenbichler, P; Kaider, A; Leodolter, S; Husslein, P; Mayerhofer, K

    2001-10-15

    The aim of the study was to assess the frequency of perineal lacerations during normal spontaneous vaginal delivery and to evaluate potential risk factors. The study is based on an analysis of data from the obstetric database of the University Hospital of Vienna and the Semmelweis Women's Hospital Vienna, from February 1999 through to July 1999. Women with vaginal deliveries, uncomplicated pregnancies, uncomplicated first and second stage of labor, gestational age > 37 weeks and pregnancies with cephalic presentation were included. Of 1009 women, 36.2% had perineal lacerations (18.1% had first-degree, 15.2% second-degree, and 2.9% third-degree perineal tears). Univariate logistic regression models showed that only low parity (p = 0.004), the absence of episiotomy (p = 0.0001), and a large head diameter of the infant (p = 0.005) increased the risk for perineal laceration. After adjustment in multivariate analysis, low parity (p = 0.0001), the absence of episiotomy (p = 0.0001) and a large head diameter (p = 0.0004) remained independent risk factors for perineal laceration. Additionally, advanced age of the mother was associated with an increased risk of perineal laceration (p = 0.03). When analyzing the probability for third-degree perineal tears, a strong association with primiparity (p = 0.01), the use of episiotomy (p = 0.0001), a prolonged second stage of labor (p = 0.0001), a large head diameter of the infant (p = 0.01) and the use of oxytocin (p = 0.008) was found. Primiparous women who are being delivered of a large child are at a greater risk for severe perineal lacerations. In the study population episiotomy did not appear to protect against severe perineal lacerations.

  20. Sequential cooling insert for turbine stator vane

    DOEpatents

    Jones, Russel B

    2017-04-04

    A sequential flow cooling insert for a turbine stator vane of a small gas turbine engine, where the impingement cooling insert is formed as a single piece from a metal additive manufacturing process such as 3D metal printing, and where the insert includes a plurality of rows of radial extending impingement cooling air holes alternating with rows of radial extending return air holes on a pressure side wall, and where the insert includes a plurality of rows of chordwise extending second impingement cooling air holes on a suction side wall. The insert includes alternating rows of radial extending cooling air supply channels and return air channels that form a series of impingement cooling on the pressure side followed by the suction side of the insert.