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.

Military women's risk factors for and symptoms of genitourinary infections during deployment.

PubMed

Lowe, Nancy K; Ryan-Wenger, Nancy A

2003-07-01

Symptoms of vaginitis and urinary tract infections are miserable, distracting, and significantly affect women's quality of life. Among civilian women, these symptoms account for 10.5 million office visits per year. To examine the scope of the problem for military women during deployment situations, surveys were sent to randomly selected Army and Navy units. Of 841 women who completed the anonymous survey and had been deployed, vaginal infections were experienced by 30.1% and urinary tract infections by 18.4% of them during deployment. Vaginal symptoms were consistent with symptoms associated with the three most common vaginal infections (candida, bacterial, and trichomonas vaginitis). A variety of risk factors, both behavioral and situational, significantly differentiated women with and without infections. Urinary tract infections and vaginal infections are common during deployment situations where resources for self-care and appropriate primary health care for women are scarce or unavailable. One solution is a self-diagnosis and treatment kit for deployed military women.

[Microecological investigation of vaginal microflora in women with varying degree gynecologic symptoms in clinics].

PubMed

Xiao, Bing-bing; Liu, Zhao-hui; Liao, Qin-ping

2009-01-01

To investigate the microecological status of vaginal microflora in the women with different vaginal symptoms. From March 2006 to October 2007, 6982 cases with varying degree vaginal symptoms including pruritus, increaseed leucorrhea, the leucorrhea having unusual smell, in the gynecology outpatient department were studied. The vagina secretions were examined in terms of the pH value, the hydrogen peroxide test, and Gram dyeing inspection of vaginal bacteria and microecology appraisal for colony's density, the multiplicity, the superiority fungus, and the inflammatory response. Among 6982 patients, normal vaginal microecology was identified in 750 (10.74%, 750/6982); abnormal microecology was found in 6232 (89.26%, 6232/6982); bacterial vaginosis (BV) was detected in 729 (10.44%, 729/6982); vulvovaginal candidiasis (VVC) was in 1527 (21.87%, 1527/6982). Ninety five patients (1.36%, 95/6982) were with both BV and VVC. Abnormal bacteria colonies were found in 1229 (17.60%, 1229/6982), and others were found in 2652 (37.98%, 2652/6982). The vaginal microecology in the women with different vaginal symptoms can be either normal or abnormal. Microecology clinical evaluation system can assess the vaginal microecosystem.

[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.

Pelvic Floor Disorders in Female Veterans: What a Difference an X Makes

DTIC Science & Technology

2011-07-22

vaginal support has weakened  Known risk factors:  Vaginal deliveries  Multiple deliveries  High birth weight deliveries  Chronic cough – increase...2010 Backup slides: UTI, Lowe Study Symptoms of vaginitis and urinary tract infections are miserable, distracting, and significantly affect women’s...had been deployed, vaginal infections were experienced by 30.1% and urinary tract infections by 18.4% of them during deployment. Vaginal symptoms were

Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey.

PubMed

Kingsberg, Sheryl A; Wysocki, Susan; Magnus, Leslie; Krychman, Michael L

2013-07-01

Vulvar and vaginal atrophy (VVA) is a chronic medical condition experienced by many postmenopausal women. Symptoms include dyspareunia (pain with intercourse), vaginal dryness, and irritation and may affect sexual activities, relationships, and activities of daily life. The aim of this study is to characterize postmenopausal women's experience with and perception of VVA symptoms, interactions with healthcare professionals (HCPs), and available treatment options. An online survey was conducted in the United States in women from KnowledgePanel(®) , a 56,000-member probability-selected Internet panel projectable to the overall US population. Altogether, 3,046 postmenopausal women with VVA symptoms (the largest US cohort of recent surveys) responded to questions about their knowledge of VVA, impact of symptoms on their activities, communication with HCPs, and use of available treatments. Percent is calculated as the ratio of response over total responding for each question for all and stratified participants. The most common VVA symptoms were dryness (55% of participants), dyspareunia (44%), and irritation (37%). VVA symptoms affected enjoyment of sex in 59% of participants. Additionally, interference with sleep, general enjoyment of life, and temperament were reported by 24%, 23%, and 23% of participants, respectively. Few women attributed symptoms to menopause (24%) or hormonal changes (12%). Of all participants, 56% had ever discussed VVA symptoms with an HCP and 40% currently used VVA-specific topical treatments (vaginal over-the-counter [OTC] products [29%] and vaginal prescription therapies [11%]). Of those who had discussed symptoms with an HCP, 62% used OTC products. Insufficient symptom relief and inconvenience were cited as major limitations of OTC products and concerns about side effects and cancer risk limited use of topical vaginal prescription therapies. VVA symptoms are common in postmenopausal women. Significant barriers to treatment include lack of knowledge about VVA, reluctance to discuss symptoms with HCPs, safety concerns, inconvenience, and inadequate symptom relief from available treatments. © 2013 International Society for Sexual Medicine.

Vaginal cytokines do not correlate with postmenopausal vulvovaginal symptoms.

PubMed

Kollmann, Zahraa; Bersinger, Nick; von Wolff, Michael; Thurman, Andrea R; Archer, David F; Stute, Petra

2015-04-01

Exploratory pilot study to determine the correlation between postmenopausal vulvovaginal symptoms and vaginal cytokine levels. Postmenopausal women (n = 34) not using menopausal hormone therapy and presenting with or without symptoms of vulvovaginal irritation were screened. Each participant underwent a vaginal examination and screening for vaginitis. A cervicovaginal lavage (CVL) with sterile saline and a peripheral blood sample were obtained. Main outcome measures were assessed by Luminex® X-map method on the Bio-Plex® platform. Main outcome measures were cervicovaginal and serum interleukin (IL)-4, IL-5, IL-10, IL-12, IL-13, TNF-α, GM-CSF, MIP-1-alpha and RANTES level. Cervicovaginal cytokines were adjusted to total protein concentration [pg/mcg protein]. Twenty-six postmenopausal women were enrolled (symptomatic: n = 15; asymptomatic: n = 11). There were no significant differences between groups: age, age at menopause, vaginal pH and all CVL and serum cytokines (IL-4, IL-5, IL-10, IL-12, IL-13, TNF-α, GM-CSF, MIP-1-alpha and RANTES). GM-CSF was the most abundant vaginal cytokine (symptomatic: 146.5 ± 165.6 pg/mcg protein; asymptomatic: 146.0 ± 173.5 pg/mcg protein; p = 0.99). Postmenopausal vulvovaginal symptoms did not correlate with vaginal inflammatory marker. There was no difference in serum or CVL cytokines between symptomatic and asymptomatic postmenopasual women. Vaginal symptoms after menopause are not related to the vaginal cytokine changes associated with loss of estrogen.

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.

Are vaginal symptoms ever normal? a review of the literature.

PubMed

Anderson, Matthew; Karasz, Alison; Friedland, Sarah

2004-11-22

Vaginal symptoms such as discharge, odor, and itch are among the most common presenting complaints in primary care. We undertook to determine if the symptoms associated with vaginitis (discharge, odor, irritation) occur in normal women. To answer this question, we performed a literature review. We conducted a Medline search using the following terms: "vagina," "vaginal discharge," "secretion," "odors," discharge," "pruritus," "normal," "irritation," "itch," "physical examination," "healthy," "asymptomatic," "quantity," and "physiology." To find additional references we reviewed textbooks in gynecology, primary care, and physical diagnosis and contacted authors. There are few primary studies, and most are not of high quality. Existing data show that the quantity and quality of vaginal discharge in healthy women vary considerably both across individuals and in the same individual during the menstrual cycle. Most studies indicate that discharge is greatest at midcycle. Vaginal fluid contains malodorants, and one study of intact vaginal fluid found it to be malodorous. Two studies found that normal women reported irritative symptoms in the course of their menstrual cycle. The primary literature indicates that there is a wide variation in the normal vagina and that some of the symptoms associated with vaginal abnormality are found in well women. Both clinicians and their patients would benefit from a better understanding of the range of normal as well as what constitutes a meaningful departure from that range.

Clothing factors and vaginitis.

PubMed

Heidrich, F E; Berg, A O; Bergman, J J

1984-10-01

Associations of clothing factors and vulvovaginal symptoms, signs, and microbiology were sought in 203 women seeking care at a university family medicine clinic. Clothing factors studied were use of panty hose, underwear for sleep, cotton lining panels, and pants vs skirts. Women wearing and not wearing panty hose had similar rates of vaginitis symptoms and signs, but yeast vaginitis was about three times more common among wearers. Relationships of other clothing factors to vaginitis were not found. Nonspecific vaginitis was not found to be related to clothing.

One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires.

PubMed

Lone, Farah; Thakar, Ranee; Sultan, Abdul H

2015-09-01

Vaginal pessaries, pelvic floor exercises and surgery are treatment options for women with symptomatic pelvic organ prolapse (POP). The aim of this study was to compare the outcomes of pessaries and surgery in women with symptomatic POP using the validated International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) and Urinary Incontinence (ICIQ-UI) Short Form (SF). Women attending the Urogynecology clinics with symptomatic POP were recruited. All women were treated using either a vaginal pessary or surgery. Outcomes were evaluated and then compared at 1 year using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires. A total of 287 women with symptomatic prolapse were recruited. 269 women completed the questionnaires at baseline and 183 at 1 year. At 1 year, improvement was noted in quality of life (QOL), frequency of urinary leak and vaginal symptoms in both groups except for the symptom of vaginal soreness in the pessary group and the symptom of a tight vagina in the surgery group. However, both these symptoms were not bothersome. Women who underwent surgery demonstrated an improvement in faecal evacuation and sex life. There was an overall statistically significant improvement in vaginal, sex, QOL and urinary symptom scores in both groups. No statistically significant difference was noted between the surgery and the pessary groups. Using validated questionnaires 1 year after treatment, women with symptomatic POP report improvement in vaginal, bowel, urinary and quality of life scores when treated with either pessary use or surgery. No statistically significant difference was noted in the two groups.

A prospective study of genital infections in a family-planning clinic. 1. Microbiological findings and their association with vaginal symptoms.

PubMed Central

Riordan, T.; Macaulay, M. E.; James, J. M.; Leventhall, P. A.; Morris, E. M.; Neal, B. R.; Rowland, J.; Evans, B. M.

1990-01-01

A prospective study of genital infection was conducted in four inner-city family-planning clinics. Fifteen per cent of routine attenders had symptoms and signs of vaginal infection and many more women attended primarily because of symptoms. Among the women with both signs and symptoms, 70% had positive laboratory findings, Trichomonas vaginalis, Candida albicans and bacterial vaginosis being equally prevalent. Measurement of vaginal pH in the clinic was the single most useful clinical finding for directing empirical therapy. Among patients with a discharge confirmed on examination and an abnormally high pH, 72% had either T. vaginalis or bacterial vaginosis. Neisseria gonorrhoeae was isolated from 4% of women with, and 1% of those without, symptoms. We believe that it is worthwhile to investigate patients presenting to family-planning clinics with vaginal symptoms. No single specimen was found ideal for all pathogens, a cervical swab is better for gonococci and also for T. vaginalis but a vaginal swab is needed for candida and bacterial vaginosis. PMID:2307184

Transvaginal postpartum manual removal of a prolapsed submucous leiomyoma, initially diagnosed hybrid predominantly intramural.

PubMed

Elgonaid, Wael; Belkhir, Reem; Boama, Vincent

2017-08-11

We present a rare case of a large infarcted submucous fibroid removed manually after a normal vaginal delivery. This patient was known to have a large postero-fundal hybrid predominantly intramural uterine fibroid, measuring 11 x 10 cm in diameter and diagnosed 2 years prior to last conception. Thirty-five days postpartum, she presented with severe lower abdominal pain and foul smell per vaginum. Abdominal examination revealed a very tender bulky uterus at 24 weeks size, and vaginal examination revealed a big fleshy smelly mass with friable surface just bulging from a dilated cervix. Examination under anaesthesia revealed a very foul smelly large pedunculated submucous fibroid that was felt through a dilated cervix. It was deliverable vaginally, so the submucous leiomyoma was removed manually, a procedure similar to manual removal of placenta. Histopathology examination confirmed an infarcted massive fibroid. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Does vaginal irrigation with saline solution in women with infectious vaginitis contribute to the clinical and microbiological results of antibiotic therapy?

PubMed

Derbent, Aysel Uysal; Ulukanlıgil, Mustafa; Keskin, Esra Aktepe; Soylu, Gül; Kafalı, Hasan

2012-01-01

To compare the clinical and microbiological results between patients with infectious vaginitis receiving vaginal irrigation with saline or no irrigation before standard antibiotic therapy. Women with vaginitis (n = 109) were randomized to receive vaginal irrigation with saline or no irrigation before standard antibiotic therapy. The vaginal symptoms perceived by subjects and clinical findings were assessed with a standardized scale during four follow-up visits, and Gram stain Nugent scores and vaginal fluid cultures were analyzed at each visit. Vaginal discharge (z = 7.159; p < 0.001), pruritus (z = 5.169; p < 0.001), itching (z = 2.969; p < 0.003) and odor scores (z = 2.303; p < 0.021) were significantly reduced in the study group compared to the control group between the first visit and 3-5 days after irrigation, before the start of antibiotic therapy. The second and third visits (15 and 30-45 days after antibiotic therapy) showed that the patients' symptoms and amounts of visible vaginal discharge did not differ between the two groups. Moreover, the microbiological cures of patients in each group did not differ at these visits (z = 0.447; p = 0.655). Vaginal irrigation with saline significantly reduces self-reported symptoms in the short term but has no effect on long-term clinical and laboratory results in women with infectious vaginitis. Copyright © 2012 S. Karger AG, Basel.

One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device.

PubMed

Zyczynski, Halina M; Carey, Marcus P; Smith, Anthony R B; Gauld, Judi M; Robinson, David; Sikirica, Vanja; Reisenauer, Christl; Slack, Mark

2010-12-01

The purpose of this study was to evaluate outcomes after standardized transvaginal prolapse repair with nonanchored mesh and a vaginal support device. Postoperative vaginal support was assessed by pelvic organ prolapse quantitative examination after repair of symptomatic stage II/III prolapse. Validated questionnaires assessed pelvic symptoms and sexual function. Visual analog scales quantified experience with the vaginal support device. One hundred thirty-six women received the planned surgery; 95.6% of the women returned for the 1-year assessment: 76.9% of the cases were stage 0/I; however, in 86.9% of the cases, the leading vaginal edge was above the hymen. Pelvic symptoms, quality of life, and sexual function improved significantly from baseline (P < .05). Median visual analog scale scores for vaginal support device awareness and discomfort were 2.6 and 1.2, respectively (0 = none; 10 = worst possible). Vaginal support, pelvic symptoms, and sexual function improved at 1 year, compared with baseline, after trocar-free prolapse repair with nonanchored mesh and a vaginal support device. Copyright © 2010 Mosby, Inc. All rights reserved.

Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial.

PubMed

Jokar, Azam; Davari, Tayebe; Asadi, Nasrin; Ahmadi, Fateme; Foruhari, Sedighe

2016-01-01

Vaginal atrophy is a common complication in menopause which does not improve with time and, if untreated, can affect the quality of life for women. The aim of this study was to compare the effectiveness of the vaginal cream of hyaluronic acid and conjugated estrogen (Premarin) in treatment of vaginal atrophy. This study was a randomized controlled clinical trial on 56 menopausal women with symptoms of vaginal atrophy; they were randomly allocated to two groups (recipient conjugated estrogen and hyaluronic acid). The severity of each sign of atrophy was evaluated by visual analog signals (VAS) and on the basis of a four point scale. Also to recognize the cellular maturation with pap smear and the maturation degree were calculated according to the formula and scores 0-100. As to the vaginal PH, we used PH marker band, the rate of which was divided into 4 degrees. Data were analyzed using SPSS, version 20, and P≤0.05 was considered as significant. The results of this study showed that the symptoms of vaginal atrophy compared with the baseline level were relieved significantly in both groups. Dryness, itching, maturation index, PH and composite score of the vaginal symptoms were relieved significantly in both groups (P<0.001). Dyspareunia in Premarin (P<0.05) and hyaluronic acid (P<0.001) decreased compared with pre-treatment. Urinary incontinence only showed improvement in the hyaluronic acid group (P<0.05). Improvement in urinary incontinence, dryness, maturation index (P<0.05) and composite score of vaginal symptoms (P<0.001) in the hyaluronic acid group was better than those in the Premarin group. According to the results of the present study, hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy. But hyaluronic acid was more effective and this drug is suggested for those who do not want to or cannot take local hormone treatment. IRCT2013022712644N1.

Kinematic Evaluation of Association between Disc Bulge Migration, Lumbar Segmental Mobility, and Disc Degeneration in the Lumbar Spine Using Positional Magnetic Resonance Imaging

PubMed Central

Hu, Jonathan K.; Morishita, Yuichiro; Montgomery, Scott R.; Hymanson, Henry; Taghavi, Cyrus E.; Do, Duc; Wang, Jeff C.

2011-01-01

Degenerative disc disease and disc bulge in the lumbar spine are common sources of lower back pain. Little is known regarding disc bulge migration and lumbar segmental mobility as the lumbar spine moves from flexion to extension. In this study, 329 symptomatic (low back pain with or without neurological symptoms) patients with an average age of 43.5 years with varying degrees of disc degeneration were examined to characterize the kinematics of the lumbar intervertebral discs through flexion, neutral, and extension weight-bearing positions. In this population, disc bulge migration associated with dynamic motion of the lumbar spine significantly increased with increased grade of disk degeneration. Although no obvious trends relating the migration of disc bulge and angular segmental mobility were seen, translational segmental mobility tended to increase with disc bulge migration in all of the degenerative disc states. It appears that many factors, both static (intervertebral disc degeneration or disc height) and dynamic (lumbar segmental mobility), affect the mechanisms of lumbar disc bulge migration. PMID:24353937

Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction-secondary analysis of a randomised trial.

PubMed

Kolberg Tennfjord, M; Hilde, G; Staer-Jensen, J; Siafarikas, F; Engh, M Ellström; Bø, K

2016-03-01

Evaluate effect of pelvic floor muscle training (PFMT) on vaginal symptoms and sexual matters, dyspareunia and coital incontinence in primiparous women stratified by major or no defects of the levator ani muscle. Randomised controlled trial (RCT). Akershus University Hospital, Norway. About 175 primiparous women with a singleton vaginal delivery. Two-armed assessor blinded parallel group RCT from 6 weeks to 6 months postpartum comparing effect of PFMT versus control. International Consultation on Incontinence Modular Questionnaire-vaginal symptoms questionnaire (ICIQ-VS) and ICIQ sexual matters module (ICIQ-FLUTSsex). Overall, analysis (n = 175) showed no difference between training and control groups in women having vaginal symptoms or symptoms related to sexual dysfunction 6 months postpartum. The majority of women (88%) had intercourse and there was no difference between groups. Unadjusted subgroup analysis of women with a major defect of the levator ani muscle (n = 55) showed that women in the training group had 45% less risk of having the symptom 'vagina feels loose or lax' compared with the control group (relative risk 0.55, 95% confidence interval 0.31, 0.95; P = 0.03). Unadjusted analysis showed that in women with major defect of the levator ani muscle, significantly fewer in the training group had the symptom 'vagina feels loose or lax' compared with the control group. No difference was found between groups for symptoms related to sexual dysfunction. More studies are needed to explore effect of PFMT on vaginal symptoms and sexual dysfunction. Unadjusted analysis shows that PFMT might prevent symptoms of 'vagina feels loose or lax'. © 2015 Royal College of Obstetricians and Gynaecologists.

Evaluation of vaginal complaints.

PubMed

Anderson, Matthew R; Klink, Kathleen; Cohrssen, Andreas

2004-03-17

Vaginal symptoms are one of the most common reasons for gynecological consultation. Clinicians have traditionally diagnosed vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis using some combination of physical examination, pH, the wet mount, and the whiff test. To evaluate the role of the clinical examination and determine the positive and negative likelihood ratios (LRs) for the diagnosis of vaginal candidiasis, bacterial vaginosis, and vaginal trichomoniasis. Using a structured literature review, we abstracted information on sensitivity and specificity for symptoms, signs, and office laboratory procedures. We chose published (1966 to April 2003) articles that appeared in the MEDLINE database and were indexed under the combined search terms of diagnosis with vaginitis, vaginal discharge, candidiasis, bacterial vaginosis, and trichomoniasis. Included studies of symptomatic premenopausal women seen in primary care settings. Tests were evaluated only if they would provide diagnostic information during the office visit and were compared with an acceptable criterion standard. All 3 authors extracted the data and computed sensitivity and specificity from each article independently. The absence of standard definitions for symptoms and signs made it impossible to combine results across studies. Symptoms alone do not allow clinicians to distinguish confidently between the causes of vaginitis. However, a patient's lack of itching makes candidiasis less likely (range of LRs, 0.18 [95% confidence interval [CI], 0.05-0.70] to 0.79 [95% CI, 0.72-0.87]) and lack of perceived odor makes bacterial vaginosis unlikely (LR, 0.07 [95% CI, 0.01-0.51]). Similarly, physical examination signs are limited in their diagnostic power. The presence of inflammatory signs is associated with candidiasis (range of LRs, 2.1 [95% CI, 1.5-2.8] to 8.4 [95% CI, 2.3-31]). Presence of a "high cheese" odor on examination is predictive of bacterial vaginosis (LR, 3.2 [95% CI, 2.1-4.7]) while lack of odor is associated with candidiasis (LR, 2.9 [95% CI, 2.4-5.0]). Office laboratory tests, particularly microscopy of vaginal discharge, are the most useful way of diagnosing these 3 conditions. The cause of vaginal complaints may be easily diagnosed when typical findings appear in microscopy. However, the poor performance of individual symptoms, signs, and office laboratory tests often makes it problematic to identify the cause of vaginal symptoms.

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.

Graves' Disease

MedlinePlus

... your dose as needed. What is Graves’ ophthalmopathy (GO)? GO is a condition that occurs when the immune ... causing vision loss. Symptoms Besides bulging eyes, other GO symptoms are dry, gritty, and irritated eyes puffy ...

Anterior vaginal introitoplasty for an acquired sensation of wide vagina: a case report and new surgical intervention.

PubMed

Ostrzenski, Adam

2014-01-01

A vaginal introital defect case and its symptomatology have never been published before. The objective of this presentation was to describe symptoms associated with an acquired sensation of wide vagina and to present a new surgical treatment for anterior vaginal introital defects. A 42-year-old, Caucasian woman, G4P4013, presented with a sensation of wide vagina at the vaginal opening and a history of colpoperineoplasty, without mesh, for the same condition 4 years prior. Clinical evaluation documented anterior vaginal introital defects and the absence of vaginal site-specific defects. Reconstruction of a vaginal introital defect was completed without complications. Surgical resolution of symptoms and signs of this condition were noted. Anterior vaginal introitoplasty can assist in the management of an acquired sensation of wide vagina.

Thyroxine (T4) Test

MedlinePlus

... having too little thyroid hormone, a condition called hypothyroidism . Symptoms of hyperthyroidism, also known as overactive thyroid, ... Bulging of the eyes Trouble sleeping Symptoms of hypothyroidism, also known as underactive thyroid, include: Weight gain ...

Vaginal para-urethral myxoid leiomyoma: case report and review of the literature.

PubMed

Costantini, Elisabetta; Cochetti, Giovanni; Porena, Massimo

2008-08-01

Vaginal leiomyoma is a rare solid tumour of unknown aetiology, which usually develops in women between the ages of 35 and 50. As it presents with a wide range of symptoms, diagnosis is based on histological findings. Here we present the case of a 27-year-old white woman with a painless vaginal mass associated with dyspareunia, dysmenorrhea and foul-smelling vaginal discharge. She underwent surgery by vaginal route, and the histological findings confirmed a myxoid leiomyoma. After 17 months, the patient was disease-free, and symptoms disappeared. Vaginal leiomyomas are rare, local recurrence and transformation into sarcoma are rare, and complete surgical excision as soon as possible is recommended.

TSH (Thyroid-stimulating hormone) test

MedlinePlus

... your blood ( hyperthyroidism ), or too little thyroid hormone ( hypothyroidism ). Symptoms of hyperthyroidism, also known as overactive thyroid, ... Bulging of the eyes Difficulty sleeping Symptoms of hypothyroidism, also known as underactive thyroid, include: Weight gain ...

Yeast Infection (Vaginal)

MedlinePlus

Yeast infection (vaginal) Overview A vaginal yeast infection is a fungal infection that causes irritation, discharge and intense itchiness ... symptoms Causes The fungus candida causes a vaginal yeast infection. Your vagina naturally contains a balanced mix of yeast, including ...

Management of Vaginal Atrophy: Implications from the REVIVE Survey

PubMed Central

Wysocki, Susan; Kingsberg, Sheryl; Krychman, Michael

2014-01-01

Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA. PMID:24987271

Management of Vaginal Atrophy: Implications from the REVIVE Survey.

PubMed

Wysocki, Susan; Kingsberg, Sheryl; Krychman, Michael

2014-01-01

Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA.

Comparison of the Effect of Vaginal Zataria multiflora Cream and Oral Metronidazole Pill on Results of Treatments for Vaginal Infections including Trichomoniasis and Bacterial Vaginosis in Women of Reproductive Age

PubMed Central

Abdali, Khadijeh; Jahed, Leila; Amooee, Sedigheh; Zarshenas, Mahnaz; Tabatabaee, Hamidreza; Bekhradi, Reza

2015-01-01

Effect of Zataria multiflora on bacterial vaginosis and Trichomonas vaginalis is shown in vivo and in vitro. We compare the effectiveness of Zataria multiflora cream and oral metronidazole pill on results of treatment for vaginal infections including Trichomonas and bacterial vaginosis; these infections occur simultaneously. The study included 420 women with bacterial vaginosis, Trichomonas vaginalis, or both infections together, who were randomly divided into six groups. Criteria for diagnosis were wet smear and Gram stain. Vaginal Zataria multiflora cream and placebo pill were administered to the experiment groups; the control group received oral metronidazole pill and vaginal placebo cream. Comparison of the clinical symptoms showed no significant difference in all three vaginitis groups receiving metronidazole pill and vaginal Zataria multiflora cream. However, comparison of the wet smear test results was significant in patients with trichomoniasis and bacterial vaginosis associated with trichomoniasis in the two treatment groups (p = 0.001 and p = 0.01). Vaginal Zataria multiflora cream had the same effect of oral metronidazole tablets in improving clinical symptoms of all three vaginitis groups, as well as the treatment for bacterial vaginosis. It can be used as a drug for treatment of bacterial vaginosis and elimination of clinical symptoms of Trichomonas vaginitis. PMID:26266260

Comparison of the Effect of Vaginal Zataria multiflora Cream and Oral Metronidazole Pill on Results of Treatments for Vaginal Infections including Trichomoniasis and Bacterial Vaginosis in Women of Reproductive Age.

PubMed

Abdali, Khadijeh; Jahed, Leila; Amooee, Sedigheh; Zarshenas, Mahnaz; Tabatabaee, Hamidreza; Bekhradi, Reza

2015-01-01

Effect of Zataria multiflora on bacterial vaginosis and Trichomonas vaginalis is shown in vivo and in vitro. We compare the effectiveness of Zataria multiflora cream and oral metronidazole pill on results of treatment for vaginal infections including Trichomonas and bacterial vaginosis; these infections occur simultaneously. The study included 420 women with bacterial vaginosis, Trichomonas vaginalis, or both infections together, who were randomly divided into six groups. Criteria for diagnosis were wet smear and Gram stain. Vaginal Zataria multiflora cream and placebo pill were administered to the experiment groups; the control group received oral metronidazole pill and vaginal placebo cream. Comparison of the clinical symptoms showed no significant difference in all three vaginitis groups receiving metronidazole pill and vaginal Zataria multiflora cream. However, comparison of the wet smear test results was significant in patients with trichomoniasis and bacterial vaginosis associated with trichomoniasis in the two treatment groups (p = 0.001 and p = 0.01). Vaginal Zataria multiflora cream had the same effect of oral metronidazole tablets in improving clinical symptoms of all three vaginitis groups, as well as the treatment for bacterial vaginosis. It can be used as a drug for treatment of bacterial vaginosis and elimination of clinical symptoms of Trichomonas vaginitis.

Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial

PubMed Central

Jokar, Azam; Davari, Tayebe; Asadi, Nasrin; Ahmadi, Fateme; Foruhari, Sedighe

2016-01-01

Background: Vaginal atrophy is a common complication in menopause which does not improve with time and, if untreated, can affect the quality of life for women. The aim of this study was to compare the effectiveness of the vaginal cream of hyaluronic acid and conjugated estrogen (Premarin) in treatment of vaginal atrophy. Methods: This study was a randomized controlled clinical trial on 56 menopausal women with symptoms of vaginal atrophy; they were randomly allocated to two groups (recipient conjugated estrogen and hyaluronic acid). The severity of each sign of atrophy was evaluated by visual analog signals (VAS) and on the basis of a four point scale. Also to recognize the cellular maturation with pap smear and the maturation degree were calculated according to the formula and scores 0-100. As to the vaginal PH, we used PH marker band, the rate of which was divided into 4 degrees. Data were analyzed using SPSS, version 20, and P≤0.05 was considered as significant. Results: The results of this study showed that the symptoms of vaginal atrophy compared with the baseline level were relieved significantly in both groups. Dryness, itching, maturation index, PH and composite score of the vaginal symptoms were relieved significantly in both groups (P<0.001). Dyspareunia in Premarin (P<0.05) and hyaluronic acid (P<0.001) decreased compared with pre-treatment. Urinary incontinence only showed improvement in the hyaluronic acid group (P<0.05). Improvement in urinary incontinence, dryness, maturation index (P<0.05) and composite score of vaginal symptoms (P<0.001) in the hyaluronic acid group was better than those in the Premarin group. Conclusion: According to the results of the present study, hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy. But hyaluronic acid was more effective and this drug is suggested for those who do not want to or cannot take local hormone treatment. Trial Registration Number: IRCT2013022712644N1 PMID:26793732

Accuracy of vaginal symptom self-diagnosis algorithms for deployed military women.

PubMed

Ryan-Wenger, Nancy A; Neal, Jeremy L; Jones, Ashley S; Lowe, Nancy K

2010-01-01

Deployed military women have an increased risk for development of vaginitis due to extreme temperatures, primitive sanitation, hygiene and laundry facilities, and unavailable or unacceptable healthcare resources. The Women in the Military Self-Diagnosis (WMSD) and treatment kit was developed as a field-expedient solution to this problem. The primary study aims were to evaluate the accuracy of women's self-diagnosis of vaginal symptoms and eight diagnostic algorithms and to predict potential self-medication omission and commission error rates. Participants included 546 active duty, deployable Army (43.3%) and Navy (53.6%) women with vaginal symptoms who sought healthcare at troop medical clinics on base.In the clinic lavatory, women conducted a self-diagnosis using a sterile cotton swab to obtain vaginal fluid, a FemExam card to measure positive or negative pH and amines, and the investigator-developed WMSD Decision-Making Guide. Potential self-diagnoses were "bacterial infection" (bacterial vaginosis [BV] and/or trichomonas vaginitis [TV]), "yeast infection" (candida vaginitis [CV]), "no infection/normal," or "unclear." The Affirm VPIII laboratory reference standard was used to detect clinically significant amounts of vaginal fluid DNA for organisms associated with BV, TV, and CV. Women's self-diagnostic accuracy was 56% for BV/TV and 69.2% for CV. False-positives would have led to a self-medication commission error rate of 20.3% for BV/TV and 8% for CV. Potential self-medication omission error rates due to false-negatives were 23.7% for BV/TV and 24.8% for CV. The positive predictive value of diagnostic algorithms ranged from 0% to 78.1% for BV/TV and 41.7% for CV. The algorithms were based on clinical diagnostic standards. The nonspecific nature of vaginal symptoms, mixed infections, and a faulty device intended to measure vaginal pH and amines explain why none of the algorithms reached the goal of 95% accuracy. The next prototype of the WMSD kit will not include nonspecific vaginal signs and symptoms in favor of recently available point-of-care devices that identify antigens or enzymes of the causative BV, TV, and CV organisms.

Qualitative cross-cultural exploration of vaginal bleeding/spotting symptoms and impacts associated with hormone therapy in post-menopausal women to inform the development of new patient-reported measurement tools.

PubMed

Arbuckle, Rob; Humphrey, Louise; Abraham, Lucy; Dennerstein, Lorraine; Simon, James A; Mirkin, Sebastian; Bonner, Nicola; Walmsley, Steven; Tatlock, Sophi; Symonds, Tara

2014-07-01

To understand the vaginal bleeding/spotting experiences of postmenopausal (PM) women taking estrogen plus progestin therapies (EPT) and develop measures to assess these symptoms and their impact on women's daily lives in four countries. (1) Concept elicitation interviews were conducted with PM women in the US (n=14), Italy (n=15), Mexico (n=15) and China (n=15) to explore vaginal bleeding/spotting symptoms associated with EPT. The Post-Menopausal Bleeding Questionnaire (PMBQ) was also debriefed to evaluate understanding and comprehensiveness. (2) Based on concept elicitation, a single item electronic daily diary was developed and the PMBQ modified to form a 12-item impact measure. (3) The measures were pilot-tested and then cognitively debriefed with US women receiving EPT. All qualitative data was subject to thematic analysis. The Vaginal Bleeding/Spotting Daily Diary, (VBS-DD) and Post-Menopausal Bleeding Impact Questionnaire (PMBIQ) were developed in this study. Concept elicitation identified vaginal bleeding and spotting as important symptoms for women taking EPT, impacting their emotional wellbeing, social life, ability to move freely, clothing and sexual activity. Based on pilot testing and cognitive debriefing, women demonstrated good understanding of the VBS-DD and the PMBQ was reduced to 10 items due to conceptual redundancy. Women taking EPT in the US, China, Mexico and Italy reported vaginal bleeding/spotting symptoms that have a detrimental impact on their quality of life. Two new measures were developed to assess the severity and impact of vaginal bleeding/spotting specific to EPT. This work highlights the need for EPT-related symptoms to be a part of treatment decision-making. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Efficiency of fenticonazole for the treatment of vaginal candidiasis].

PubMed

2012-01-01

Uncomplicated vulvovaginal candidiasis appears in 75% women of reproductive age. The most frequent causes are Candida albicans (85-95%) or C. glabrata, and infrequently C. krusei, C. tropicalis, C. parapsilosis, C. pseudotropicalis, etc. The aim of the study was to investigate efficiency and safety of fenticonazole for vaginal candidiasis treatment. Therapeutic effect of a single 600 mg fenticonasole vaginal capsule was observed in 417 women, aged 16-67, in five centers in Serbia. In all women, before the treatment, vaginal candidiasis was confirmed by testing of vaginal smear. Based on smear findings and associated symptoms observed on the 7th and 28th day after therapy administration, treatment results were evaluated. On the next day after drug application the patients recorded by using a questionnaire their own feelings on withdrawal symptoms and possible side effects in the period prior to the first control. Control after seven days showed a statistically significant decrease of symptoms. In 385 women, vaginal smear was found negative to yeast and yeast blastospores. Within the first seven days after treatment 84 women had to repeat therapy due to the persistence of symptoms or positive vaginal smear. After 28 days we recorded full recovery in 392 patients, clinical improvement in eight, no change in 16, and deterioration in one patient only. Side effects were very seldom, mostly in the form of a slight redness of the vulva and vagina, and mild itching during several days. Our observations confirmed good efficacy and safety of fenticonazole in the treatment of vaginal candidiasis.

Ablative dual-phase Erbium:YAG laser treatment of atrophy-related vaginal symptoms in post-menopausal breast cancer survivors omitting hormonal treatment.

PubMed

Mothes, A R; Runnebaum, M; Runnebaum, I B

2018-05-01

First evaluation of dual-phase vaginal Er:YAG laser to omit hormonal treatment for atrophy-related symptoms in post-menopausal breast cancer survivors following prolapse surgery. Patients with a history of breast cancer at the time of surgery for pelvic organ prolapse were offered non-hormonal vaginal Er:YAG laser treatment when complaining of atrophy-related genitourinary syndrome of menopause. A single 10-min course of dual-phase protocol of pulsed Er:YAG laser (2940 nm, fractional ablative and thermal mode, fluence according to tissue thickness). Follow-up included subjective satisfaction, vaginal pH, vaginal health index (VHI), and complications after 6 weeks. A total of 16 breast cancer survivors (age 71 years, SD 7) had been seeking treatment for pelvic floor symptoms related to vaginal atrophy at follow-up visits after prolapse surgery. All ablative vaginal Er:YAG laser outpatient procedures were successfully completed, all patients returned to daily activities without a need for analgetic medication. Evaluation was performed after 8.3 (SD 2.5) weeks. Pre-laser VHI scored 16 (SD 4.6) and post-laser VHI 20 (SD 3) with p = 0.01. Patients were satisfied in 94% (n = 15) regarding symptom relief. Breast cancer survivors with atrophy-related complaints after pelvic floor surgery may benefit from vaginal application of this innovative dual protocol of Er:YAG laser technology as a non-hormonal treatment approach.

The Comparison of vaginal cream of mixing yogurt, honey and clotrimazole on symptoms of vaginal candidiasis.

PubMed

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

2015-04-03

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 treatment 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. In this randomized, triple blind clinical trial of 70 non-pregnant women infected with Candidal vulvovaginitis 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 form and secretions culture results. Data by chi-square test, t test, McNemar tests were analyzed by SPSS version 21. Significance level of 0.05 was considered. The result of present study reveals the significant differences in symptom improvement of ' yogurt and honey, than 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 he therapeutic effects of vaginal cream, yogurt and honey is not only similar with clotrimazole vaginal cream but 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.

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

"Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis.

PubMed

Carr, Phyllis L; Rothberg, Michael B; Friedman, Robert H; Felsenstein, Donna; Pliskin, Joseph S

2005-09-01

Although vaginitis is a common outpatient problem, only 60% of patients can be diagnosed at the initial office visit of a primary care provider using the office procedures of pH testing, whiff tests, normal saline, and potassium hydroxide preps. To determine the most cost-effective diagnostic and treatment approach for the medical management of vaginitis. Decision and cost-effectiveness analyses. Healthy women with symptoms of vaginitis undiagnosed after an initial pelvic exam, wet mount preparations, pH, and the four criteria to diagnose bacterial vaginosis. General office practice. We evaluated 28 diagnostic strategies comprised of combinations of pH testing, vaginal cultures for yeast and Trichomonas vaginalis, Gram's stain for bacterial vaginosis, and DNA probes for Neisseria gonorrhoeae and Chlamydia. Data sources for the study were confined to English language literature. The outcome measures were symptom-days and costs. The least expensive strategy was to perform yeast culture, gonorrhoeae and Chlamydia probes at the initial visit, and Gram's stain and Trichomonas culture only when the vaginal pH exceeded 4.9 (330 dollars, 7.30 symptom days). Other strategies cost 8 dollars to 76 dollars more and increased duration of symptoms by up to 1.3 days. In probabilistic sensitivity analysis, this strategy was always the most effective strategy and was also least expensive 58% of the time. For patients with vaginitis symptoms undiagnosed by pelvic examination, wet mount preparations and related office tests, a comprehensive, pH-guided testing strategy at the initial office visit is less expensive and more effective than ordering tests sequentially.

Microdose transdermal estrogen therapy for relief of vulvovaginal symptoms in postmenopausal women.

PubMed

Bachmann, Gloria A; Schaefers, Matthias; Uddin, Alkaz; Utian, Wulf H

2009-01-01

The aim of this study was to investigate the effectiveness of microdose transdermal 17beta-estradiol (E2) therapy in postmenopausal women with moderate to severe vulvovaginal symptoms. This report is based on a subset of 121 women who reported most bothersome moderate or severe vulvovaginal symptoms at baseline, from a previous randomized, double-blind, placebo-controlled, multicenter study of 425 healthy, symptomatic, postmenopausal women. Recruits had experienced at least 7 moderate or severe hot flushes daily for at least 1 week or at least 50 moderate or severe hot flushes per week for at least 1 week. Effects on coprimary efficacy variables have been reported previously. Participants received low-dose transdermal E2 plus levonorgestrel (n = 43; nominal delivery 0.023 mg/d E2/0.0075 mg/d levonorgestrel), microdose E2 (n = 42; nominal delivery 0.014 mg/d), or placebo (n = 36) for 12 weeks. Secondary efficacy variables reported herein include mean change from baseline in vaginal pH and vaginal maturation index, the proportion of women with symptoms of vulvar and vaginal atrophy at baseline and week 12, and the proportion of women with moderate-to-severe symptoms of vulvar and vaginal atrophy. Microdose transdermal E2 treatment was associated with a consistent benefit versus placebo in women with vulvovaginal atrophy. There was a statistically significant difference between both E2 versus placebo for changes in vaginal pH and vaginal maturation index. Microdose transdermal E2 offers a useful addition to the therapeutic armamentarium for postmenopausal women in whom vulvovaginal symptoms are particularly troublesome.

Visual improvements in vaginal mucosa correlate with symptoms of VVA: data from a double-blind, placebo-controlled trial.

PubMed

Simon, James A; Archer, David F; Kagan, Risa; Bernick, Brian; Graham, Shelli; Constantine, Ginger D; Mirkin, Sebastian

2017-09-01

To evaluate the response of the vaginal mucosa with TX-004HR and its correlation with vulvar and vaginal atrophy (VVA) symptoms, and whether visual examination is a useful measure for assessing VVA. REJOICE was a 12-week, phase 3, multicenter, randomized, double-blind, placebo-controlled study of a vaginal, muco-adhesive, 17β-estradiol softgel capsule (TX-004HR 4, 10, and 25 μg) in postmenopausal women with VVA and moderate-to-severe dyspareunia. Treatments were self-administered vaginally once per day for 2 weeks, then twice per week for 10 weeks. The vagina was visually examined at baseline and at weeks 2, 6, 8, and 12; changes were evaluated using a 4-item scale for vaginal color, vaginal epithelial integrity, vaginal epithelial surface thickness, and vaginal secretions. Significant improvements were observed with all three TX-004HR doses versus placebo in vaginal color (least square mean score changes of -0.96 to -1.06 for TX-004HR doses vs -0.60 for placebo at week 12), epithelial integrity (-0.97 to -1.07 vs -0.60), epithelial surface thickness (-0.94 to -1.03 vs -0.61), and secretions (-1.01 to -1.06 vs -0.64) (P < 0.001 for all comparisons at all time points). Both Pearson's correlations and logistic regression receiver-operating characteristic curve analyses significantly correlated the sum of the individual visual assessment scores with dyspareunia (P < 0.0001) and vaginal dryness (P < 0.0001) at 12 weeks. Greater improvements in the vaginal mucosa of postmenopausal women with VVA and moderate-to-severe dyspareunia were observed with TX-004HR versus placebo, and vaginal mucosa assessment scores correlated with vaginal symptoms of dyspareunia and dryness. Visual vaginal assessment by healthcare professionals is a useful measure for diagnosing VVA and assessing response to treatment.

Vaginal Changes Due to Varying Degrees of Rectocele Prolapse: A Computational Study.

PubMed

Chanda, Arnab; Meyer, Isuzu; Richter, Holly E; Lockhart, Mark E; Moraes, Fabia R D; Unnikrishnan, Vinu

2017-10-01

Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the U.S. annually. Rectocele, a posterior vaginal wall (PVW) prolapse of the rectum, is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multicompartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (AVP) (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In this work, a full-scale magnetic resonance imaging (MRI) based three-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, and rectum, was developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size and average abdominal pressures were estimated. Considering the direction pointing from anterior to posterior side of the pelvic system as the positive Y-direction, it was found that rectocele leads to negative Y-direction displacements, causing the vaginal cross section to shrink significantly at the lower half of the vaginal canal. Besides the negative Y displacements, the rectocele bulging was observed to push the PVW downward toward the vaginal hiatus, exhibiting the well-known "kneeling effect." Also, the stress field on the PVW was found to localize at the upper half of the vaginal canal and shift eventually to the lower half with increase in rectocele size. Additionally, clinical relevance and implications of the results were discussed.

Oxytocin stimulates cell proliferation in vaginal cell line Vk2E6E7.

PubMed

Kallak, Theodora K; Uvnäs-Moberg, Kerstin

2017-03-01

Objective During and after menopause, the symptoms of vaginal atrophy cause great discomfort and necessitate effective treatment options. Currently, vaginally applied oxytocin is being investigated as a treatment for the symptoms of vaginal atrophy in postmenopausal women. To clarify the mechanisms behind oxytocins effects on vaginal atrophy, the present study investigated the effects of oxytocin on cell proliferation in the cells of the Vk2E6E7 line, a non-tumour vaginal cell line. The study also compared the effects of oxytocin with those of estradiol (E2). Study design The effects of both oxytocin and E2 on the proliferation of Vk2E6E7 cells were investigated using Cell Proliferation ELISA BrdU Colorimetric Assay. The expression of both oxytocin and oxytocin receptor was studied in Vk2E6E7 cells using quantitative real-time polymerase chain reaction and immunofluorescent staining. Main outcome measures Cell proliferation and gene expression. Results Oxytocin increased cell proliferation both time dependently and dose dependently. This differed from the effect pattern observed in cells treated with E2. In addition, in oxytocin-treated cells, the oxytocin receptor was found to be co-localized with caveolin-1, indicating pro-proliferative signalling within the cell. Conclusions Oxytocin stimulates cell proliferation and the co-localization of oxytocin receptor with caveolin-1 in oxytocin-treated cells, supporting the role of oxytocin signalling in cell proliferation. In addition, these findings suggest that increased cell proliferation is one mechanism by which local vaginal oxytocin treatment increases vaginal thickness and relieves vaginal symptoms in postmenopausal women with vaginal atrophy.

Flank muscle volume changes after open and laparoscopic partial nephrectomy.

PubMed

Crouzet, Sebastien; Chopra, Sameer; Tsai, Sheaumei; Kamoi, Kazumi; Haber, Georges-Pascal; Remer, Erick M; Berger, Andre K; Gill, Inderbir S; Aron, Monish

2014-10-01

To determine the occurrence of flank symptoms, flank muscle atrophy, bulge, and hernia formation after open and laparoscopic partial nephrectomy (LPN). Our prospective Institutional Review Board-approved database was queried to identify 50 consecutive patients who were treated with open partial nephrectomy (OPN) and 50 consecutive patients who were treated with LPN between September 2006 and May 2008. Study patients had: Solitary clinical T1 renal tumor, preoperative and ≥6 month postoperative CT scan performed at our institution, and a confirmed renal-cell carcinoma on the final pathology report. Patients with previous abdominal surgery and neuromuscular disorders were excluded. Oncocare software was used to measure abdominal wall musculature on preoperative and postoperative CT scan. Bilateral flanks were compared for muscle volume, bulge, and hernia. Patients were administered a phone questionnaire to assess postoperative flank symptoms. No statistical significant difference was found in the demographics between the two groups. Median age (range) was 59.9 years (20.6-80.7) in the OPN group and 57.5 years (25-78) in the LPN group (P=0.89). Median (range) body mass index and American Society of Anesthesiologists scores were similar between the two groups. On CT scans, median percent variation (range) in abdominal wall muscle volume was significantly greater in the OPN group: -1.03% (-31.4-1.5) vs-0.39% (-5.2-1.8) (P=0.006). The median extent of flank bulge on CT scans (range) was also greater in the OPN group: 0.75 cm (-1.9-7.6) vs 0 cm (-2.7-2.8) (P=0.0004). The OPN group was also more symptomatic, including paresthesia 48% vs 8% (P=0.0053); numbness 44% vs 0% (P=0.002); and flank bulge 57% vs 12% (P=0.007). Minimally invasive partial nephrectomy has lesser deleterious impact on flank muscle volume compared with OPN with fewer symptoms of flank bulge, paresthesia, and numbness.

Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery.

PubMed

Goughnour, S L; Thurston, R C; Althouse, A D; Freese, K E; Edwards, R P; Hamad, G G; McCloskey, C; Ramanathan, R; Bovbjerg, D H; Linkov, F

2016-01-01

Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women. This study is a longitudinal analysis of data from 69 women (ages 35-72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar's test and Wilcoxon signed-rank test. The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p < 0.01). There was no significant change in the prevalence of hot flushes or vaginal dryness in the overall study sample. The degree of bother of symptoms associated with hot flushes among midlife women may decrease after bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

The Women's EMPOWER Survey: Women's Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate.

PubMed

Krychman, Michael; Graham, Shelli; Bernick, Brian; Mirkin, Sebastian; Kingsberg, Sheryl A

2017-03-01

Postmenopausal women's knowledge about vulvar and vaginal atrophy (VVA) and available treatment options has historically been inadequate. Recent direct-to-consumer marketing and educational efforts would have been expected to increase awareness and treatment options. To compare results of the Women's EMPOWER survey with other available VVA surveys to assess progress in women's understanding and approaches to treatment of VVA. The Women's EMPOWER survey, an internet-based survey of US women with VVA symptoms, assessed women's awareness of VVA and their behaviors and attitudes associated with symptom treatment. These survey results were compared with previously published results of the Revealing Vaginal Effects at Mid-Life (REVEAL), Women's Voices in Menopause (WVM), Vaginal Health: Insight, Views, & Attitudes (VIVA), Clarifying Vaginal Atrophy's Impact on Sex and Relationship (CLOSER), and Real Women's Views of Treatment Options for Menopausal Vaginal Changes (REVIVE) surveys. Results of the Women's EMPOWER survey were consistent with those of past VVA surveys and showed that postmenopausal women generally failed to recognize VVA and its chronic, progressive process and that they were reluctant to discuss vaginal or sexual symptoms with their health care professionals (HCPs). However, women indicated a strong desire for accurate medical information about VVA from their health care professionals and a willingness to learn if HCPs would initiate the conversation. Most women believed that vaginal symptoms are a normal part of aging and they just need to cope with the symptoms. In the United States, women were most concerned with safety-related issues, including increased risk of breast cancer, side effects, and systemic absorption. The Women's EMPOWER survey demonstrates and reinforces that even with multimedia marketing and educational strategies in the years after other major VVA surveys, minimal progress has been made toward increasing women's awareness of, knowledge about, or understanding of VVA. Based on these data, a focus on initiating discussions and education with postmenopausal women so that they better comprehend VVA as a chronic progressive medical condition (not just aging), the symptoms associated with VVA, and the benefit-risk profile regarding treatment options is warranted. Krychman M, Graham S, Bernick B, et al. The Women's EMPOWER Survey: Women's Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. J Sex Med 2017;14:425-433. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Cancer treatment -- early menopause

MedlinePlus

... symptoms as natural menopause. Vaginal dryness or tightness Hot flashes Mood changes Lower sex drive Problems sleeping In some cases, these symptoms ... prescribe another type of medicine to help with hot flashes, such as certain ... products can help make sex more comfortable if you have vaginal dryness. Look ...

Accuracy of the clinical diagnosis of vaginitis compared with a DNA probe laboratory standard.

PubMed

Lowe, Nancy K; Neal, Jeremy L; Ryan-Wenger, Nancy A

2009-01-01

To estimate the accuracy of the clinical diagnosis of the three most common causes of acute vulvovaginal symptoms (bacterial vaginosis, candidiasis vaginitis, and trichomoniasis vaginalis) using a traditional, standardized clinical diagnostic protocol compared with a DNA probe laboratory standard. This prospective clinical comparative study had a sample of 535 active-duty United States military women presenting with vulvovaginal symptoms. Clinical diagnoses were made by research staff using a standardized protocol of history, physical examination including pelvic examination, determination of vaginal pH, vaginal fluid amines test, and wet-prep microscopy. Vaginal fluid samples were obtained for DNA analysis. The research clinicians were blinded to the DNA results. The participants described a presenting symptom of abnormal discharge (50%), itching/irritation (33%), malodor (10%), burning (4%), or others such as vulvar pain and vaginal discomfort. According to laboratory standard, there were 225 cases (42%) of bacterial vaginosis, 76 cases (14%) of candidiasis vaginitis, 8 cases (1.5%) of trichomoniasis vaginalis, 87 cases of mixed infections (16%), and 139 negative cases (26%). For each single infection, the clinical diagnosis had a sensitivity and specificity of 80.8% and 70.0% for bacterial vaginosis, 83.8% and 84.8% for candidiasis vaginitis, and 84.6% and 99.6% for trichomoniasis vaginalis when compared with the DNA probe standard. Compared with a DNA probe standard, clinical diagnosis is 81-85% sensitive and 70-99% specific for bacterial vaginosis, Candida vaginitis, and trichomoniasis. Even under research conditions that provided clinicians with sufficient time and materials to conduct a thorough and standardized clinical evaluation, the diagnosis and, therefore, subsequent treatment of these common vaginal problems remains difficult. II.

Amine content of vaginal fluid from untreated and treated patients with nonspecific vaginitis.

PubMed Central

Chen, K C; Forsyth, P S; Buchanan, T M; Holmes, K K

1979-01-01

We examined the vaginal washings from patients with nonspecific vaginitis (NSV) to seek biochemical markers and possible explanations for the signs and symptoms of this syndrome. Seven amines were identified including methylamine, isobutylamine, putrescine, cadaverine, histamine, tyramine, and phenethylamine. These amines may contribute to the symptoms of NSV and may contribute to the elevated pH of the vaginal discharge. They may also be partly responsible for the "fishy" odor that is characteristic of vaginal discharges from these patients. Among the seven amines, putrescine and cadaverine were the most abundant and were present in all vaginal discharges from each of ten patients before treatment. These amines are produced in vitro during growth of mixed vaginal bacteria in chemically defined medium, presumably by decarboxylation of the corresponding amino acids. We hypothesize the anaerobic vaginal organisms, previously shown to be quantitatively increased in NSV, are responsible for the amine production, because metronidazole inhibited the production of amines by vaginal bacteria in vitro, and Haemophilus vaginalis did not produce amines. H. vaginalis did release high concentrations of pyruvic acid and of amino acids during growth in peptone-starch-dextrose medium, whereas, other vaginal flora consumed both pyruvic acid and amino acids in the same medium during growth. These findings suggest that a symbiotic relationship may exist between H. vaginalis and other vaginal flora in patients with NSV. Images PMID:447831

Vaginal douching practice: Frequency, associated factors and relationship with vulvovaginal symptoms.

PubMed

Yanikkerem, Emre; Yasayan, Aysegul

2016-04-01

To determine the frequency, associated factors and relationship with vulvovaginal symptoms and vaginal douching among Turkish women. The cross-sectional, analytical study was conducted at Merkez Efendi Hospital, Manisa, Turkey, from January to June 2014 using a questionnaire. Statistical analysis was carried out using SPSS 17. Of the total 343 women in the study, 91(26.5%) had reported vaginal douching in the preceding year. Statistically significant relationship was determined between the vaginal douching behaviour and couples who had low educationand low income levels, having unplanned pregnancy and had someone in their neighbourhood who douched (p< 0.05 each). The most common reason for using vaginal douching was reported to be cleanliness by 85(93.4%) women, prevention of genital infections 75(82.4%), cleaning after/before sexual intercourse 72(79%), during menstruation 49(54%), prevention of vaginal discharge 69(76%), decreasing of unpleasant odours 65(71.4%) and religious beliefs 46(50.5%). Self-reported history of vaginal infection was significantly more common for women who douched compared those who did not (p< 0.05). Healthcare providers should determine the reason and risky groups of women and educate the women to stop the vaginal douching behaviour and harmful effects of vaginal douching.

Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy: a case study.

PubMed

Mercier, Joanie; Morin, Mélanie; Lemieux, Marie-Claude; Reichetzer, Barbara; Khalifé, Samir; Dumoulin, Chantale

2016-07-01

Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged. Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA.

GROUP B STREPTOCOCCUS: PREVALENCE IN A NON-OBSTETRIC POPULATION

PubMed Central

LECLAIR, Catherine M.; HART, Ashley E.; GOETSCH, Martha F.; CARPENTIER, Heather; JENSEN, Jeffrey T.

2010-01-01

Objective: To establish and compare the prevalence of Group B streptococcus (GBS) colonization in the vaginas of non-obstetric women with and without vaginitis. Materials and Methods: Cross-sectional analysis Group B streptococcus vaginal culture status of non-pregnant, estrogen-replete women ≥18 years presenting for annual gynecological exams or vaginal infection. Subjects were classified into 3 groups: no vaginitis (NV) if symptoms were absent and exam was normal, common vaginitis (CV) if microscopic exam revealed yeast, bacterial vaginosis or trichomonads, or inflammatory vaginitis (IV) if exam revealed inflammation and immature squamous cells, but no pathogens. Results: Of the 215 women recruited: 147 (68.4%) showed no evidence of vaginitis, 41 (19.1%) had CV, and 27 (12.6%) showed evidence of IV. The overall prevalence rate of GBS was 22.8%. Vaginitis was associated with a significantly increased risk of GBS colonization [Adjusted OR: CV 2.7 (1.1-6.2); IV 2.9 (1.1-8.0)]. Logistic regression revealed pH >4.5, presence of abnormal discharge on exam and a women's complaint of current symptoms to be significant predicators of the presence of GBS. Conclusion: GBS colonization occurs more commonly in women with vaginitis. This suggests that disruption of the normal vaginal bacterial environment is an important predictor for GBS colonization. PMID:20592549

The aetiology of vaginal symptoms in rural Haiti.

PubMed

Bristow, Claire C; Desgrottes, Tania; Cutler, Lauren; Cutler, David; Devarajan, Karthika; Ocheretina, Oksana; Pape, Jean William; Klausner, Jeffrey D

2014-08-01

Vaginal symptoms are a common chief complaint amongst women visiting outpatient clinics in rural Haiti. A systematic sample of 206 consecutive women over age 18 with gynaecological symptoms underwent gynaecologic examination and laboratory testing for chlamydia, gonorrhoea, syphilis, HIV infection, trichomoniasis, candidiasis, and bacterial vaginosis. Among 206 women, 174 (84%) presented with vaginal discharge, 165 (80%) with vaginal itching, 123 (60%) with vaginal pain or dysuria, and 18 (9%) with non-traumatic vaginal sores or boils. Laboratory results were positive forChlamydia trachomatisin 5.4% (11/203), syphilis in 3.5% (7/202), HIV in 1.0% (2/200), andNeisseria gonorrhoeaein 1.0% (2/203). Among those that had microscopy, hyphae suggestive of candidiasis were visualized in 2.2% (1/45) and no cases of trichomoniasis were diagnosed 0% (0/45). Bacterial vaginosis was diagnosed in 28.3% (13/46). The prevalence of chlamydia was 4.9 (95% CI: 1.3-17.7) times greater among those 25 years of age and under (10.8%) than those older (2.3%). Chlamydia and bacterial vaginosis were the most common sexually transmitted infection and vaginal condition, respectively, in this study of rural Haitian adult women. The higher risk of chlamydia in younger women suggests education and screening programmes in young women should be considered. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Safety, efficacy, and tolerability of differential treatment to prevent and treat vaginal dryness and vulvovaginitis in diabetic women.

PubMed

Carati, D; Zizza, A; Guido, M; De Donno, A; Stefanizzi, R; Serra, R; Romano, I; Ouedraogo, C; Megha, M; Tinelli, A

2016-01-01

Problems affecting the vaginal tract in diabetic women are very often neglected. The efficacy and safety of three gynecological treatments in diabetic women have been assessed. A single-blind randomized progressive trial on 48 diabetic women affected by vaginal dryness, dyspareunia, and recurrent Candida infections was carried out. The ICIQ Vaginal Symptoms (ICIQ-VS) questionnaire was administered. The analysis of the parameters of ICIQ-VS questionnaire among the three groups showed significant difference only for "dragging pain" (p = 0.0 19) and "soreness" (p = 0.028). In all groups and for all parameters of the questionnaire, improvement of symptoms was observed. In particular, in Group 1 for all symptoms a highly significant difference was observed, to support the already known benefits of the products and of the proposed combination. Significant improvement was also observed in Group 2. The proposed treatment with DermoXEN® Ultracalming Special for diabetics and DermoXEN® Vitexyl vaginal gel exert effective moisturizing and soothing action. Indeed, the aforementioned products have been proven effective for the main gynecological problems of diabetic women.

Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey.

PubMed

Nappi, R E; Palacios, S; Panay, N; Particco, M; Krychman, M L

2016-04-01

The aim of the European REVIVE survey was to achieve a better understanding of vulvovaginal atrophy (VVA), a chronic and progressive condition after menopause. We investigated perceptions, experiences and needs in terms of sexual and vaginal health in a sample of European postmenopausal women. An online internet based survey was conducted in Italy, Germany, Spain and the UK with a total surveyed sample of 3768 postmenopausal women (age: 45-75 years). The most common VVA symptom was vaginal dryness (70%). VVA has a significant impact on the ability to be intimate (62%), to enjoy sexual intercourse (72%) and to feel sexual spontaneity (66%). Postmenopausal women with VVA are sexually active (51%), but their sexual drive is reduced. Health-care professionals (HCPs) have discussed VVA with postmenopausal women (62%), but they initiated the conversation only in 10% of the cases. The most common treatments for VVA are over-the-counter, non-hormonal, local vaginal products. Thirty-two per cent of postmenopausal women were naïve to any kind of treatment, whereas discussion with the HCP was relevant to be on current treatment (60% of postmenopausal women that discussed VVA with a HCP vs. 23% who did not). The top reasons for poor compliance with vaginal treatments were: not bothersome enough symptoms (18%); vaginal changes not therapeutically reversed (18%); relief from VVA symptoms (17%). Approximately 45% were satisfied with treatment. The most frequent disliked aspects of treatment were the route of administration or the messiness. The fear of hormones was common in postmenopausal women using vaginal prescription products. The European REVIVE survey confirmed that VVA symptoms are frequent in postmenopausal women and demonstrates a significant impact on quality of life and sexual life. However, the condition is still under-diagnosed and under-treated, with a high rate of dissatisfaction for actual available treatments in the four European countries surveyed. The discussion of symptoms with HCPs seems the most critical factor for diagnosis and treatment of VVA.

Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perceptions.

PubMed

Palacios, S; Cancelo, M J; Castelo Branco, C; Llaneza, P; Molero, F; Borrego, R Sanchez

2017-02-01

To gain a deeper comprehension of current vulvovaginal atrophy (VVA) knowledge among Spanish postmenopausal women. An online survey (REVIVE) was conducted in four European countries with an overall sample of 768 participants included in Spain. Perceptions, experiences and needs of Spanish postmenopausal women in terms of sexual and vaginal health were reported. Vaginal dryness was the most common VVA symptom in Spain (81%). The severity of symptoms reported by postmenopausal women tended to be similar or worse than at onset, especially in the most troublesome symptom, dyspareunia (80%). VVA symptoms significantly impact on Spanish participants' ability to achieve sexual enjoyment (75%), relationship with partner (67%) and sexual spontaneity (66%). Although 71% of participants with partners (83%) were sexually active, their sex drive was reduced by one-third as a consequence of VVA. Despite the fact that women expected doctors to start asking them about menopausal symptoms, this rarely occurred. Treatments were administered mainly vaginally without prescription (62% were using over-the-counter products at the time). Postmenopausal women who had discussed their symptoms with physicians were twice as likely to be treated (66% vs. 33%) than those who had not. Low compliance with treatment was justified by Spanish participants with not bothersome enough symptoms (22%), relief (21%), inability to reverse vaginal changes (15%) and treatment price (13%). Almost half of the participants with a current local estrogen prescription showed satisfaction. The acknowledged main limitation for all treatments was the inability to restore the natural conditions of the vagina. The price of over-the-counter products was also reported as an important concern in Spanish postmenopausal women. VVA remains underdiagnosed and undertreated in Spain, despite its high frequency and significant impact on quality of life. Since patient satisfaction with available treatments remains compromised, an effective discussion of symptoms and therapies with doctors would improve its management.

The stimulation of the vaginal immune system with short-term administration of a vaginal gel containing fraction of Propionibacterium acnes, hyaluronic acid and polycarbophil is efficacious in vaginal infections dependent on disorders in the vaginal ecosystem.

PubMed

Melis, Gian Benedetto; Piras, Bruno; Marotto, Maria Francesca; Neri, Manuela; Corda, Valentina; Vallerino, Valerio; Saba, Alessandra; Lello, Stefano; Pilloni, Monica; Zedda, Pierina; Paoletti, Anna Maria; Mais, Valerio

2018-04-12

The vaginal immune system (VIS) is the first defense against antigens recognized as foreign. Substances capable of locally activating the VIS could be a valid strategy to treat vulvo-vaginal infections (VVI), caused by changes in the vaginal ecosystem, such as bacterial vaginosis (BV), vulvo-vaginal candidiasis (CA), and mixed vaginitis (MV). Bacterial lysates, obtained by crushing bacterial cultures, exert immuno-modulatory activities. The parietal fraction from Propionibacterium acnes is a patent of Depofarma (MoglianoVeneto, Italy). The preparation that associates such fraction to hyaluronic acid and polycarbophil is a registered trademark, commercially available in Italy as vaginal gel, Immunovag ® . The study aimed to evaluate whether a 5-day-treatment with Immunovag ® improves the symptoms and signs of VVI, in 60 women with Gardnerella vaginalis (GV), 154 with CA, 95 with MV, diagnosed with vulvar vaginal swab (VVS), and in 283 with BV, diagnosed with the Amsel criteria. At the end of the treatment (visit 2), the symptoms and signs of VVI disappeared in a significant number of subjects (χ 2 p < .02 vs pre-treatment) in all VVI groups, and their intensity was significantly (p < .0002) reduced in the subjects in which they were still present. Immunovag ® represents a valid treatment of VVI induced by changes in the vaginal ecosystem.

Nd:YAG laser therapy for rectal and vaginal venous malformations.

PubMed

Gurien, Lori A; Jackson, Richard J; Kiser, Michelle M; Richter, Gresham T

2017-08-01

Limited therapeutic options exist for rectal and vaginal venous malformations (VM). We describe our center's experience using Nd:YAG laser for targeted ablation of abnormal veins to treat mucosally involved pelvic VM. Records of patients undergoing non-contact Nd:YAG laser therapy of pelvic VM at a tertiary children's hospital were reviewed. Symptoms, operative findings and details, complications, and outcomes were evaluated. Nine patients (age 0-24) underwent Nd:YAG laser therapy of rectal and/or vaginal VM. Rectal bleeding was present in all patients and vaginal bleeding in all females (n = 5). 5/7 patients had extensive pelvic involvement on MRI. Typical settings were 30 (rectum) and 20-25 W (vagina), with 0.5-1.0 s pulse duration. Patients underwent the same-day discharge. Treatment intervals ranged from 14 to 180 (average = 56) weeks, with 6.1-year mean follow-up. Five patients experienced symptom relief with a single treatment. Serial treatments managed recurrent bleeding successfully in all patients, with complete resolution of vaginal lesions in 40% of cases. No complications occurred. Nd:YAG laser treatment of rectal and vaginal VM results in substantial improvement and symptom control, with low complication risk. Given the high morbidity of surgical resection, Nd:YAG laser treatment of pelvic VM should be considered as first line therapy.

Vaginal Testosterone for Management of Aromatase Inhibitor-Related Sexual Dysfunction: An Integrative Review.

PubMed

Lemke, Emily A; Madsen, Lydia T; Dains, Joyce E

2017-05-01

Women taking aromatase inhibitors (AIs) as part of the management of hormone receptor-positive breast cancer experience more symptoms of sexual dysfunction, including vaginal atrophy, as opposed to postmenopausal women and women treated with tamoxifen (Nolvadex®). Vaginal testosterone could be an alternative to estrogen, which is contraindicated in this population.
. A systematic review was completed by searching PubMed and Scopus databases.
. 64 search results were reduced to a final sample of 3 articles after applying inclusion and exclusion criteria.
. Published results suggest that vaginally applied testosterone doses of 150 mcg and 300 mcg improve symptoms of sexual dysfunction in women taking AIs. Minimal side effects are observed, and estradiol levels are not affected by vaginally applied testosterone. Additional research is needed to evaluate vaginal testosterone in women taking AIs.
. Vaginal testosterone shows preliminary promise as an option to manage sexual side effects of AI therapy in postmenopausal cancer survivors; however, available data are too limited to draw practice-changing conclusions.
. Large-scale randomized, controlled trials need to be completed to evaluate the efficacy and safety of vaginal testosterone in women taking AIs.

Hysteroscopic Resection of the Vaginal Septum in Uterus Didelphys with Obstructed Hemivagina: A Case Report

PubMed Central

Kim, Tae Eun; Lee, Gyoung Hoon; Jee, Byung Chul; Ku, Seung-Yup; Suh, Chang Suk; Kim, Seok Hyun; Kim, Jung Gu; Moon, Shin Yong

2007-01-01

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare congenital anomaly. Excision of the obstructed vaginal septum is the treatment of choice for symptom relief and the preservation of reproductive capability. A 14-yr-old girl complained of persistent vaginal spotting following each menstruation. Pelvic magnetic resonance imaging revealed a uterus didelphys with left hematocolpos and ipsilateral renal agenesis. Instead of conventional transvaginal excision of the vaginal septum, we used hysteroscopic excision under transabdominal ultrasonographic guidance to preserve the integrity of the hymen. The postoperative course was uneventful, and clinical symptoms were completely resolved after this intervention. Resectoscopic excision of the vaginal septum was found to be easy, safe, effective, and appropriate for young women as it preserved hymen integrity. We believe that this is the first Korean report on the use of a hysteroscopy for vaginal septum resection in a patient with uterus didelphys with obstructed hemivagina. PMID:17728527

Medium-term clinical outcomes following surgical repair for vaginal prolapse with tension-free mesh and vaginal support device.

PubMed

Sayer, T; Lim, J; Gauld, J M; Hinoul, P; Jones, P; Franco, N; Van Drie, D; Slack, M

2012-04-01

This study was designed to evaluate clinical outcomes ≥2 years following surgery with polypropylene mesh and vaginal support device (VSD) in women with vaginal prolapse, in a prospective, multi-center setting. Patients re-consented for this extended follow-up (n = 110), with anatomic evaluation using Pelvic Organ Prolapse Quantification (POP-Q) and validated questionnaires to assess pelvic symptoms and sexual function. Complications were recorded (safety set; n = 121). Median length of follow-up was 29 months (range 24-34 months). The primary anatomic success, defined as POP-Q 0-I, was 69.1%; however, in 84.5% of the cases, the leading vaginal edge was above the hymen. Pelvic symptoms and sexual function improved significantly from baseline (p < 0.01). Mesh exposure rate was 9.1%. Five percent reported stress urinary incontinence and 3.3% required further prolapse surgery. These results indicate this non-anchored mesh repair is a safe and effective treatment for women with symptomatic vaginal prolapse in the medium term.

Comparing Serum Follicle-Stimulating Hormone (FSH) Level with Vaginal PH in Women with Menopausal Symptoms.

PubMed

Vahidroodsari, Fatemeh; Ayati, Seddigheh; Yousefi, Zohreh; Saeed, Shohreh

2010-01-01

Despite the important implication for women's health and reproduction, very few studies have focused on vaginal PH for menopausal diagnosis. Recent studies have suggested vaginal PH as a simple, noninvasive and inexpensive method for this purpose. The aim of this study is to compare serum FSH level with vaginal PH in menopause. This is a cross-sectional, descriptive study, conducted on 103 women (aged 31-95 yrs) with menopausal symptoms who were referred to the Menopausal Clinic at Ghaem Hospital during 2006. Vaginal pH was measured using pH meter strips and serum FSH levels were measured using immunoassay methods. The data was analyzed using SPSS software (version 11.5) and results were evaluated statistically by the Chi-square and Kappa tests. p≤0.05 was considered statistically significant. According to this study, in the absence of vaginal infection, the average vaginal pH in these 103 menopausal women was 5.33±0.53. If the menopausal hallmark was considered as vaginal pH>4.5, and serum FSH as ≥20 mIU/ml, then the sensitivity of vaginal pH for menopausal diagnosis was 97%. The mean of FSH levels in this population was 80.79 mIU/ml. Vaginal pH is a simple, accurate, and cost effective tool that can be suggested as a suitable alternative to serum FSH measurement for the diagnosis of menopause.

Attitudes and perceptions towards vulvar and vaginal atrophy in Italian post-menopausal women: Evidence from the European REVIVE survey.

PubMed

Nappi, Rossella E; Particco, Martire; Biglia, Nicoletta; Cagnacci, Angelo; Di Carlo, Costantino; Luisi, Stefano; Paoletti, Anna Maria

2016-09-01

To achieve a deeper understanding of the attitudes and perceptions of Italian post-menopausal women (PMW) regarding vulvo-vaginal atrophy (VVA). As part of the EU REVIVE study, an online survey was conducted in four European countries; the Italian arm comprised 1000 participants from representative regions of Italy. The perceptions, experiences and needs of Italian PMW in relation to sexual and vaginal health. The most frequent VVA symptom was vaginal dryness (78%). Usually, the severity of symptoms was similar to or worse than when they first appeared. This was particularly true for dyspareunia, the most bothersome symptom (76%). VVA symptoms had a significant impact on Italian participants' ability to achieve pleasurable relations (74%) and spontaneity (70%). Although 75% of participants were still sexually active, their sex drive had been reduced by a third because of VVA. Women expected that doctors would start a discussion of menopausal symptoms and sexual health, but this was rarely the case (11%). Most women had been treated with a vaginal over-the-counter (OTC) product. Women who had discussed their condition with a physician were more likely (68%) to be under treatment for VVA than those who had not (36%). Low compliance was associated with symptom improvement (23%), not having annoying symptoms (22%), and the impossibility if restoring the vagina to normal (14%). Common reasons for treatment dissatisfaction were related to route of administration or discomfort. Lack of efficacy and fear of a hormone effect were perceived as the main limitations for OTC and local estrogen products, respectively. Despite the commonness of VVA and its significant impact on quality of life, the condition remains underdiagnosed in Italy. Discussion of symptoms with doctors influences the diagnosis, and patients' satisfaction with available treatments is not high. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Reproductive tract infections in rural women from the highlands, jungle, and coastal regions of Peru.

PubMed Central

García, Patricia J.; Chavez, Susana; Feringa, Barbara; Chiappe, Marina; Li, Weili; Jansen, Kathrin U.; Cárcamo, César; Holmes, King K.

2004-01-01

OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy. PMID:15508193

Vaginal symptoms and bacterial vaginosis (BV): how useful is self-report? Development of a screening tool for predicting BV status.

PubMed

Nelson, D B; Bellamy, S; Odibo, A; Nachamkin, I; Ness, R B; Allen-Taylor, L

2007-11-01

Vaginal complaints compel an evaluation of bacterial vaginosis (BV), however, many cases of BV are asymptomatic. We evaluated the sensitivity and specificity of vaginal symptoms in the diagnosis of BV and examined the utility of creating a BV screening tool using clinical, behavioural and demographic characteristics. A total of 1916 pregnant women were included in this analysis. In total, 757 women screened positive for BV and over one third of BV-positive women presented without any lower genital tract symptoms (39.4%). African American race, abnormal vaginal odour, and smoking were independently related to BV positivity. A BV screening tool including these three factors was fairly predictive of BV status with the area under the ROC curve equal to 0.669. This three-item prediction rule may be useful in identifying high- risk pregnant women in need of BV screening and, given the high specificity, accurately identify the group of BV-negative pregnant women.

Pelvic Organ Support in Animals with Partial Loss of Fibulin-5 in the Vaginal Wall

PubMed Central

Shi, Haolin; Balgobin, Sunil; Montoya, T. Ignacio; Yanagisawa, Hiromi; Word, R. Ann

2016-01-01

Compromise of elastic fiber integrity in connective tissues of the pelvic floor is most likely acquired through aging, childbirth-associated injury, and genetic susceptibility. Mouse models of pelvic organ prolapse demonstrate systemic deficiencies in proteins that affect elastogenesis. Prolapse, however, does not occur until several months after birth and is thereby acquired with age or after parturition. To determine the impact of compromised levels of fibulin-5 (Fbln5) during adulthood on pelvic organ support after parturition and elastase-induced injury, tissue-specific conditional knockout (cKO) mice were generated in which doxycycline (dox) treatment results in deletion of Fbln5 in cells that utilize the smooth muscle α actin promoter-driven reverse tetracycline transactivator and tetracycline responsive element-Cre recombinase (i.e., Fbln5f/f/SMA++-rtTA/Cre+, cKO). Fbln5 was decreased significantly in the vagina of cKO mice compared with dox-treated wild type or controls (Fbln5f/f/SMA++-rtTA/Cre-/-). In controls, perineal body length (PBL) and bulge increased significantly after delivery but declined to baseline values within 6–8 weeks. Although overt prolapse did not occur in cKO animals, these transient increases in PBL postpartum were amplified and, unlike controls, parturition-induced increases in PBL (and bulge) did not recover to baseline but remained significantly increased for 12 wks. This lack of recovery from parturition was associated with increased MMP-9 and nondetectable levels of Fbln5 in the postpartum vagina. This predisposition to prolapse was accentuated by injection of elastase into the vaginal wall in which overt prolapse occurred in cKO animals, but rarely in controls. Taken together, our model system in which Fbln5 is conditionally knock-downed in stromal cells of the pelvic floor results in animals that undergo normal elastogenesis during development but lose Fbln5 as adults. The results indicate that vaginal fibulin-5 during development is crucial for baseline pelvic organ support and is also important for protection and recovery from parturition- and elastase-induced prolapse. PMID:27124299

Pelvic Organ Support in Animals with Partial Loss of Fibulin-5 in the Vaginal Wall.

PubMed

Chin, Kathleen; Wieslander, Cecilia; Shi, Haolin; Balgobin, Sunil; Montoya, T Ignacio; Yanagisawa, Hiromi; Word, R Ann

2016-01-01

Compromise of elastic fiber integrity in connective tissues of the pelvic floor is most likely acquired through aging, childbirth-associated injury, and genetic susceptibility. Mouse models of pelvic organ prolapse demonstrate systemic deficiencies in proteins that affect elastogenesis. Prolapse, however, does not occur until several months after birth and is thereby acquired with age or after parturition. To determine the impact of compromised levels of fibulin-5 (Fbln5) during adulthood on pelvic organ support after parturition and elastase-induced injury, tissue-specific conditional knockout (cKO) mice were generated in which doxycycline (dox) treatment results in deletion of Fbln5 in cells that utilize the smooth muscle α actin promoter-driven reverse tetracycline transactivator and tetracycline responsive element-Cre recombinase (i.e., Fbln5f/f/SMA++-rtTA/Cre+, cKO). Fbln5 was decreased significantly in the vagina of cKO mice compared with dox-treated wild type or controls (Fbln5f/f/SMA++-rtTA/Cre-/-). In controls, perineal body length (PBL) and bulge increased significantly after delivery but declined to baseline values within 6-8 weeks. Although overt prolapse did not occur in cKO animals, these transient increases in PBL postpartum were amplified and, unlike controls, parturition-induced increases in PBL (and bulge) did not recover to baseline but remained significantly increased for 12 wks. This lack of recovery from parturition was associated with increased MMP-9 and nondetectable levels of Fbln5 in the postpartum vagina. This predisposition to prolapse was accentuated by injection of elastase into the vaginal wall in which overt prolapse occurred in cKO animals, but rarely in controls. Taken together, our model system in which Fbln5 is conditionally knock-downed in stromal cells of the pelvic floor results in animals that undergo normal elastogenesis during development but lose Fbln5 as adults. The results indicate that vaginal fibulin-5 during development is crucial for baseline pelvic organ support and is also important for protection and recovery from parturition- and elastase-induced prolapse.

[Application of sumamed in treatment of bacterial vaginal infections during pregnancy].

PubMed

Nikolov, A; Shopova, E; Nashar, S; Dimitrov, A

2008-01-01

To study the efficacy of Sumamed in cases of endogenous bacterial vaginal infections during third trimester of pregnancy. 34 women in last trimester of pregnancy with Streptococcus group B, Streptococcus group A, alpha hemolytic Streptococci, S. aureus infections and intermediate state of vaginal ecosystem (Nugent score 4-6) were treated with Sumamed (Azithromycin, 500 mg. p.o. for 3 days). Patients were separated in two groups. First group included 19 women with symptomatic and microbiologically proven recurrent vaginal infection during last 6 months. Second group included 15 symptom free pregnant women, in whom, pathogenic bacteria were found on vaginal swab and culture. Culture revealed 2 cases of Streptococcus group A infection in the second study group. Streptococcus group B was isolated in 19 patients--11 group 1 and 8--group 2. S. aureus was found in 6 patients from group 1 and 3 patients from group 2. Alpha hemolytic streptococci were cultured in 4 cases--2 from group 1 and 2 from group 2. Isolated microorganisms showed in vitro sensibility toward Sumamed. After treatment completion, control swab and culture was performed in 26 cases (14 group 1 and 12 group 2 patients). In group 1 in 12 (85,7%) patients no pathological microorganisms were cultured, Nugent scores were between 0-3 and no subjective symptoms were reported. 2 (14,3%) patients had Candida infection. In the second group 10 patients (83,5%) had normal vaginal microbiology, 2(16,5%) remained with intermediate vaginal microflora state. No newborn infections and cases of endometritis were found in both study groups. Sumamed is an efficacious treatment in cases of streptococcal and staphylococcal vaginal infections during pregnancy. Application of Sumamed results in alleviation of clinical symptoms and in sanitation of birth canal.

[Progress in research of relationship between vaginal Lactobacillus and preterm delivery].

PubMed

He, Y N; Xiong, H Y; Zheng, Y J

2017-03-10

The vaginal flora in most healthy women is dominated by Lactobacillus species. The absence of Lactobacillus species in vaginal flora might lead to a series of symptoms, especially in pregnant women causing adverse pregnancy outcomes, such as preterm delivery. This review focuses on the progress in the research of the relationship between vaginal Lactobacillus and preterm delivery, providing reference for the reduction of the incidence of preterm delivery.

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.

[Vaginal infections in a Family Health Clinic in the Metropolitan Region, Chile].

PubMed

Villaseca, Rodrigo; Ovalle, Alfredo; Amaya, Fernando; Labra, Bayron; Escalona, Natalia; Lizana, Paola; Montoya, M José; Lillo, Eduardo; Martínez, M Angélica

2015-02-01

Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.

The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women.

PubMed

Athanasiou, S; Pitsouni, E; Antonopoulou, S; Zacharakis, D; Salvatore, S; Falagas, M E; Grigoriadis, T

2016-10-01

To assess the effect of microablative fractional CO2 laser (MFCO2-Laser) therapy on the vaginal microenvironment of postmenopausal women. Three laser therapies at monthly intervals were applied in postmenopausal women with moderate to severe symptoms of genitourinary syndrome of menopause, pH of vaginal fluid >4.5 and superficial epithelial cells on vaginal smear <5%. Vaginal fluid pH values, fresh wet mount microscopy, Gram stain and aerobic and anaerobic cultures were evaluated at baseline and 1 month after each subsequent therapy. Nugent score and Hay-Ison criteria were used to evaluate vaginal flora. Fifty-three women (mean age 57.2 ± 5.4 years) participated and completed this study. MFCO2-Laser therapy increased Lactobacillus (p < 0.001) and normal flora (p < 0.001) after the completion of the therapeutic protocol, which decreased vaginal pH from a mean of 5.5 ± 0.8 (initial value) to 4.7 ± 0.5 (p < 0.001). The prevalence of Lactobacillus changed from 30% initially to 79% after the last treatment. Clinical signs and symptoms of bacterial vaginosis, aerobic vaginitis or candidiasis did not appear in any participant. MFCO2-Laser therapy is a promising treatment for improving the vaginal health of postmenopausal women by helping repopulate the vagina with normally existing Lactobacillus species and reconstituting the normal flora to premenopausal status.

Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey

PubMed Central

Nappi, R. E.; Palacios, S.; Panay, N.; Particco, M.; Krychman, M. L.

2016-01-01

Abstract Objectives The aim of the European REVIVE survey was to achieve a better understanding of vulvovaginal atrophy (VVA), a chronic and progressive condition after menopause. We investigated perceptions, experiences and needs in terms of sexual and vaginal health in a sample of European postmenopausal women. Methods An online internet based survey was conducted in Italy, Germany, Spain and the UK with a total surveyed sample of 3768 postmenopausal women (age: 45–75 years). Results The most common VVA symptom was vaginal dryness (70%). VVA has a significant impact on the ability to be intimate (62%), to enjoy sexual intercourse (72%) and to feel sexual spontaneity (66%). Postmenopausal women with VVA are sexually active (51%), but their sexual drive is reduced. Health-care professionals (HCPs) have discussed VVA with postmenopausal women (62%), but they initiated the conversation only in 10% of the cases. The most common treatments for VVA are over-the-counter, non-hormonal, local vaginal products. Thirty-two per cent of postmenopausal women were naïve to any kind of treatment, whereas discussion with the HCP was relevant to be on current treatment (60% of postmenopausal women that discussed VVA with a HCP vs. 23% who did not). The top reasons for poor compliance with vaginal treatments were: not bothersome enough symptoms (18%); vaginal changes not therapeutically reversed (18%); relief from VVA symptoms (17%). Approximately 45% were satisfied with treatment. The most frequent disliked aspects of treatment were the route of administration or the messiness. The fear of hormones was common in postmenopausal women using vaginal prescription products. Conclusions The European REVIVE survey confirmed that VVA symptoms are frequent in postmenopausal women and demonstrates a significant impact on quality of life and sexual life. However, the condition is still under-diagnosed and under-treated, with a high rate of dissatisfaction for actual available treatments in the four European countries surveyed. The discussion of symptoms with HCPs seems the most critical factor for diagnosis and treatment of VVA. PMID:26581580

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 infections White, cottage cheese-like discharge Swelling and ...

Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study.

PubMed

Larmo, Petra S; Yang, Baoru; Hyssälä, Juha; Kallio, Heikki P; Erkkola, Risto

2014-11-01

Vaginal atrophy, the thinning and drying of vaginal mucosa, is associated with menopause. The standard estrogen treatment is not suitable for all women. To investigate the effects of oral sea buckthorn (SB) oil supplementation on vaginal atrophy. A total of 116 postmenopausal women experiencing symptoms of vaginal dryness, itching or burning were randomized to this placebo-controlled, double-blind study. Ninety-eight participants completed the intervention of three months, during which they consumed 3g of SB or placebo oil daily. At the beginning and end, factors of vaginal health were scored by a gynecologist, vaginal pH and moisture were measured and vaginal health index was calculated. Symptoms of atrophy and menopause were evaluated at study visits and by daily logbooks. Serum samples were collected for the analysis of circulating lipids, liver enzymes and C-reactive protein. Compared to placebo, there was a significantly better rate of improvement in the integrity of vaginal epithelium in the SB group when both compliant and noncompliant participants were included (odds ratio (OR)=3.1, 95% CI 1.11-8.95). A beneficial trend was observed when only the compliant participants were included (OR=2.9; 95% CI 0.99-8.35). There was a tendency (P=0.08) toward better improvement of vaginal health index from baseline to the end in the SB group [(0.8 (SD 2.8)] compared to placebo [-0.1 (SD 2.0)]. SB oil showed beneficial effects on vaginal health, indicating it is a potential alternative for mucosal integrity for those women not able to use estrogen treatment for vaginal atrophy. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

[Intravaginal treatment of colpitis maculosa with an oestriol-containing vaginal cream (author's transl)].

PubMed

Schröck, A; Kofler, K; Baumgarten, K; Endl, J; Schmidt, J; Tatschl, S

1981-12-11

43 patients with colpitis maculosa (average age 60.2 years) were selected for an open control therapeutic study with Ortho-Gynest vaginal cream (Ortho-Cilag). The cream contains 0.5 mg of oestriol per single applicator filling. The treatment lasted from 3 to 4 weeks, success being evaluated by clinical documentation and cytological evaluation of vaginal smears before and after treatment. 10 patients (23.3%) were treated successfully, 29 (67.4%) showed a distinct improvement both clinically and cytologically, whilst the remaining 4 (9.3%) showed only moderate improvement. Hence, 39 patients (90.7%) were classified as having been successfully or partly successfully treated. Severe symptoms disappeared completely or were greatly alleviated in 91.4% cases. Moderate symptoms vanished in 59.7%. 58.1% showed a complete normalisation of the former atrophic vaginal skin. Blood spotting and reddening of the vaginal wall vanished completely. A change from dry to moist vagina occurred in 77.3% patients. Discharge vanished completely in 80.6% cases. No untoward side effects were recorded.

Fractional CO2 Laser: From Skin Rejuvenation to Vulvo-Vaginal Reshaping.

PubMed

Filippini, Maurizio; Del Duca, Ester; Negosanti, Francesca; Bonciani, Diletta; Negosanti, Luca; Sannino, Mario; Cannarozzo, Giovanni; Nisticò, Steven Paul

2017-03-01

The CO 2 laser has become the gold standard treatment in dermatologic surgery for the treatment of a large number of skin and mucosal lesions. The introduction of the fractional micro-ablative technology represented an integration to the ablative resurfacing technique, reducing the healing time and the side effects. Vaginal rejuvenation performed with this technique is a minimally invasive procedure that stimulates internal tissues of the female lower genital tract to regenerate the mucosa, improving tissue trophism and restoring the correct functionality. In our experience, 386 menopausal women affected with vulvo-vaginal atrophy (VVA) were treated with three section of fractional micro-ablative CO 2 laser. After three treatments, patients reported a complete improvement of the symptoms (59.94% dryness, 56.26% burn, sensation, 48.75% dyspareunia, 56.37% itch, 73.15% soreness, and 48.79% vaginal introitus pain). Fractional micro-ablative CO 2 laser seems to reduce symptoms related to vaginal atrophy. The beneficial effects were reported just after the first session and confirmed 12 months after the last session.

How Do Health Care Providers Diagnose Vaginitis?

MedlinePlus

... Share Facebook Twitter Pinterest Email Print How do health care providers diagnose vaginitis? To find out the cause of a woman's symptoms, her health care provider will Examine the vagina, the vulva, and ...

Local oestrogen for vaginal atrophy in postmenopausal women.

PubMed

Suckling, J; Lethaby, A; Kennedy, R

2003-01-01

Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the estradiol releasing ring). The objective of this review is to compare the effectiveness, safety and acceptability of oestrogenic preparations for women who suffer from vaginal atrophy. We searched the Cochrane Menstrual Disorders and Subfertility Group register of trials (searched January 2003), The Cochrane Library (Issue 2, 2003), MEDLINE (1966-January 2003), EMBASE (1980-January 2003), Current Contents (1993-January 2003), Biological Abstracts (1969-2002), Social Sciences Index (1980-January 2003), PsycINFO (1972-February 2003), CINAHL (1982-January 2003) and reference list of articles. We also contacted manufacturers and researchers in the field. The inclusion criteria were randomised comparisons of oestrogenic preparations administered intravaginally in postmenopausal women for the treatment of symptoms resulting from vaginal atrophy or vaginitis. Twenty nine trials were identified, of these 13 were excluded. Trials were assessed for quality and two reviewers extracted data independently. Ratios for dichotomous and means for continuous outcomes were estimated. Outcomes analysed were included under the headings of efficacy, safety and acceptability. Sixteen trials with 2129 women were included in this review. The overall quality of the studies was good, although not all trials measured the same outcomes. All trials measured efficacy with various outcome measures. When comparing efficacy of oestrogenic preparations (in the form of creams, pessaries, tablets and the estradiol releasing vaginal ring) with each other in relieving the symptoms of vaginal atrophy, results indicated significant differences favouring the cream, ring, and tablets when compared to placebo and non-hormonal gel. Fourteen trials compared safety. Four looked at hyperplasia, four looked at endometrial overstimulation and six looked at adverse effects. One trial showed significant adverse effects of cream (conjugated equine oestrogen) when compared to tablets (estradiol) which included uterine bleeding, breast pain and perineal pain (1 RCT; OR 0.18, 95% CI 0.07 to 0.50). Two trials showed significant endometrial overstimulation as evaluated by progestagen challenge test in the cream (conjugated equine oestrogen) group when compared to the ring (OR 0.29, 95% CI 0.11 to 0.78). Although not statistically significant there was a 2% incidence of simple hyperplasia in the ring group when compared to cream (conjugated equine oestrogen) and 4% incidence of hyperplasia (one simple, one complex) in the cream group (conjugated equine oestrogen) when compared to the tablet (estradiol). Nine studies compared acceptability to the participants by comparing comfort of product, ease of use, overall product rating, delivery system and satisfaction. Results showed a significant preference for the estradiol releasing vaginal ring. Creams, pessaries, tablets and the estradiol vaginal ring appeared to be equally effective for the symptoms of vaginal atrophy. One trial found significant side effects noted following cream (conjugated equine oestrogen) administration when compared to tablets causing uterine bleeding, breast pain and perineal pain. Another trial found significant endometrial overstimulation following cream (conjugated equine oestrogen) when compared to the ring. As a treatment choice women appeared to favour the estradiol releasing vaginal ring for ease of use, comfort of product and overall satisfaction.

Local oestrogen for vaginal atrophy in postmenopausal women.

PubMed

Suckling, J; Lethaby, A; Kennedy, R

2006-10-18

Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the oestradiol-releasing ring). The objective of this review was to compare the effectiveness, safety and acceptability of oestrogenic preparations for women who suffer from vaginal atrophy. We searched the Cochrane Menstrual Disorders and Subfertility Group Register of trials (searched January 2006), The Cochrane Library (2006,Issue 2), MEDLINE (1966 to January 2006), EMBASE (1980 to January 2006), Current Contents (1993 to January 2006, Biological Abstracts (1969 to 2006), Social Sciences Index (1980 to January 2006), PsycINFO (1972 to February 2006), CINAHL (1982 to January 2006) and reference list of articles. We also contacted manufacturers and researchers in the field. The inclusion criteria were randomised comparisons of oestrogenic preparations administered intravaginally in postmenopausal women for the treatment of symptoms resulting from vaginal atrophy or vaginitis. Thirty-seven trials were identified: of these 18 were excluded. Included trials were assessed for quality and two reviewer authors extracted data independently. The ratios for dichotomous outcomes and means for continuous outcomes were calculated. The outcomes analysed were categorised under the headings of: efficacy, safety and acceptability. Nineteen trials with 4162 women were included in this review. The overall quality of the studies was good, although not all trials measured the same outcomes. All trials measured efficacy, with various outcome measures. When comparing the efficacy of different oestrogenic preparations (in the form of creams, pessaries, tablets and the oestradiol-releasing vaginal ring) in relieving the symptoms of vaginal atrophy, results indicated significant findings favouring the cream, ring, and tablets when compared to placebo and non-hormonal gel. Fourteen trials compared safety. Four looked at hyperplasia, four looked at endometrial overstimulation and seven looked at adverse effects. One trial showed significant adverse effects of the cream (conjugated equine oestrogen) when compared to tablets (oestradiol) which included uterine bleeding, breast pain and perineal pain (1 RCT; OR 0.18, 95% CI 0.07 to 0.50). Two trials showed significant endometrial overstimulation as evaluated by a progestagen challenge test with the cream (conjugated equine oestrogen) group when compared to the ring (OR 0.29, 95% CI 0.11 to 0.78). Although not statistically significant there was a 2% incidence of simple hyperplasia in the ring group when compared to the cream (conjugated equine oestrogen) and 4% incidence of hyperplasia (one simple, one complex) in the cream group (conjugated equine oestrogen) when compared to the tablet (oestradiol). Eleven studies compared acceptability to the participants by comparing: comfort of product use, ease of use, overall product rating, delivery system and satisfaction. Results showed a significant preference for the oestradiol-releasing vaginal ring. Creams, pessaries, tablets and the oestradiol vaginal ring appeared to be equally effective for the symptoms of vaginal atrophy. One trial found significant side effects following cream (conjugated equine oestrogen) administration when compared to tablets causing uterine bleeding, breast pain and perineal pain. Another trial found significant endometrial overstimulation following use of the cream (conjugated equine oestrogen) when compared to the ring. As a treatment choice women appeared to favour the oestradiol-releasing vaginal ring for ease of use, comfort of product and overall satisfaction.

Do female patients with nonpathological vaginal discharge need the same evaluation as for Dhat syndrome in males?

PubMed Central

Grover, Sandeep; Avasthi, Ajit; Gupta, Sunil; Hazari, Nandita; Malhotra, Nidhi

2016-01-01

Aim: The aim of this study was to evaluate the concept of female Dhat syndrome characterized by the complaint of nonpathological vaginal discharge in association with somatic, anxiety, and depressive symptoms. Materials and Methods: A total of 26 female subjects with nonpathological vaginal discharge along with depressive and somatic complaints were assessed on a self-rated questionnaire modified from Comprehensive Questionnaire for Assessment of Dhat Syndrome designed for males. They were also assessed for psychiatric comorbidity as per ICD-10. Results: All female subjects received an ICD-10 psychiatric diagnosis, with somatoform/dissociative disorder (57.7%) being the most common. The mean age of onset of vaginal discharge was 24.6 (standard deviation - 7.0) years, noted every day or for 2–3 times per week by more than two-third of the participants. Two-fifth (61.5%) of the women described it as a milky discharge. The most common reason reported for passage of vaginal discharge was that of urinary infection or problems of urinary tract infections (42.3%) followed by vaginal infection/disease (34.6%). More than half (53.8%) of the subjects considered vaginal discharge to be responsible for weakness in the body, weakness in stamina and thinness of physique, while slightly more than two-third (69.2%) of them reported bodily weakness and sleep disturbances. Overall the clinical picture in females was similar to male patients with Dhat syndrome on most of the account. Conclusions: Subgroup of patients with vaginal discharge attribute their somatic and mental symptoms to the passage of whitish vaginal discharge and are distressed due to the same. The clinical picture is similar to Dhat syndrome in males. There is a need to recognize female variant of Dhat syndrome as a culture-bound syndrome. Identification of the same may help in managing this subgroup of patients seeking help from the gynecologists for their nonpathological vaginal discharge or from mental health professionals for their symptoms of common mental disorders. PMID:26985107

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

PubMed Central

Noyes, Noelle; Cho, Kyu-Chul; Ravel, Jacques; Forney, Larry J.

2018-01-01

The vaginal microbiome plays an influential role in several disease states in reproductive age women, including bacterial vaginosis (BV). While demographic characteristics are associated with differences in vaginal microbiome community structure, little is known about the influence of sexual and hygiene habits. Furthermore, associations between the vaginal microbiome and risk symptoms of bacterial vaginosis have not been fully elucidated. Using Bayesian network (BN) analysis of 16S rRNA gene sequence results, demographic and extensive questionnaire data, we describe both novel and previously documented associations between habits of women and their vaginal microbiome. The BN analysis approach shows promise in uncovering complex associations between disparate data types. Our findings based on this approach support published associations between specific microbiome members (e.g., Eggerthella, Gardnerella, Dialister, Sneathia and Ruminococcaceae), the Nugent score (a BV diagnostic) and vaginal pH (a risk symptom of BV). Additionally, we found that several microbiome members were directly connected to other risk symptoms of BV (such as vaginal discharge, odor, itch, irritation, and yeast infection) including L. jensenii, Corynebacteria, and Proteobacteria. No direct connections were found between the Nugent Score and risk symptoms of BV other than pH, indicating that the Nugent Score may not be the most useful criteria for assessment of clinical BV. We also found that demographics (i.e., age, ethnicity, previous pregnancy) were associated with the presence/absence of specific vaginal microbes. The resulting BN revealed several as-yet undocumented associations between birth control usage, menstrual hygiene practices and specific microbiome members. Many of these complex relationships were not identified using common analytical methods, i.e., ordination and PERMANOVA. While these associations require confirmatory follow-up study, our findings strongly suggest that future studies of the vaginal microbiome and vaginal pathologies should include detailed surveys of participants’ sanitary, sexual and birth control habits, as these can act as confounders in the relationship between the microbiome and disease. Although the BN approach is powerful in revealing complex associations within multidimensional datasets, the need in some cases to discretize the data for use in BN analysis can result in loss of information. Future research is required to alleviate such limitations in constructing BN networks. Large sample sizes are also required in order to allow for the incorporation of a large number of variables (nodes) into the BN, particularly when studying associations between metadata and the microbiome. We believe that this approach is of great value, complementing other methods, to further our understanding of complex associations characteristic of microbiome research. PMID:29364944

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis.

PubMed

Noyes, Noelle; Cho, Kyu-Chul; Ravel, Jacques; Forney, Larry J; Abdo, Zaid

2018-01-01

The vaginal microbiome plays an influential role in several disease states in reproductive age women, including bacterial vaginosis (BV). While demographic characteristics are associated with differences in vaginal microbiome community structure, little is known about the influence of sexual and hygiene habits. Furthermore, associations between the vaginal microbiome and risk symptoms of bacterial vaginosis have not been fully elucidated. Using Bayesian network (BN) analysis of 16S rRNA gene sequence results, demographic and extensive questionnaire data, we describe both novel and previously documented associations between habits of women and their vaginal microbiome. The BN analysis approach shows promise in uncovering complex associations between disparate data types. Our findings based on this approach support published associations between specific microbiome members (e.g., Eggerthella, Gardnerella, Dialister, Sneathia and Ruminococcaceae), the Nugent score (a BV diagnostic) and vaginal pH (a risk symptom of BV). Additionally, we found that several microbiome members were directly connected to other risk symptoms of BV (such as vaginal discharge, odor, itch, irritation, and yeast infection) including L. jensenii, Corynebacteria, and Proteobacteria. No direct connections were found between the Nugent Score and risk symptoms of BV other than pH, indicating that the Nugent Score may not be the most useful criteria for assessment of clinical BV. We also found that demographics (i.e., age, ethnicity, previous pregnancy) were associated with the presence/absence of specific vaginal microbes. The resulting BN revealed several as-yet undocumented associations between birth control usage, menstrual hygiene practices and specific microbiome members. Many of these complex relationships were not identified using common analytical methods, i.e., ordination and PERMANOVA. While these associations require confirmatory follow-up study, our findings strongly suggest that future studies of the vaginal microbiome and vaginal pathologies should include detailed surveys of participants' sanitary, sexual and birth control habits, as these can act as confounders in the relationship between the microbiome and disease. Although the BN approach is powerful in revealing complex associations within multidimensional datasets, the need in some cases to discretize the data for use in BN analysis can result in loss of information. Future research is required to alleviate such limitations in constructing BN networks. Large sample sizes are also required in order to allow for the incorporation of a large number of variables (nodes) into the BN, particularly when studying associations between metadata and the microbiome. We believe that this approach is of great value, complementing other methods, to further our understanding of complex associations characteristic of microbiome research.

Huge maternal hydronephrosis: a rare complication in pregnancy.

PubMed

Peng, Hsiu-Huei; Wang, Chin-Jung; Yen, Chih-Feng; Chou, Chien-Chung; Lee, Chyi-Long

2003-06-10

A huge maternal hydronephrosis is uncommon in pregnancy and might be mistaken as a pelvic mass. A 21-year-old primigravida was noted at 25th week of gestation to have a visible bulging mass on her left flank. The mass was originally mistaken as a large ovarian cyst but later proved to be a huge hydronephrosis. Retrograde insertion of ureteroscope and a ureteric stent failed, so we performed repeated ultrasound-guided needle aspiration to decompress the huge hydronephrosis, which enabled the patient to proceed to a successful term vaginal delivery. Nephrectomy was performed after delivery and proved the diagnosis of congenital ureteropelvic junction obstruction.

Stages of Vaginal Cancer

MedlinePlus

... stage of the cancer being treated. External and internal radiation therapy are used to treat vaginal cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life . Chemotherapy Chemotherapy is a cancer treatment ...

Diagnostic Value of Vaginal Discharge, Wet Mount and Vaginal pH – An Update on the Basics of Gynecologic Infectiology

PubMed Central

Frobenius, W.; Bogdan, C.

2015-01-01

The majority of uncomplicated vulvovaginal complaints (e.g. bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis) can be detected with uncomplicated basic infectiological tests and can usually be treated effectively without requiring further diagnostic procedures. Tests include measurement of vaginal pH, preparation and assessment of wet mount slides prepared from vaginal or cervical discharge, and the correct clinical and microbiological classification of findings. In Germany, at least in recent years, this has not been sufficiently taught or practiced. As new regulations on specialist gynecologic training in Germany are currently being drawn up, this overview provides basic information on gynecologic infectiology and summarizes clinically relevant aspects of recent microbiological findings on the physiology and pathology of vaginal flora. The clinical signs and symptoms of aerobic vaginitis, the pathogenesis of which is still not completely understood, are also reviewed. Finally, the symptoms, indications and risk factors for pelvic inflammatory disease (PID) are presented. In contrast to the above-listed infections, PID requires immediate culture of the pathogen from samples (e.g. obtained by laparoscopy) with microbiological diagnostic procedures carried out by specialist laboratories. A schematic summary of all pathologies discussed here is presented. PMID:26028693

The most bothersome symptom of vaginal atrophy: Evidence from the observational AGATA study.

PubMed

Palma, Federica; Xholli, Anjeza; Cagnacci, Angelo

2018-02-01

Vaginal atrophy (VA) is a chronic medical condition. It is managed unsatisfactorily, despite its high prevalence and negative impact on female quality of life. In order to meet their needs, it would be useful to know what women perceive to be the most bothersome symptom (MBS) of VA. Cross-sectional, multicenter study of 913 postmenopausal women consulting 22 gynecological outpatient services. Prevalence of the MBS perceived by postmenopausal women of different age and vaginal condition. Vaginal dryness was the most prevalent MBS (54.4%), followed by dyspareunia (17.6%), itching (7.8%), dysuria (5.9%) and burning (2.0%). The prevalence of vaginal dryness as the MBS increased with years since menopause, while that of itching, dysuria and burning remained approximately constant over time. The prevalence of dyspareunia as the MBS was 26.2% in the first 6 years after menopause and declined thereafter, to 8.8%. Among all postmenopausal women vaginal dryness per se, independent of dyspareunia, is the most commonly reported MBS. In each woman, the identification of the MBS may help to define more appropriate VA management. Copyright © 2017. Published by Elsevier B.V.

Efficacy and safety of vitamin C vaginal tablets in the treatment of non-specific vaginitis. A randomised, double blind, placebo-controlled study.

PubMed

Petersen, E Eiko; Magnani, Paola

2004-11-10

This was a randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of Vitamin C vaginal tablets (250 mg) given once a day in patients suffering from non-specific vaginitis. The total length of the study was 20 days, including a treatment phase of 6 days. The primary end-point was the presence in the two groups of non-specific vaginitis 1 and 2 weeks after the end of treatment, as assessed by at least 3 out of the 4 characteristic symptoms: discharge, fishy odour, vaginal pH >/= 4.7, and presence of clue cells. Secondary end-points were the individual symptoms and signs, above reported, and pruritus, fever, superinfections, microscopic findings on vaginal smear, and colposcopy. One hundred female patients aged 18 years or older and suffering from non-specific vaginitis were included in the study after giving their informed consent. Fifty were randomised to the active treatment and 50 to placebo. Seven patients, three in the Vitamin C group and four in the placebo group, were lost to follow-up and did not complete the treatment period. Two patients in the active group showed protocol deviations (age under 18 years and HIV-positive, respectively). The two groups resulted comparable for demographics, history and baseline clinical picture. A cluster analysis of the four main symptoms showed a statistically significant difference between the active group and the placebo group; significantly more patients were still affected by non-specific vaginitis after placebo (35.7%) compared to patients treated with Vitamin C tablets (14.0%). The meaningful secondary variable, referring to the microscopic examination of vaginal smear, supported the trend for efficacy in the Vitamin C treated group. The clue cells disappeared in 79% of patients treated with the drug and in 53% of patients on placebo. Similarly, bacteria disappeared in 77 and 54%, respectively, while lactobacilli reappeared in 79.1 and 53.3%, respectively. Vaginal pH values decreased significantly in both groups, but the frequency rate of subjects with pH >/= 4.7, as measured 1 week after the drug discontinuation, was significantly lesser in the Vitamin C group (16.3%) than in the placebo group (38.6%). Adverse events occurred in four patients, two on placebo (pruritus, cystitis) and two on Vitamin C (two candidiasis).

Aerobic vaginitis and mixed infections: comparison of clinical and laboratory findings.

PubMed

Fan, Aiping; Yue, Yingli; Geng, Nv; Zhang, Huiying; Wang, Yingmei; Xue, Fengxia

2013-02-01

To investigate the clinical features of aerobic vaginitis (AV) and mixed infections with AV to achieve efficient diagnosis. From April 2008 to August 2009, 657 consecutive outpatients with vaginal symptoms in gynecology clinic in the General Hospital of Tianjin Medical University were investigated. Samples were taken for examination of vaginal discharge and fresh wet mount microscopy. AV, bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomonal vaginitis (TV) were diagnosed according to standardized definitions. Sixty patients with single AV were randomly selected over the same period. Each patient accepted moxifloxacin therapy. Two kinds of treatment course (400 mg qd, 6 days or 400 mg qd, 12 days) were given. Clinical features and laboratory test results in the first visit and follow-ups were recorded and statistically analyzed. Among the 657 cases, AV was found in 23.74 % of the cases (156/657). AV mixed infections were diagnosed in 53.85 % (84/156): the mixed infections included VVC (32/84, 38.10 %), BV (31/84, 36.90 %), and TV (21/84, 25.00 %). Common symptoms of AV were a change in the characteristics of the discharge (44/72, 61.11 %) and increased discharge (30/72, 41.67 %). Vaginal pH was usually higher than 4.5 (63/72, 87.50 %). Enterococcus faecalis, Streptococcus viridans, Escherichia coli, and Staphylococcus epidermidis were frequently isolated. There is no statistically significant difference between two moxifloxacin treatment groups (p > 0.05). Cure rate was 89.7 % in 6-day group, and 71.4 % in 12-day group. AV is a common vaginal infection, and it is often mixed with other infections, especially VVC, BV and TV. The symptoms and signs of AV mixed infections are atypical. If a patient has vaginal complaints, it is necessary to determine whether AV or mixed infections are present. Oral moxifloxacin is effective in treating AV, and an appropriate course should be selected taking the severity of AV into consideration.

Delayed diagnosis of Herlyn-Werner-Wunderlich syndrome due to microperforation and pyocolpos in obstructed vaginal canal.

PubMed

Wozniakowska, Ewa; Torres, Anna; Milart, Pawel; Wozniak, Slawomir; Czuczwar, Piotr; Szkodziak, Piotr; Paszkowski, Tomasz

2014-08-01

To present a rare anomaly consisting of uterus didelphys, longitudinal vaginal septum, obstructed hemivagina with pyocolpos, fistula to the open vaginal canal, and ipsilateral renal agenesis, referred as Herlyn-Werner-Wunderlich syndrome (HWWS). A 14-year-old girl with recurring purulent vaginal discharge lasting for a few months. Preoperative examination revealed one vaginal canal with one cervical opening on the right side. There was a fistula leading from the obstructed vaginal canal to the left vagina. Intravaginal ultrasound examination demonstrated a longitudinal vaginal septum and a closed pyocolpos on the right side. The longitudinal vaginal septum was excised by way of electrocauterization under direct vision. HWWS should be considered in the differential diagnosis in patients with uterus didelphys and unusual symptoms such as pyocolpos and vaginal discharge. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Treatment Options by Stage (Vaginal Cancer)

MedlinePlus

... stage of the cancer being treated. External and internal radiation therapy are used to treat vaginal cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life . Chemotherapy Chemotherapy is a cancer treatment ...

Treatment Option Overview (Vaginal Cancer)

MedlinePlus

... stage of the cancer being treated. External and internal radiation therapy are used to treat vaginal cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life . Chemotherapy Chemotherapy is a cancer treatment ...

Most bothersome symptom in women with genitourinary syndrome of menopause as a moderator of treatment effects.

PubMed

Pinkerton, JoAnn V; Bushmakin, Andrew G; Abraham, Lucy; Cappelleri, Joseph C; Komm, Barry S

2016-10-01

Conjugated estrogens/bazedoxifene (CE/BZA) is indicated to treat moderate/severe menopausal vasomotor symptoms and prevent postmenopausal osteoporosis. This analysis examines the impact of the most bothersome vaginal symptom at baseline on effects of CE/BZA. This post hoc analysis used data from a 12-week clinical trial of nonhysterectomized postmenopausal women (n = 664) randomly assigned to double-blind treatment with CE/BZA (0.45/20 mg and 0.625/20 mg), BZA 20 mg, or placebo. At baseline, women indicated which moderate/severe vaginal symptom (dryness, itching/irritation, or pain with intercourse) bothered them most. Repeated measures models were used to explore treatment effects in relationship to the most bothersome symptom. We calculated effect sizes for treatment differences versus placebo (effect sizes: trivial, 0.1; small, 0.2; medium, 0.5; large, 0.8). At baseline, 52% of women selected pain with intercourse, 35% selected vaginal dryness, and 13% selected vaginal itching/irritation as most bothersome. For these three symptom groups respectively, CE/BZA was associated with statistically significant improvements in Menopause-Specific Quality of Life sexual functioning (effect size: 0.45/20 mg, -0.36, -0.30, -0.67; 0.625/20 mg, -0.37, -0.40, -0.26) and/or overall score (effect size: 0.45/20 mg, -0.29, -0.41, -0.78; 0.625/20 mg, -0.41, -0.48, -0.68). Both those doses significantly improved the ease of lubrication item on the Arizona Sexual Experiences Scale in those with pain with intercourse (effect size: 0.45/20 mg, -0.43; 0.625/20 mg, -0.50) and produced some statistically significant improvements in vaginal cell counts in women with dryness or pain with intercourse as the most bothersome symptom. The higher dose was associated with greater treatment satisfaction on the Menopause Symptoms Treatment Satisfaction Questionnaire versus placebo in women who selected pain with intercourse (effect size: 0.40) or dryness (effect size: 0.43) as most bothersome. The approved dose of CE/BZA had clear benefits, particularly in women with pain with intercourse (the most common bothersome symptom), in whom it improved lubrication, superficial cell counts, and sexual functioning.

How changes in depression and anxiety symptoms correspond to variations in female sexual response in a nonclinical sample of young women: a daily diary study.

PubMed

Kalmbach, David A; Kingsberg, Sheryl A; Ciesla, Jeffrey A

2014-12-01

A large body of literature supports the co-occurrence of depression, anxiety, and sexual dysfunction. However, the manner in which affective symptoms map onto specific female sexual response indices is not well understood. The present study aimed to examine changes in depression and anxiety symptoms and their correspondence to fluctuations in desire, subjective arousal, genital response, orgasmic function, and vaginal pain. The study used a 2-week daily diary approach to examine same-day and temporal relations between affective symptoms and sexual function. The unique relations between shared and disorder-specific symptoms of depression and anxiety (i.e., general distress, anhedonia, and anxious arousal) and female sexual response (i.e., desire, subjective arousal, vaginal lubrication, orgasmic function, and sexual pain) were examined, controlling for baseline levels of sexual distress, depression, and anxiety, as well as age effects and menstruation. Analyses revealed that changes in depression and anxiety severity corresponded to same-day variations in sexual response. Specifically, anhedonia (depression-specific symptom) was related to poorer same-day sexual desire, whereas greater anxious arousal (anxiety-specific symptom) was independently related to simultaneous increases in subjective sexual arousal, vaginal lubrication, and sexual pain. Increases in general distress (i.e., shared symptoms) were associated with greater same-day difficulties achieving orgasm. Notably, only one temporal relation was found; it indicated that higher levels of anhedonia predicted a next-day decrease in sexual desire. It is proposed that the simultaneous changes in affective symptoms and sexual function may indicate that they are products of shared underlying mechanisms. That is, in response to stress, the processes manifesting as feelings of weak positive affect and amotivation are the very same processes responsible for diminished capacity for sexual desire. In contrast, the physiological hyperarousal associated with anxiety also gives rise to sexual arousal difficulties and vaginal pain. © 2014 International Society for Sexual Medicine.

Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: a case report and literature review.

PubMed

Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

2014-08-01

Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare.

Unruptured Internal Carotid-Posterior Communicating Artery Aneurysm Splitting the Oculomotor Nerve: A Case Report and Literature Review

PubMed Central

Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

2014-01-01

Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare. PMID:25083381

Brain Aneurysm

MedlinePlus

A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

Vaginal Gene Expression During Treatment With Aromatase Inhibitors.

PubMed

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

2015-12-01

Aromatase inhibitor (AI) treatment suppresses estrogen biosynthesis and causes genitourinary symptoms of menopause such as vaginal symptoms, ultimately affecting the quality of life for many postmenopausal women with breast cancer. Thus, the aim of this study was to examine vaginal gene expression in women during treatment with AIs compared with estrogen-treated women. The secondary aim was to study the presence and localization of vaginal aromatase. Vaginal biopsies were collected from postmenopausal women treated with AIs and from age-matched control women treated with vaginal estrogen therapy. Differential gene expression was studied with the Affymetrix Gene Chip Gene 1.0 ST Array (Affymetrix Inc, Santa Clara, CA) system, Ingenuity pathway analysis, quantitative real-time polymerase chain reaction, and immunohistochemistry. The expression of 279 genes differed between the 2 groups; AI-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion. Some differentially expressed genes were found to interact indirectly with the estrogen receptor alpha. In addition, aromatase protein staining was evident in the basal and the intermediate vaginal epithelium layers, and also in stromal cells with a slightly stronger staining intensity found in AI-treated women. In this study, we demonstrated that genes involved in cell differentiation, proliferation, and cell adhesion are differentially expressed in AI-treated women. The expression of vaginal aromatase suggests that this could be the result of local and systemic inhibition of aromatase. Our results emphasize the role of estrogen for vaginal cell differentiation and proliferation and future drug candidates should be aimed at improving cell differentiation and proliferation. Copyright © 2015 Elsevier Inc. All rights reserved.

A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

PubMed Central

Kim, Hee Seung; Kim, Jae Weon; Kim, Mi-Kyung; Chung, Hyun Hoon; Lee, Taek Sang; Jeon, Yong-Tark; Kim, Yong Beom; Jeon, Hye Won; Yun, Young Ho; Park, Noh Hyun; Song, Yong Sang; Kang, Soon-Beom

2009-01-01

Background Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus. Methods and design Patients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation. Discussion Among treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with symptomatic relief. The current study fully recruited in June 2008 and the results will be available in June 2009. If there is no difference of postoperative QOL between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids, the comparison of quality of life between laparoscopic uterine artery ligation and uterine artery embolization will be also needed as a surgical treatment for preserving uterus. Trial registration Current Controlled Trials ISRCTN76790866 PMID:19178748

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort.

PubMed

Sapra, K J; Buck Louis, G M; Sundaram, R; Joseph, K S; Bates, L M; Galea, S; Ananth, C V

2016-04-01

What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation? Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not. Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss. Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception. Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs) and 95% CIs for presence compared with absence of signs or symptoms were estimated using Cox proportional hazard models. Women experienced lower abdominal cramping (85%), nausea (48%), vomiting (46%) and light/moderate/heavy vaginal bleeding (24%) during early pregnancy. Ninety-five (28%) women experienced a loss. Cumulative incidence of pregnancy loss varied by symptomatology: 19% for vomiting, 27% for lower abdominal cramping, 35% for nausea only, 52% for vaginal bleeding, 81% for vaginal bleeding with lower abdominal cramping. Incidence of pregnancy loss was increased among women with vaginal bleeding (HR: 3.62, 95% CI: 2.29-5.74) and among women with vaginal bleeding and lower abdominal cramping (HR: 5.03, 95% CI: 2.07-12.20). Incidence of pregnancy loss was decreased for women with vomiting (HR: 0.51, 95% CI: 0.30-0.86). In the setting of vaginal bleeding with lower abdominal cramping, vomiting reduced the incidence of pregnancy loss (HR: 0.24, 95% CI: 0.11-0.56). There were few losses beyond 14 weeks gestation; thus, the precision of our findings related to losses occurring after the first trimester is limited. By using sensitive home pregnancy tests, we are able to document and characterize the cumulative incidence of the earliest pregnancy losses, which constitute the majority of losses. The use of daily, prospective capture of signs and symptoms relative to ascertainment of pregnancy loss minimizes potential biases associated with reporting after rather than before a loss, which could potentially distort the relationship between signs and symptoms and pregnancy loss. The findings of our study suggest that it may be useful to develop prognostic models for pregnancy loss based on signs and symptoms. This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract numbers N01-HD-3-3355; N01-HD-3-3356; N01-HD-3-3358). The authors have no conflict of interest to declare. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

A Multi-center, Double-blind, Randomized Study, Comparing Clindamycin Phosphate Vaginal Cream 2% (Watson Laboratories, Inc.) to Clindesse® (Ther-Rx™, Clindamyin Phosphate Vaginal Cream 2%) and Both Active Treatments to a Placebo Control in the Treatment of Bacterial Vaginosis in Non-pregnant Women

ClinicalTrials.gov

2015-03-18

BACTERIAL VAGINOSIS; Signs and Symptoms to be Evaluated and Recorded Include:; Vaginal Discharge: Color, Odor, and Consistency;; Vulvovaginal Itching and Irritation (Subjective): Absent, Mild, Moderate, or Severe; Vulvovaginal Inflammation (Objective): Absent, Mild, Moderate, or Severe.

Graft-versus-Host Disease-Associated Vulvovaginal Symptoms after Bone Marrow Transplantation.

PubMed

Chung, Christopher P; Sargent, Rachel E; Chung, Nadia T; Lacey, James V; Wakabayashi, Mark T

2016-02-01

We conducted a retrospective review to assess the prevalence of graft-versus-host disease (GVHD)-associated gynecologic conditions among bone marrow transplantation (BMT) patients at City of Hope Medical Center. We calculated the associations among the estimated risks of various gynecologic complications, including vaginal stenosis, by performing chi-square tests and t-test statistics. Between 2010 and 2014, 180 patients were referred to the gynecologic clinic after their BMT. One hundred twenty-four patients (69%) had GVHD; among these patients, 51 (41%) experienced dyspareunia and 43 (35%) had vaginal stenosis. GVHD patients were significantly more likely to have vaginal stenosis (P < .0001), more likely to have used a vaginal dilator (P = .0008), and less likely to have urinary incontinence (UI) than those without GVHD (P < .001). There was no difference in developing pelvic organ prolapse (POP) in patients with or without GVHD (P = .4373). GVHD was a common complication after allogenic BMT. Patients with BMT were more likely to have vulvovaginal symptoms, such as dyspareunia and pelvic pain. Patients with GVHD are at high risk for vaginal stenosis requiring the use of a vaginal dilator. However, they are at low risk for developing UI and POP. Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Vulvovaginal symptoms in women with bacterial vaginosis.

PubMed

Klebanoff, Mark A; Schwebke, Jane R; Zhang, Jun; Nansel, Tonja R; Yu, Kai-Fun; Andrews, William W

2004-08-01

A substantial, but highly variable, percentage of women with bacterial vaginosis are said to be asymptomatic. The purpose of this study was to estimate the prevalence of symptoms among women with bacterial vaginosis compared with women without bacterial vaginosis by direct, explicit, and detailed questioning of these women. Women presenting for a routine health care visit at 12 health department clinics in Birmingham, Alabama, were recruited to participate in a longitudinal study of vaginal flora. At the first visit, they underwent a pelvic examination, lower genital tract microbiological evaluation, and an interview that included detailed questions regarding lower genital tract symptoms. The prevalence of symptoms among women with and without bacterial vaginosis (Gram stain score 7 or higher) was compared. Among 2,888 women without gonorrhea, Chlamydia, or trichomonas, 75% of women with and 82% of women without bacterial vaginosis never noted any vaginal odor in the past 6 months (P <.001). The corresponding values were 63% and 65% for never noting vaginal "wetness" (P =.02); 58% and 57% for vaginal discharge (P =.65); 91% and 86% for irritation (P =.004); 88% and 85% for itching (P =.64); and 96% and 94% for dysuria (P =.002), respectively. Cumulatively, 58% of women with bacterial vaginosis noted odor, discharge, and/or wetness in the past 6 months compared with 57% of women without bacterial vaginosis (P =.70). The 2 classic symptoms of bacterial vaginosis discharge and odor are each reported by a minority of women with bacterial vaginosis and are only slightly more prevalent than among women without bacterial vaginosis.

Long-term follow-up of treatment for synthetic mesh complications.

PubMed

Hansen, Brooke L; Dunn, Guinn Ellen; Norton, Peggy; Hsu, Yvonne; Nygaard, Ingrid

2014-01-01

The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh. Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments. A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse. Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.

DIFFERENCES IN MENTAL HEALTH AND SEXUAL OUTCOMES BASED ON TYPE OF NONCONSENUAL SEXUAL PENETRATION

PubMed Central

Pinsky, Hanna T.; Shepard, Molly E.; Bird, Elizabeth R.; Gilmore, Amanda K.; Norris, Jeanette; Davis, Kelly Cue; George, William H.

2016-01-01

Little is known based on the stratification and localization of penetration type of rape: oral, vaginal, and/or anal. The current study examined associations between type of rape and mental and sexual health symptoms in 865 community women. All penetration types were positively associated with negative mental and sexual health symptoms. Oral and/or anal rape accounted for additional variance in anxiety, depression, some trauma-related symptoms, and dysfunctional sexual behavior than the association with vaginal rape alone. Findings suggest that penetration type can be an important facet of a rape experience and may be useful to assess in research and clinical settings. PMID:27486127

Effects of Reproductive History on Symptoms of Menopause: A Brief Report

PubMed Central

Nelson, Deborah B.; Sammel, Mary D.; Patterson, Freda; Lin, Hui; Gracia, Clarisa R.; Freeman, Ellen W.

2011-01-01

Objective To examine the relationship between reproductive history and menopausal symptoms among urban women. Methods A cohort study of women aged 35–47 recruited in Philadelphia, PA. Two hundred and ninety one pre-menopausal women meeting study eligibility criteria and contributing reproductive health history and infertility information completed assessments of occurrence and severity of several menopausal symptoms over a 14 year period. Reproductive history included the number of pregnancies, live births, preterm deliveries and miscarriages. Trying to get pregnant for more than one year was used as an assessment of infertility. The occurrence of severe hot flashes, vaginal dryness and decreased libido were evaluated. Results Women scoring positive on the infertility index were significantly more likely to report severe decreased libido (OR=1.86, 95% CI: 1.05–3.31) and over twice as likely to report severe vaginal dryness (OR=2.79, 95% CI: 1.19–6.94) in multivariable models. None of the other reproductive health indices were related to report of severe hot flashes, vaginal dryness or decreased libido. The race-specific models continued to find a significant, increased risk of severe vaginal dryness (OR=2.79, 95% CI: 1.22–6.36) and decreased libido (OR=1.87, 95% CI: 1.04–3.34) among white women scoring positive on the infertility index; however the relationship did not remain significant among African-American women. Conclusions Severe vaginal dryness and decreased libido are common and important considerations of the menopausal transition and the experience of infertility problems may influence the report of severe vaginal dryness and decreased libido particularly among white women. PMID:21552165

Quality of life and sexual function of patients following radical hysterectomy and vaginal extension.

PubMed

Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Chuang, Linus T; Shen, Keng

2014-05-01

Radical hysterectomy (RH) has negative consequences on sexual function due to a shortened vagina, vaginal dryness, and dyspareunia. Peritoneovaginoplasty aims to extend vagina by vesical peritoneum and anterior rectal wall to improve postoperative sexual function. The aim of this study was to investigate whether vaginal extension can improve sexual function and quality of life and the problem of sexual dysfunction in early-stage cervical cancer survivors (CCSs) in China. Case-control and questionnaire-based methods were employed. Thirty-one patients who had undergone vaginal extension following RH and 28 patients with matching factors after RH alone were enrolled in the study. Both groups were assessed retrospectively by questionnaires at least 6 months after treatment. The European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module and the Sexual Function Vaginal Changes Questionnaire are validated measurements for disease- and treatment-specific issues. Vaginal length was 10.03 ± 1.26 cm and 5.92 ± 1.05 cm in study and control group, respectively (P < 0.05). In the study group, 67.7% patients and 64.3% of control group resumed sexual activity at the time of interview, averaging 6 months between treatment and sexual activity. While difficulty emptying bladder, incomplete emptying, and constipation were the most commonly reported symptoms, no significant difference was observed regarding pelvic floor symptoms. Reduced vagina size and shortened vagina was significantly more prominent in the control group, whereas both group presented with hypoactive sexual desire (88.1%), orgasm dysfunction (71.8%), and low enjoyment or relaxation after sex (51.3%). Shortened vagina was significantly less reported in study group, while no difference was observed in other sex-related dimensions. Vaginal extension does not worsen pelvic floor symptoms. Sexual rehabilitation interventions are of significance and should be paid more attention to the CCSs in China. © 2014 International Society for Sexual Medicine.

Giant primary vaginal calculus secondary to vesicovaginal fistula with partial vaginal outlet obstruction in a 12-year-old girl.

PubMed

Chen, Shushang; Ge, Rong; Zhu, Lingfeng; Yang, Shunliang; Wu, Weizhen; Yang, Yin; Tan, Jianming

2011-10-01

A vesicovaginal fistula with vagina obstruction associated with vaginal calculi is an extremely rare medical condition. We report a giant primary vaginal calculus resulting from vesicovaginal fistula with partial vaginal outlet obstruction secondary to perineum trauma and surgery in a 12-year-old girl. Episiotomy was performed and the adhesive labia minora was split. After the removal of a giant calculus in the vagina, approximately 8 cm in diameter, the fistula tract was completely excised, followed by the repair of the vesicovagina fistula and the vagina. The patient was symptom-free at 6-month follow-up examination. Copyright © 2011 Elsevier Inc. All rights reserved.

[Analysis of mesh related complications after trans-vaginal mesh-augmented pelvic floor reconstruction surgery].

PubMed

Zhang, Kun; Han, Jin-song; Zhu, Fu-li; Yao, Ying

2012-09-01

To evaluate the complications after trans-vaginal mesh-augmented pelvic floor reconstruction in treatment of pelvic organ prolapse (POP). From February 2007 to October 2009, vaginal mesh procedures were performed on 91 women with POP stage III-IV in Peking University Third Hospital. The operative complications were studied. Ninety patients underwent successful surgery among 91 patients. Follow-up rate was 94% (85/90) at a median follow-up of 28.4 (15 - 44) months. One patient underwent intraoperative organ injuries, and 10 patients had postoperation mesh-related complications. The rate of mesh-related complications was 2% (2/85), 2% (2/85), 4% (3/85), 4% (3/85) on 6, 6 - 12, 12 - 24 and more than 24 months following up, respectively. Seven patients underwent conservative treatment and the symptoms were improved. Three patients underwent the second surgery, and the symptoms were cured or relieved. The incidence of mesh-related complications was low, and interventions were effective in vaginal mesh procedure.

Genital malodor in women: a modern reappraisal.

PubMed

Subramanian, Chithra; Nyirjesy, Paul; Sobel, Jack D

2012-01-01

Genital malodor is a common distressing complaint that brings a woman to her physician's office. Vaginal infections, primarily bacterial vaginosis and trichomoniasis, still remain the commonest causes and are relatively easy to diagnose and treat. However, in approximately one third of women who present with malodor, no cause is identified. Although data on the management of vaginal discharge are extensive, the management of genital odor beyond common vaginal infections remains poorly studied. This presents a frustrating situation for both the patient and her physician. Often, patients resort to home remedies and over-the-counter preparations, which, while providing short-term relief for some women, almost never address the cause and, in some cases, can exacerbate symptoms. In this review, we have attempted to consolidate the known and documented causes of genital malodor including the nonvaginal causes and provide case studies that will help clinicians understand the possible settings for the various causes. We also provide an algorithm for the management of this symptom beyond vaginal infections.

Chronic vaginal discharge and left leg edema after a transobturator tape procedure.

PubMed

Kim, Tae-Hee; Lee, Hae-Hyeog; Kim, Jun-Mo

2014-05-01

We report on a patient who underwent total vaginal hysterectomy for urinary incontinence 8 years previously with a sling operation using transobturator tape (TOT). She was admitted to our hospital after complaints of vaginal discharge, foul odor, and bleeding, left thigh pain, and edema. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a fistula tract from the vagina or urethra with remnant sling tape. We removed the remnant tape using intraoperative ultrasonography. This case exemplifies the rare occurrence of a vaginal fistula extending to the obturator, adductor, and pectineus muscles combined with myositis after TOT placement. It is important that urogynecologists recognize that TOT procedures may result in complications accompanied by common recurrent vaginal symptoms, such as vaginal odor and spotting, which can be identified by MRI or CT.

Self-Reported Menopausal Symptoms, Coronary Artery Calcification and Carotid Intima-Media Thickness in Recently Menopausal Women Screened for the Kronos Early Estrogen Prevention Study (KEEPS)

PubMed Central

Wolff, Erin Foran; He, Yunxiao; Black, Dennis M.; Brinton, Eliot A.; Budoff, Mathew J.; Cedars, Marcelle I.; Hodis, Howard N.; Lobo, Rogerio A.; Manson, JoAnn E.; Merriam, George R.; Miller, Virginia M.; Naftolin, Fredrick; Pal, Lubna; Santoro, Nanette; Zhang, Heping; Harman, S. Mitchell; Taylor, Hugh S.

2012-01-01

Objective To determine whether self-reported menopausal symptoms are associated with measures of subclinical atherosclerosis. Setting Multi-center, randomized controlled trial. Patients Recently menopausal women (n=868) screened for the Kronos Early Estrogen Prevention Study (KEEPS). Design Cross sectional analysis. Interventions None Main Outcome Measures Baseline menopausal symptoms (hot flashes, dyspareunia, vaginal dryness, night sweats, palpitations, mood swings, depression, insomnia, irritability), serum estradiol (E2) levels and measures of atherosclerosis were assessed. Atherosclerosis was quantified using Coronary Artery Calcium (CAC) Agatston scores (n=771) and Carotid Intima-Media Thickness (CIMT). Logistic regression model of menopausal symptoms and E2 was used to predict CAC. Linear regression model of menopausal symptoms and E2 was used to predict CIMT. Correlation between length of time in menopause with menopausal symptoms, estradiol (E2), CAC, and CIMT were assessed. Results In early menopausal women screened for KEEPS, neither E2 nor climacteric symptoms predicted the extent of subclinical atherosclerosis. Palpitations (p=0.09) and depression (p=0.07) approached significance as predictors of CAC. Other symptoms of insomnia, irritability, dyspareunia, hot flashes, mood swings, night sweats, and vaginal dryness were not associated with CAC. Women with significantly elevated CAC scores were excluded from further participation in KEEPS; in women meeting inclusion criteria, neither baseline menopausal symptoms nor E2 predicted CIMT. Years since menopause onset correlated with CIMT, dyspareunia, vaginal dryness and E2. Conclusions Self-reported symptoms in recently menopausal women are not strong predictors of subclinical atherosclerosis. Continued follow-up of this population will be performed to determine if baseline or persistent symptoms in the early menopause are associated with progression of cardiovascular disease. PMID:23312232

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

Vaginal rings for delivery of HIV microbicides.

PubMed

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.

Donor-site morbidity after pedicled TRAM breast reconstruction: a comparison of two different types of mesh.

PubMed

Sværdborg, Mille; Damsgaard, Tine Engberg

2013-11-01

Many different approaches have been used to minimize the risk of bulge or hernia formation when using autologous abdominal tissue for breast reconstruction. Studies have shown that further reinforcement of the abdominal wall using a mesh may decrease the complication rate.The current study included 40 consecutive patients having unilateral breast reconstruction with the pedicled transverse rectus abdominus musculocutaneous flap. The defect in the abdominal fascia was closed primarily and further reinforced using a Prolene mesh (Ethicon), n = 20, or using a self-fixating Parietex ProGrip mesh (Covidien), n = 20. The patients were examined at an outpatient consultation, with a minimum follow-up of 1 year and questioned about donor-site symptoms using a standardized questionnaire.Of the 20 patients in the Prolene group, 2 (10%) developed abdominal wall bulging, and of the 20 patients in the ProGrip group, 11 (55%) developed abdominal wall bulging (P = 0.006). In both the Prolene and the ProGrip group, most patients reported having continued donor-site symptoms at the time of the follow-up (70% and 80%, respectively); 15% and 30%, respectively, reported having symptoms that influenced their daily or physical activities (not a significant difference). All but 1 patient in our study reported being very happy with the reconstruction and would have done it again, had they known what they did at the time of the follow-up.We conclude that the self-gripping properties of the Parietex ProGrip mesh are not sufficient in withstanding the abdominal wall tension at the donor site after transverse rectus abdominus musculocutaneous-flap harvest and do not recommend using the Parietex ProGrip mesh without fixating sutures for this procedure.

Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article

PubMed Central

Park, Yoo Jin

2017-01-01

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter, Escherichia coli, Candida, and Gardnerella). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC. PMID:29354612

Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article.

PubMed

Kim, Jun-Mo; Park, Yoo Jin

2017-12-01

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter , Escherichia coli , Candida , and Gardnerella ). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC.

Foreign Body in Vagina: An Uncommon Cause of Vaginitis in Children

PubMed Central

Chinawa, JM; Obu, HA; Uwaezuoke, SN

2013-01-01

Vaginal discharge in children may result from a variety of causes. A long-standing intra-vaginal foreign body can pose both diagnostic and therapeutic challenges in children. Treatment failure may occur because of alteration of the normal vaginal flora. A 6-year-old girl, who lived with her parents, presented with a foul-smelling, blood-stained vaginal discharge as well as dysuria for 2 years. There was no history of sexual abuse. Initial evaluation that excluded gynecologic examination revealed lower abdominal tenderness. Vaginal swab and urine cultures yielded Staphylococcus aureus sensitive to ceftriaxone only. She was commenced on this antibiotic for 2 weeks, but the discharge persisted, necessitating referral to the gynecologist. Examination under anesthesia by the gynecologist revealed shreds of toilet tissue paper extracted from the vagina and slight excoriations on the wall of the vagina. Vaginal foreign body can present with diverse symptoms. It should be considered in any young female patient presenting with recurrent or persistent vaginal discharge. PMID:23634340

[EPIDEMIOLOGICAL, CLINICAL AND MICROBIOLOGICAL FINDINGS IN WOMEN WITH AEROBIC VAGINITIS].

PubMed

Dermendjiev, T; Pehlivanov, B; Hadjieva, K; Stanev, S

2015-01-01

Aerobic vaginitis (AV) is an alterarion of the normal lactobacillic flora accompanied by signs of inflammation, presence of mainly aerobic microorganisms from intestinal commensals or other aerobic pathogens. Clinical symptoms may vary by type and intensity and are marked by a high tendency for recurrence and chronification. Inflammation and ulcerations in AV could increase the risk of contracting HIV or other sexually transmitted infections. The aim is to study some epidemiological, clinical and microbiological features of the aerobic vaginitis in patients of the specialized Obstetric and Gynecological Clinic in Plovdiv, Bulgaria. In a retrospective research 4687 vaginal smears have been gathered in Microbiological laboratory at "St. George" Hospital - Plovdiv. We used clinical, microbiological and statistical methods. Information processing is performed by variation, alternative, correlation and graphical analysis using specialized package SPSS v13.0. The overall prevalence rate of AV in the studied population is 11.77%. The levels of prevalence of AV in pregnant and non-pregnant women are respectively 13.08% and 4.34%. The highest frequency of AV is in the age group 21-30 years (32.3%). The results show a marked association between Escherichia coli and the cases of AV (p < 0.001). AV is a common cause of vaginal symptoms in patients of specialized ambulatory outpatient. One in ten women with vaginal complaints suffers from AV Streptococcus agalactiae and Escherichia coli are most often isolated aerobic microorganisms.

Association of pregnancy and Candida vaginal colonization in women with or without symptoms of vulvovaginitis.

PubMed

Leli, C; Mencacci, A; Meucci, M; Bietolini, C; Vitali, M; Farinelli, S; D' Alò, F; Bombaci, J C; Perito, S; Bistoni, F

2013-06-01

Candida infection is one of the main causes of vulvovaginitis. The experience of symptoms of vulvovaginitis during pregnancy changes in relation to clinical, behavioral, and demographic factors. Candidiasis is associated with an increased risk of delivery complications. In some studies pregnant women are found more symptomatic than non-pregnant women, but in others a higher prevalence of asymptomatic infections is described during pregnancy. The aims of this study were to evaluate the prevalence of Candida vaginal colonization in pregnant women, and investigate if the occurrence of symptoms is influenced by pregnancy, in a population of Italian native and immigrant women. A total of 344 outpatients, who visited the laboratory for routine genital examination, independently of pregnancy or presence or absence of symptoms of vulvovaginitis, were evaluated. Colonization by Candida spp. was significantly higher in pregnant than non-pregnant patients (31.4% vs. 19.9%; χ2=5.59; P=0.018), nevertheless pregnant women were significantly more often asymptomatic compared to non-pregnant (46.5% vs. 16%; χ2=42.31; P<0.0001). In the sub-group of women colonized by Candida spp., pregnancy resulted significantly associated to asymptomatic infection (58.1% vs. 30.8%; χ2 =6.18; P=0.013). A binary logistic regression analysis showed pregnancy or lactobacilli colonization independently associated to a lower probability of experiencing symptoms of vulvovaginitis (respectively: P<0.0001 and P=0.008). Pregnancy seems to be independently associated to Candida spp. asymptomatic vaginal infection. Given that candidiasis has been associated with possible delivery complications, these results suggest to screen for Candida spp. vaginal colonization asymptomatic women during pregnancy.

The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women.

PubMed

Chughtai, Bilal; Forde, James C; Buck, Jessica; Asfaw, Tirsit; Lee, Richard; Te, Alexis E; Kaplan, Steven A

2016-03-01

The objective of this study is to investigate the combination effect of anti-muscarinic medication and topical vaginal estrogen in the treatment of overactive bladder (OAB) and female sexual dysfunction in postmenopausal women. After IRB approval, 23 female subjects who met the entry criteria were randomized into two groups: (1) fesoterodine (Toviaz®, Pfizer, NY) with topical vaginal estrogen (Premarin®, Pfizer, NY) once daily or (2) fesoterodine once daily alone. If 4 mg fesoterodine was tolerated at 1-week, the dose was increased to 8 mg. Primary endpoints were improvement in OAB symptom severity (Overactive Bladder Questionnaire, OAB-Q SF), improvement in OAB health-related quality of life (HRQL) (OAB-Q SF), and sexual function (Sexual Quality of Life-Female, SQOL-F) after 12 weeks. Secondary endpoint was change in total number of micturitions. After 12-weeks, the combination group had a significant improvement in OAB symptom severity (p = 0.006), HRQL (p = 0.029), and SQOL-F (0.0003). The fesoterodine alone group also had significant improvement in OAB symptom severity (p < 0.0001), HRQL (p = 0.0002), and SQOL-F (p = 0.02). When compared directly to the fesoterodine alone group, the combination group after 12-weeks had a reduced OAB symptom severity (10 versus 23.3; p = 0.35), higher HRQL (96.9 versus 84.6; p = 0.75), and higher SQOL-F (99 versus 81; p = 0.098). The total number of micturitions over 3 d was significantly reduced in the combination group (45-26, p = 0.03) between baseline and 12-weeks. The combined effect of fesoterodine and topical vaginal estrogen improved OAB symptoms and sexual function in postmenopausal women. © The Author(s) 2016.

Group A Streptococcus vulvovaginitis in breastfeeding women.

PubMed

Rahangdale, Lisa; Lacy, Judith; Hillard, Paula A

2008-08-01

Group A beta-hemolytic streptococcus-associated vulvovaginitis is uncommon in adult women. Clinicians should include group A beta-hemolytic streptococcus as a possible cause of vulvovaginal symptoms in breastfeeding women. Along with appropriate antibiotic therapy, vaginal estrogen therapy may be considered to diminish susceptibility to recurrent infection in women with vaginal atrophy.

The effect of a vaginal suppository formulation of dill (Anethum graveolens) in comparison to clotrimazole vaginal tablet on the treatment of vulvovaginal candidiasis.

PubMed

Saghafi, Nafiseh; Karjalian, Maryam; Ghazanfarpour, Masumeh; Khorsand, Imaneh; Rakhshandeh, Hassan; Mirteimouri, Masumeh; Babakhanian, Masoudeh; Khadivzadeh, Talat; Najafzadeh, Mohammad Javad; Ghorbani, Ahmad; Pourali, Leila; Bahman, Sara

2018-03-19

The goal of this study was to compare the effect of Anethum graveolens (dill) vaginal suppositories and 100 mg clotrimazole vaginal tablets on vulvovaginal Candidiasis. This study was a single centre, single-blind, randomised, placebo-controlled trial, in which 60 women with microbiology-confirmed vulvovaginal candidiasis were randomly assigned to dill and clotrimazole groups. At the end of the study, the estimated prevalence of leucorrhoea, burning, and itching was 23%, 23% and 20% in dill users, respectively. This figure was 20%, 10% and 16.7% for the clotrimazole group, respectively. The difference between the two groups was not significant. 13% of suppository patients, compared with 10% of clotrimazole-treatment patients, had a positive culture, which was not significant (p = .68). According to findings, 2% dill vaginal suppositories were as effective as clotrimazole vaginal tablets in reducing both clinical and microbiological symptoms of Candidiasis. Studies with larger sample sizes are required to confirm current findings. Impact statement What is already known on the subject? Based on results from in vivo and in vitro animal studies, dill (Anethum graveolens) has anti-candida activity. What do the results of this study add? It appears that 2% dill vaginal suppositories were as effective as 100 mg clotrimazole vaginal tablets in reducing both the clinical and microbiological symptoms. What are the implications of these findings for clinical practice and further research? Obstetricians and gynaecologists can offer dill as a useful alternative to chemical drugs, especially in women who are often interested in herbal medicine, or in women who are resistant or are not allowed to use antifungal drugs.

[Sulphurous vaginal douching and vulvovaginal atrophy].

PubMed

Costantino, M; Conti, V; Marongiu, M B; Napolano, G; Filippelli, A

2017-01-01

During climacteric the reduction or interruption of estrogenic stimulus determines a gradual atrophy of the tissues of the urogenital tract.Vulvovaginal atrophy can be cause of dryness, itch, burning, and dyspareunia. Vulvovaginal atrophy is associated also with depression. Hence the importance of an appropriate treatment of the vulvovaginal atrophy. Between therapeutic options we can add, particularly for women who suffer only from vaginal symptoms, the spa therapy that uses mineral waters with benefic effects on vaginal tissue wellness and health. On the basis of considerations described above and on the insufficient literature data, the objective of our single-arm pilot study has been to evaluate, in women suffering from vulvovaginal atrophy, the effects and safety of a vaginal douching cycle with sulphurous mineral water and impact on depression disorder frequently observed. The study was conducted on 24 women affected by vulvovaginal atrophy; mean age:57±11 years; age range:42-81 years. The subjects were treated, for 2 weeks, with sulphurous vaginal douching from Terme of Telese S.p.A. (Benevento-Italy). At the beginning and at the end of the SPA treatment the following symptoms were evaluated: dryness, burning, itch, dyspareunia and leucorrhoea (using VAS scale); the impact on psychological distress (using S.D.S. Zung-test). At the end of the spa treatment, the mean values±SD, compared to baseline, have showed a significant (p<0.05) reduction in leucorrhoea (-88%), in vulvar itch (-79%), in vaginal burning (-71%), in vaginal dryness (-65%) with an improvement of psichological distress as demonstrated by S.D.S. Zung-test. The data of this single-arm pilot clinical trial show that the sulphurous vaginal douching cycle can be considered very useful in women suffering from vulvovaginal atrophy with improving of the quality of life and social relationship.

Vaginal Use of Ibuprofen Isobutanolammonium (Ginenorm): Efficacy, Tolerability, and Pharmacokinetic Data: A Review of Available Data

PubMed Central

Milani, Massimo; Iacobelli, Piero

2012-01-01

Vaginal infection and inflammation with or without vulvar involvement are very common gynecologicaly clinical conditions associated with morbidity and reduced quality of life. Vaginal infections are commonly treated with causal antimicrobial treatments. In addition to specific antimicrobial treatment, anti-inflammatory therapy, both systemic or topical (vaginal douche), could be useful in the integrated treatment approach of these conditions reducing symptoms and speeding up the recovery in vulvovaginitis. Ibuprofen is a well-known effective and well-tolerated anti-COX (anti-COX1 and COX2) compound. In addition, several in vitro studies suggest that Ibuprofen shares antimicrobial and antifungal activities. Ibuprofen isobutanolammonium (Ib-isb) (Ginenorm) is a soluble salt from formulation suitable for external and intravaginal use. This salt completely dissociates in aqueous solution. Ib-isob is available in sachet and vaginal douche pharmaceutical formulations. Clinical efficacy of Ib-isob has been documented in 10 clinical studies (6 controlled and 4 open trials) which have enrolled in total 399 women with vulvovaginitis. The six controlled clinical trials were performed both versus placebo (2 studies) or versus active comparators such as benzydamine. In these studied, Ib-Isb has been used in general for 7 consecutive days with a twice application daily regimen at the dose of 1 g per application. Topical application of Ib-isob induced a marked and rapid reduction in signs (erythema, oedema) and symptoms (itching and burning sensation) of vulvovaginitis. In head-to-head studies carried out in comparison with other topical products, Ib-isob induced a more rapid reduction in both subjective and objective symptoms. In particular a remarkable significant improvement of all the symptoms has been observed in the group of patients treated with Ib-isob in comparison with women receiving benzydamine. The clinical data available for Ib-isob confirm that this salt, specifically developed for gynecological use, is effective and well tolerated in vulvovaginal inflammation conditions. Efficacy of Ib-isob was greater in comparison with commonly used products. Ibuprofen-isob may be considered a useful and effective tool for the topical treatment of nonspecific vaginal diseases. PMID:22844609

Vulvar Pain-Associations Between First-Time Vaginal Intercourse, Tampon Insertion, and Later Experiences of Pain.

PubMed

Elmerstig, Eva; Thomtén, Johanna

2016-11-16

This study examines associations between the first experience of vaginal intercourse/tampon insertion and later experiences of vulvar pain. The study is based on questionnaire data from 1,259 Swedish female senior high-school students, aged 18 to 22 years old. Of these, 592 women reported present vulvar pain. Present vulvar pain was associated with first-time experiences of vaginal intercourse (pain, negative experience, against will) and with pain at tampon insertion. First-time experiences were also related to temporal aspects of present vulvar pain during vaginal intercourse (at the beginning, after a while during, and after). Implications of first-time experiences of vaginal intercourse for future symptoms of vulvar pain are discussed.

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort

PubMed Central

Sapra, K.J.; Buck Louis, G.M.; Sundaram, R.; Joseph, K.S.; Bates, L.M.; Galea, S.; Ananth, C.V.

2016-01-01

STUDY QUESTION What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation? SUMMARY ANSWER Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not. WHAT IS KNOWN ALREADY Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss. STUDY DESIGN, SIZE, DURATION Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception. PARTICIPANTS, SETTING, METHODS Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs) and 95% CIs for presence compared with absence of signs or symptoms were estimated using Cox proportional hazard models. MAIN RESULTS AND THE ROLE OF CHANCE Women experienced lower abdominal cramping (85%), nausea (48%), vomiting (46%) and light/moderate/heavy vaginal bleeding (24%) during early pregnancy. Ninety-five (28%) women experienced a loss. Cumulative incidence of pregnancy loss varied by symptomatology: 19% for vomiting, 27% for lower abdominal cramping, 35% for nausea only, 52% for vaginal bleeding, 81% for vaginal bleeding with lower abdominal cramping. Incidence of pregnancy loss was increased among women with vaginal bleeding (HR: 3.62, 95% CI: 2.29–5.74) and among women with vaginal bleeding and lower abdominal cramping (HR: 5.03, 95% CI: 2.07–12.20). Incidence of pregnancy loss was decreased for women with vomiting (HR: 0.51, 95% CI: 0.30–0.86). In the setting of vaginal bleeding with lower abdominal cramping, vomiting reduced the incidence of pregnancy loss (HR: 0.24, 95% CI: 0.11–0.56). LIMITATIONS, REASONS FOR CAUTION There were few losses beyond 14 weeks gestation; thus, the precision of our findings related to losses occurring after the first trimester is limited. WIDER IMPLICATIONS OF THE FINDINGS By using sensitive home pregnancy tests, we are able to document and characterize the cumulative incidence of the earliest pregnancy losses, which constitute the majority of losses. The use of daily, prospective capture of signs and symptoms relative to ascertainment of pregnancy loss minimizes potential biases associated with reporting after rather than before a loss, which could potentially distort the relationship between signs and symptoms and pregnancy loss. The findings of our study suggest that it may be useful to develop prognostic models for pregnancy loss based on signs and symptoms. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract numbers N01-HD-3-3355; N01-HD-3-3356; N01-HD-3-3358). The authors have no conflict of interest to declare. PMID:26936888

Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna; Nout, Remi A.

2014-05-01

Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up timemore » of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity is still pronounced with currently applied IGABT, and it needs further attention.« less

Odorous vaginal discharge - a case study for thorough investigation.

PubMed

Cernat, Geta; Leung, Lawrence

2011-08-01

Odorous vaginal discharge is a common presentation to general practitioners, and a frequent presentation for bacterial infections and sexually transmissible diseases. Busy GPs may be tempted to make a diagnosis from the clinical history and symptoms, and prescribe antibiotics as a first line treatment. This case highlights an unusual cause of persistent odorous vaginal discharge. If a thorough examination had not been conducted, the cause would have been overlooked, first line antibiotics would most likely have been ineffective, and potentially life threatening consequences may have occurred.

The vaginal microbiome: New information about genital tract flora using molecular based techniques

PubMed Central

Lamont, Ronald F.; Sobel, Jack D.; Akins, Robert A.; Hassan, Sonia S.; Chaiworapongsa, Tinnakorn; Kusanovic, Juan Pedro; Romero, Roberto

2011-01-01

Vaginal microbiome studies provide information which may change the way we define vaginal flora. Normal flora appears dominated by one or two species of Lactobacillus. Significant numbers of healthy women lack appreciable numbers of vaginal lactobacilli. Bacterial vaginosis (BV) is not a single entity, but different bacterial communities or profiles of greater microbial diversity than is evident from cultivation-dependent studies. BV should be considered a syndrome of variable composition which results in different symptoms, phenotypical outcomes, and responses to different antibiotic regimens. This information may help to elucidate the link between BV and infection-related adverse outcomes of pregnancy. PMID:21251190

Validation of the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) in two south- Asian languages.

PubMed

Ekanayake, Chanil D; Pathmeswaran, Arunasalam; Herath, Rasika P; Perera, H Suharshi S; Patabendige, Malitha; Wijesinghe, Prasantha S

2017-12-01

The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya. Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p < 0.001), sexual symptoms score (SSS) (p < 0.01), and quality of life (QoL) (p < 0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r s  = 0.64, p < 0.001, Tamil r s  = 0.65, p < 0.001), and QoL (Sinhala r s  = 0.49, p < 0.001, Tamil r s  = 0.60, p < 0.001). Internal consistency as assessed using Cronbach's coefficient alpha: 0.78 (0.76-0.78) and 0.83 (0.80-0.84) in Sinhala and Tamil, respectively. Test-retest reliability was assessed by weighted kappa scores (Sinhala 0.58-0.88 and Tamil 0.76-0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p < 0.001). The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.

Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study

PubMed Central

Nygaard, Ingrid E; Clark, Erin; Clark, Lauren; Egger, Marlene J; Hitchcock, Robert; Hsu, Yvonne; Norton, Peggy; Sanchez-Birkhead, Ana; Shaw, Janet; Sheng, Xiaoming; Varner, Michael

2017-01-01

Introduction Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, ‘Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery’, uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Methods and analysis Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. Ethics and dissemination The University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals. PMID:28073797

Pelvic floor muscle training for urinary incontinence in female stroke patients: a randomized, controlled and blinded trial.

PubMed

Shin, Doo Chul; Shin, Seung Ho; Lee, Myung Mo; Lee, Kyoung Jin; Song, Chang Ho

2016-03-01

To examine the effects of pelvic floor muscle training (PFMT) on the contractility of pelvic floor muscle and lower urinary tract symptoms in female stroke patients. Randomized, single-blind controlled study. Outpatient rehabilitation hospital. Thirty one female patients who were more than three months post-stroke and stress urinary incontinence. The subjects were randomized to either a PFMT group (n = 16), or a control group (n = 15). Both groups received general rehabilitation exercise for 6 weeks, but the PFMT group additionally received PFMT for 6 weeks. Vaginal function test using a perineometer (maximal vaginal squeeze pressure) and intra-vaginal electromyography (activity of pelvic floor muscle), and urinary symptoms and quality of life using a Bristol Female Lower Urinary Tract Symptom questionnaire. After intervention, the maximal vaginal squeeze pressures for the PFMT and control groups were 18.35 (5.24) and 8.46 (3.50) mmHg, respectively. And the activities of pelvic floor muscle of the PFMT and control groups was 12.09 (2.24) ㎶ and 9.33 (3.40) ㎶, respectively. After intervention, the changes of scores for inconvenience in the activity of daily living of the PFMT and control groups were -15.00 (6.25) and -0.17 (1.59), respectively. In addition, the changes of score for lower urinary tract symptom was improved more in the PFMT group (-4.17 (4.00)) than in the control group (-0.25 (1.29)) (P < 0.05). These findings suggest that PFMT is beneficial for the management of urinary incontinence in female stroke patients. © The Author(s) 2015.

Symptoms of Ovarian Cancer

MedlinePlus

... Informed Cancer Home What Are the Symptoms of Ovarian Cancer? Language: English (US) Español (Spanish) Recommend on Facebook Tweet Share Compartir Be Brave (:60) Ovarian cancer may cause the following signs and symptoms— Vaginal ...

Types of hormone therapy

MedlinePlus

Menopause symptoms include: Hot flashes Night sweats Sleep problems Vaginal dryness Anxiety Moodiness Less interest in sex After menopause, your body stops making estrogen and progesterone. HT can treat menopause symptoms that bother you. HT does ...

Clinicoetiological Characterization of Infectious Vaginitis amongst Women of Reproductive Age Group from Navi Mumbai, India

PubMed Central

Narayankhedkar, Anuradha; Hodiwala, Anahita; Mane, Arati

2015-01-01

Vaginitis is one of the commonest reproductive tract infections in sexually active women. In the present study clinicoetiological characterization of infectious vaginitis amongst 380 women of reproductive age group (18–45 years) was done. Bacterial vaginosis (BV) was detected by Nugent's scoring, Candida infection by culture, and trichomoniasis (TV) by wet mount. One hundred and ten (28.9%) women presented with symptoms of vaginitis. The presenting symptoms were vaginal discharge 106 (96.4%), vulval itching/irritation 19 (17.3%), malodor 5 (4.5%), pain in abdomen 3 (2.7%), and dysuria 1 (0.9%). The commonest etiology detected was Candida in 33 (30%) cases, of which 18 (54.5%) were C. albicans and 15 (45.5%) non-albicans Candida (NAC) infections. The NAC isolates were C. glabrata (n = 10), C. tropicalis (n = 3), and C. krusei (n = 2). BV and TV were observed in 19 (17.3%) and 2 (1.8%) cases, respectively. A statistically significant association between Candida infection and presence of curdy-white discharge (p = 0.001) and vulval itching/irritation (p = 0.007) was noted. To conclude, we observed the etiological predominance of Candida infection, with considerable prevalence of NAC, indicating the need for microbiological investigation up to species level in cases of Candida infections, to ensure appropriate management. PMID:26351613

Do changes in anal sphincter anatomy correlate with anal function in women with a history of vaginal delivery?

PubMed

Murad-Regadas, Sthela Maria; Dealcanfreitas, Iris Daiana; Regadas, Francisco Sergio Pinheiro; Rodrigues, Lusmar Veras; Fernandes, Graziela Olivia da Silva; Pereira, Jacyara de Jesus Rosa

2014-01-01

To evaluate anal sphincter anatomy using three-dimensional ultrasonography (3-DAUS) in incontinent women with vaginal delivery, correlate anatomical findings with symptoms of fecal incontinence and determine the effect of vaginal delivery on anal canal anatomy and function. Female with fecal incontinence and vaginal delivery were assessed with Wexner's score, manometry, and 3DAUS. A control group comprising asymptomatic nulliparous was included. Anal pressure, the angle of the defect and length of the external anal sphincter (EAS), the anterior and posterior internal anal sphincter (IAS), the EAS + puborectal and the gap were measured and correlated with score. Of the 62, 49 had fecal incontinence and 13 were asymptomatic. Twenty five had EAS defects, 8 had combined EAS+IAS defects, 16 had intact sphincters and continence scores were similar. Subjects with sphincter defects had a shorter anterior EAS, IAS and longer gap than women without defects. Those with a vaginal delivery and intact sphincters had a shorter anterior EAS and longer gap than nulliparous. We found correlations between resting pressure and anterior EAS and IAS length in patients with defects. Fecal incontinence symptoms did not correlate with anal pressures and anal sphincter anatomy changes, but women with sphincter defects have shorter anterior EAS and IAS and a longer gap.

Clinicoetiological Characterization of Infectious Vaginitis amongst Women of Reproductive Age Group from Navi Mumbai, India.

PubMed

Narayankhedkar, Anuradha; Hodiwala, Anahita; Mane, Arati

2015-01-01

Vaginitis is one of the commonest reproductive tract infections in sexually active women. In the present study clinicoetiological characterization of infectious vaginitis amongst 380 women of reproductive age group (18-45 years) was done. Bacterial vaginosis (BV) was detected by Nugent's scoring, Candida infection by culture, and trichomoniasis (TV) by wet mount. One hundred and ten (28.9%) women presented with symptoms of vaginitis. The presenting symptoms were vaginal discharge 106 (96.4%), vulval itching/irritation 19 (17.3%), malodor 5 (4.5%), pain in abdomen 3 (2.7%), and dysuria 1 (0.9%). The commonest etiology detected was Candida in 33 (30%) cases, of which 18 (54.5%) were C. albicans and 15 (45.5%) non-albicans Candida (NAC) infections. The NAC isolates were C. glabrata (n = 10), C. tropicalis (n = 3), and C. krusei (n = 2). BV and TV were observed in 19 (17.3%) and 2 (1.8%) cases, respectively. A statistically significant association between Candida infection and presence of curdy-white discharge (p = 0.001) and vulval itching/irritation (p = 0.007) was noted. To conclude, we observed the etiological predominance of Candida infection, with considerable prevalence of NAC, indicating the need for microbiological investigation up to species level in cases of Candida infections, to ensure appropriate management.

The VI-SENSE-vaginal discharge self-test to facilitate management of vaginal symptoms.

PubMed

Geva, Adam; Bornstein, Jacob; Dan, Michael; Shoham, Hadar Kessary; Sobel, Jack D

2006-11-01

This study was undertaken to evaluate a diagnostic panty liner (VI-SENSE) (Common Sense, Caesarea, Israel) developed to facilitate diagnosis of vaginal infections by detecting disordered acidity level. Five hundred sixteen women with vulvovaginal symptoms were enrolled. Final clinical diagnosis included Amsel criteria, Gram stain analysis, pH determination, and Trichomonas vaginalis and Candida culture. VI-SENSE strip color status estimated by patients was compared with clinical diagnosis and pH measurement by using nitrazine paper. Statistical analysis included sensitivity and specificity calculations. The VI-SENSE test was positive in 226 of 249 patients (90.8%) with bacterial vaginosis or trichomoniasis. Nitrazine pH paper revealed elevated pH in 165 (66.5%) and the amine test was positive in 160 (64.3%) patients. The VI-SENSE test was negative in 217 of 267 patients (81.3%) without trichomoniasis or bacterial vaginosis. The VI-SENSE was positive in 85 of 92 women (92%), with mixed vaginal infection including Candida and bacterial vaginosis or trichomoniasis. Amine test, nitrazine pH paper and physician diagnosis relying only on speculum examination were inferior and positive in only 65 (70%), 59 (64%), and 66 (72%) patients, respectively. The VI-SENSE test was found to be superior to traditional individual tests in facilitating preliminary diagnosis of vaginal infections.

Implementation of a protocol to reduce occurrence of retained sponges after vaginal delivery.

PubMed

Lutgendorf, Monica A; Schindler, Lynnett L; Hill, James B; Magann, Everett F; O'Boyle, John D

2011-06-01

Retained sponges (gossypiboma) following vaginal delivery are an uncommon occurrence. Although significant morbidity from such an event is unlikely, there are many reported adverse effects, including symptoms of malodorous discharge, loss of confidence in providers and the medical system, and legal claims. To report a protocol intended to reduce the occurrence of retained sponges following vaginal delivery. After identification of limitations with existing delivery room protocols, we developed a sponge count protocol to reduce occurrence of retained vaginal sponges. We report our experience at Naval Medical Center Portsmouth, a large tertiary care military treatment facility with our efforts to implement a sponge count protocol to reduce retained sponges following vaginal delivery. With appropriate pre-implementation training, protocols which incorporate post-delivery vaginal sweep and sponge counts are well accepted by the health care team and can be incorporated into the delivery room routine.

Clinical Trials with Agents Currently Used in the Management of Vaginitis

PubMed Central

O'Brien, J. R.

1964-01-01

Results of treatment of 151 cases of vaginitis in patients attending a leukorrhea clinic were studied. The incidence of each type of vaginitis is recorded. Analysis of results of treatment with six compounds currently used in the therapy of vaginitis indicated that acetarsol or pimaricin compounds, with their broader spectra of activity, appeared to be most useful, prior to establishment of a definite diagnosis by means of cultures. Chlordantoin is an effective antifungal agent and is associated with a high percentage of “culture cures”. Resistant cases should be investigated for diabetes mellitus, and many are aided by a low carbohydrate diet. Metronidazole was used only for resistant cases of trichomoniasis, with a cure rate of over 80% when both partners were treated simultaneously. Triple-sulfa vaginal cream was effective in over 80% of patients with nonspecific vaginitis; no cases of resistant bacterial infections were encountered. Dienestrol cream was effective in relieving the symptoms of atrophic vaginitis. PMID:14144540

Sexual response in patients treated with sacral neuromodulation for lower urinary tract symptoms or fecal incontinence.

PubMed

van Voskuilen, A C; Oerlemans, D J; Gielen, N; Lansen-Koch, S M P; Weil, E H J; van Lankveld, J J D M; van den Hombergh, U; Baeten, C G M I; van Kerrenbroeck, P E V

2012-01-01

To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation. No statistically significant changes were found, although there seems to be a trend toward improvement in orgasm scores. In plethysmography all 3 patients showed increased vaginal pulse amplitude with the stimulator turned on with both erotic and non-erotic stimuli. This study does not show a clear effect of SNM on sexual function, although there seems to be an improvement in orgasm scores. The lack of response on psychological questionnaires and the increase in vaginal pulse amplitude after SNM implantation indicate that there might be a physiological response. Copyright © 2012 S. Karger AG, Basel.

[Sacrospinous colpopexy complications].

PubMed

Estrade, J-P; Agostini, A; Roger, V; Dallay, D; Blanc, B; Cravello, L

2004-10-01

To evaluate complications of sacrospinous ligament fixation. Monocentric retrospective study. Department of Obstetrics & Gynecology, La Conception University Hospital, Marcella. Between January 1991 and September 2002, 277 women (mean age 64.9 years, range 37 to 92 years) underwent a sacrospinous ligament fixation; 91% had a menopausal status, and 15.5% used hormone replacement therapy. 33.2% of the patients had prior hysterectomy, 28.9% had a history of surgery for prolapse, and 18.8% had associated symptoms of stress urinary incontinence. In all cases, sacrospinous ligament fixation was performed under visual control using conventional stitch. Sacrospinous ligament fixation was combined with the following procedures: anterior vaginal repair (N =137), additional incontinence surgery (N =31), vaginal hysterectomy (N =137), levator myorraphy (N =203). Intraoperative complications, postoperative complications, long-term painful symptoms. Intraoperative complications were represented by 1 case of vascular wound and four rectal injuries. Main postoperative complications were vaginal haematomas (N =6) and abscesses (N =2). Long-term symptoms were perineal pain, sciatic neuralgia, and dyspareunia. There was no surgical mortality, and we noted low rates of major complications. Sacrospinous ligament fixation assumes high priority in our therapeutic regimen.

Saccharomyces cerevisiae vaginitis: transmission from yeast used in baking.

PubMed

Nyirjesy, P; Vazquez, J A; Ufberg, D D; Sobel, J D; Boikov, D A; Buckley, H R

1995-09-01

To determine whether vaginitis due to Saccharomyces cerevisiae can be caused by exposure to exogenous sources of baker's yeast. Eight women with S cerevisiae vaginitis were identified from a cohort of women referred for the evaluation of chronic vaginal symptoms. In those with high-level exposure to exogenous sources of S cerevisiae, isolates from the vagina and those sources were sent in a blinded fashion for contour-clamped homogeneous electric-field electrophoresis. Four women from a cohort of approximately 750 referred patients had high-level exposures to S cerevisiae. In one of these patients, electrophoresis analysis revealed similarities between the strains isolated from her vagina, her husband's fingers, and the yeast he used in his pizza shop. Saccharomyces cerevisiae vaginitis can be the result of the inoculation of this yeast from exogenous sources.

Vaginal and Sexual Health Treatment Strategies within a Female Sexual Medicine Program for Cancer Patients and Survivors

PubMed Central

Carter, Jeanne; Stabile, Cara; Seidel, Barbara; Baser, Raymond E.; Goldfarb, Shari; Goldfrank, Deborah J.

2016-01-01

Purpose We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program, and identify improvements of physical symptoms, per patient and clinical evaluation. Methods Evalubility criteria included gynecologic exam at initial visit; at least one follow-up with gynecologic exam within 8 months of initial visit; and all consecutive follow-ups <6 months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least 1 follow-up from 09/12–10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n=90, 53%), gynecologic (n=54, 32%), or colorectal/anal (n=15, 9%) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes. Results Mean number of visits was 3.43. Mean age was 55.4 years; 92% (n=155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy and function) associated with cancer treatment and support. At last assessment, 89% had complied with the clinical recommendation (moisturize 2–5+ times/week). Vaginal pH scores >6.5 declined over time (p=0.03). VAS scores improved by last assessment (p<0.001), as did VuAS scores (p=0.001). Sexual function scores significantly improved (p<0.001), confidence about future sexual activity increased (p=0.004), and sexual/vaginal health concerns decreased (p=0.00003). Conclusion Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and intimacy confidence. Implications for Cancer Survivors These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting. PMID:27868156

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.

How do clinicians manage vaginal complaints? An Internet survey.

PubMed

Anderson, Matthew R; Karasz, Alison

2005-06-21

Although vaginal symptoms are among the most common presentations in primary care, little is known about how clinicians manage them. We undertook an Internet survey to determine how clinicians decided what was normal, how they evaluated vaginal complaints, and what happened when a diagnosis could not be reached. A 27-question anonymous survey was conducted using the Medscape Internet publication platform and Medscape General Medicine , an online, peer-reviewed, open-access general medical journal. The study was targeted at physicians and nurse practitioners. There were 556 nurse practitioner and 608 physician respondents. Clinicians generally agreed that a midcycle increase in discharge and discharge seen at the introitus were normal; itching/irritation, odor, and a green discharge were not. There was less agreement concerning the value of a yellow discharge and "self-diagnosis" of abnormality. Eighty-two percent of MDs and 77% of NPs reported examining patients prior to treatment always or often. Only about 30% performed pH testing always or often. Ninety percent of NPs and 92% of MDs reported not making a diagnosis rarely or sometimes. When offered 4 different management strategies for patients in whom no diagnosis was made (watch and wait, symptomatic therapy, empiric antibiotics, referral), there was no clear preference. There was a weak correlation between performance of a wet mount and reports of less non-diagnosis. There was no correlation between pH and whiff testing and reports of less non-diagnosis. Clinicians do not always agree about what constitutes a vaginal symptom. Although most providers usually examine patients with vaginal complaints, pH and whiff testing are performed less frequently. Our data suggest the latter 2 maneuvers are not diagnostically helpful. There is no consensus regarding what to do when no diagnosis is made. Our findings suggest that the traditional approach to the evaluation of vaginal symptoms may have limited relevance for clinicians.

Restoring vaginal microbiota: biological control of bacterial vaginosis. A prospective case-control study using Lactobacillus rhamnosus BMX 54 as adjuvant treatment against bacterial vaginosis.

PubMed

Recine, Nadia; Palma, Ettore; Domenici, Lavinia; Giorgini, Margherita; Imperiale, Ludovica; Sassu, Carolina; Musella, Angela; Marchetti, Claudia; Muzii, Ludovico; Benedetti Panici, Pierluigi

2016-01-01

Bacterial vaginosis (BV) is the most prevalent lower genital tract infection in reproductive-age women worldwide. BV is an ecological disorder of the vaginal microbiota characterized microbiologically by replacement of the lactobacilli, predominant vaginal microbiota. It is characterized by a high rate of relapse in sexual active women, and these patients show three or more relapses each year. A healthy vagina is characterized by hydrogen peroxide and acid-producing lactobacilli, which are crucial to maintain the physiological vaginal ecosystem and their depletion speeds up bacterial overgrowth with pH elevation, salidase and amine production, leading to the observed signs and symptoms of BV. The aim of this study is to evaluate the efficacy of long-term vaginal lactobacilli's implementation in restoring and maintaining vaginal microflora and pH and to collect data about prophylactic approach based on probiotics supplementation with lactobacilli. This is a prospective case-control study, performed between January 2013 and September 2014 at Department of Gynecological Obstetrics and Urologic Sciences of "Sapienza" University of Rome. 250 non-pregnant sexually active women with diagnoses of BV were collected. Patients selected were divided in Group A (125 patients assigned to standard treatment for BV-metronidazole 500 mg orally twice a day for 7 days) and Group B (125 women undergoing the same standard antibiotic regimen followed by vaginal tablets containing Lactobacillus rhamnosus BMX 54). Patients were evaluated after 2, 6, and 9 months (T0, T2, T6, and T9) in term of recurrences rates of BV, vaginal symptoms, re-establishment of healthy vaginal flora, vaginal pH, and treatment tolerability. Vaginal flora was significantly replaced in Group B patients after 2 months comparing with Group A (p = 0.014). These data were confirmed at 6 and 9 months follow-up: patients that underwent prophylactic therapy with NORMOGIN(®) experienced significantly low rate of recurrences comparing with patients treated with antibiotics only (p < 0.001). During follow-up patients continuing supplementation had significant pH decrease respect to other patients (p < 0.001 at 9 months follow-up visit). Probiotic supplementation with vaginal Lactobacillus rhamnosus BMX54 seems to be useful in hindering bacteria growth especially after antibiotic therapy; therefore this intervention may be considered a new prophylactic treatment for preventing recurrence of BV, in particular in high-risk patients.

The influence of women’s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study

PubMed Central

2014-01-01

Background This study aimed to examine whether a mismatch between a woman’s preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. Methods The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women’s preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. Results Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. Conclusions The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even though vaginal delivery is usually the best option in the absence of medical indications. To avoid potential trauma, fear of childbirth and maternal requests for a cesarean section should be taken seriously and responded to adequately. PMID:24898436

The influence of women's preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study.

PubMed

Garthus-Niegel, Susan; von Soest, Tilmann; Knoph, Cecilie; Simonsen, Tone Breines; Torgersen, Leila; Eberhard-Gran, Malin

2014-06-05

This study aimed to examine whether a mismatch between a woman's preferred and actual mode of delivery increases the risk of post-traumatic stress symptoms after childbirth. The study sample consisted of 1,700 women scheduled to give birth between 2009 and 2010 at Akershus University Hospital, Norway. Questionnaire data from pregnancy weeks 17 and 32 and from 8 weeks postpartum were used along with data obtained from hospital birth records. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Based on the women's preferred and actual mode of delivery, four groups were established: Match 1 (no preference for cesarean section, no elective cesarean section, N = 1,493); Match 2 (preference for cesarean section, elective cesarean section, N = 53); Mismatch 1 (no preference for cesarean section, elective cesarean section, N = 42); and Mismatch 2 (preference for cesarean section, no elective cesarean section, N = 112). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were conducted to examine whether the level of post-traumatic stress symptoms differed significantly among these four groups. Examining differences for all four groups, ANOVA yielded significant overall group differences (F = 11.96, p < 0.001). However, Bonferroni post-hoc tests found significantly higher levels of post-traumatic stress symptoms only in Mismatch 2 compared to Match 1. This difference could be partly explained by a number of risk factors, particularly psychological risk factors such as fear of childbirth, depression, and anxiety. The results suggest increased post-traumatic stress symptoms in women who preferred delivery by cesarean section but delivered vaginally compared to women who both preferred vaginal delivery and delivered vaginally. In psychologically vulnerable women, such mismatch may threaten their physical integrity and, in turn, result in post-traumatic stress symptoms. These women, who often fear childbirth, may prefer a cesarean section even though vaginal delivery is usually the best option in the absence of medical indications. To avoid potential trauma, fear of childbirth and maternal requests for a cesarean section should be taken seriously and responded to adequately.

Streptococcus pyogenes pharyngeal colonization resulting in recurrent, prepubertal vulvovaginitis.

PubMed

Hansen, Megan T; Sanchez, Veronica T; Eyster, Kathleen; Hansen, Keith A

2007-10-01

Recurrent, prepubertal, vaginal infections are an uncommon, troublesome problem for the patient and her family. Failure of initial therapy to alleviate vulvovaginitis may be related to vulvar skin disease, foreign body, sexual abuse, pinworms, reactions to medications, anatomic anomalies, or allergies. This report describes a case of recurrent Streptococcus pyogenes vulvovaginitis secondary to presumed vaginal re-inoculation from pharyngeal colonization. A 4-yr-old presented with one year of culture proven, recurrent Streptococcus pyogenes vulvovaginitis. Her symptoms repeatedly resolved with penicillin therapy, but continued to recur following cessation of antibiotic therapy. Evaluation included physical examination, trans-abdominal pelvic ultrasound, and vaginoscopy which all revealed normal upper and lower genital tract anatomy. Both the patient and her mother demonstrated culture proven, Group A Streptococcus pharyngeal colonization. Because of the possibility of repeated inoculations of the vaginal area from the colonized pharynx, they were both treated for decolonization with a regimen of amoxicillin and rifampin for ten days. Following this therapy there was resolution of vaginal symptoms with no further recurrence. Follow-up pharyngeal culture done on both mother and child on their last visit were negative for Group A Streptococcus. This case demonstrated an unusual specific cause of recurrent vaginitis resulting from presumed self or maternal re-inoculation with group A beta-hemolytic streptococcus from pharyngeal colonization. Group A beta-hemolytic streptococcus are consistently sensitive to penicillin, but up to 25% of acute pharyngitis cases treated with penicillin having continued asymptomatic, bacterial carriage within the nasopharynx. Thus initial alleviation of symptoms in a patient with Group A beta-hemolytic vulvovaginitis treated with penicillin, can have continued asymptomatic pharyngeal colonization which can result in recurrence of the vulvovaginitis. This case stresses the importance of considering re-infection through this route in the patient with recurrent Group A beta-hemolytic streptococcus vulvovaginitis.

Reproductive history and progression of lower urinary tract symptoms in women: results from a population-based cohort study.

PubMed

Maserejian, Nancy N; Curto, Teresa; Hall, Susan A; Wittert, Gary; McKinlay, John B

2014-04-01

To examine whether reproductive history and related conditions are associated with the development and persistence of lower urinary tract symptoms (LUTS) other than urinary incontinence in a racially and/or ethnically diverse population-based sample of women. The Boston Area Community Health Survey enrolled 3201 women aged 30-79 years of black, Hispanic, or white race and/or ethnicity. Baseline and 5-year follow-up interviews were completed by 2534 women (conditional response rate, 83.4%). The association between reproductive history factors and population-weighted estimates of LUTS progression and persistence was tested using multivariable logistic regression models. Between baseline and 5-year follow-up, 23.9% women had LUTS progression. In age-adjusted models, women who had delivered ≥2 childbirths had higher odds of LUTS progression, but the association was completely accounted for by vaginal child delivery (eg, 2 vaginal childbirths vs none, multivariable-adjusted odds ratio = 2.21; 95% CI, 1.46-3.35; P <.001). No increased odds of LUTS progression were found for women with only 1 vaginal delivery or who only had cesarean section(s). Uterine prolapse was associated with higher odds of LUTS progression (multivariable-adjusted odds ratio = 3.05; 95% CI, 1.43-6.50; P = .004). Gestational diabetes was associated with approximately twice the odds of LUTS progression, but only among younger women (interaction P = .003). In this cohort study, ≥2 vaginal child deliveries, uterine prolapse, and among younger women, gestational diabetes were robust predictors of LUTS progression. Clinicians should assess the presence of bothersome urinary frequency, urgency, and voiding symptoms among women who have had multiple vaginal childbirths or gestational diabetes. Copyright © 2014 Elsevier Inc. All rights reserved.

Polymicrobial nature of vaginitis in young women: a microbiological and therapeutic study.

PubMed

Kippax, R A; Caradoc-Davies, G; Meech, R J

1982-03-24

Thirty-six young females attending the Student Health Service with vaginitis were investigated by serial semiquantitative aerobic, anaerobic, fungal, mycoplasma and viral cultures over a 10 day period and results were correlated with signs and symptoms. Antifungal therapy (econazole pessaries and cream) resulted in clearance of candida from 13 out of 16 patients where there was no increase in the anaerobic flora. In the four subjects where candida was isolated along with Gardnerella vaginalis plus abnormal anaerobic flora, only one cleared with econazole, the remaining three clearing during therapy with metronidazole. In the nine subjects with Gardnerella vaginalis and abnormal anaerobic flora, metronidazole relieved symptoms despite failure to eradicate G. vaginalis in seven indicating the pathogenic role of the anaerobic flora rather then G. vaginalis. Mycoplasma hominis, Ureaplasma urealyticum and gram negative enteric bacilli were not implicated as primary agents in causing vaginitis.

Hymenal stenosis and fibrosis in two adult women.

PubMed

Goldstein, Andrew T; Todd, Sarah; Bedell, Sarah; Tabbarah, Abeer

2015-05-01

Hymenal abnormalities are most commonly a result of incomplete apoptosis of the urogenital sinus during embryology. Infrequently, however, noncongenital abnormalities of the hymen can occur that can cause significant sequelae such as severe introital dyspareunia. We report on two adult women who developed severe introital dyspareunia secondary to hymenal stenosis and fibrosis in the absence of other vulvovaginal pathology. Neither woman had point tenderness of the vulvar vestibule, but their symptoms of searing pain on vaginal penetration was reproduced by stretching the hymen with two fingers. In both cases, conservative treatments with vaginal dilators in combination with topical hormonal therapy failed to relieve their symptoms, but both women were subsequently successfully treated with hymenectomy. Hymenal stenosis and fibrosis can develop in the absence of identifiable vulvar dermatoses. If conservative treatment with topical hormonal therapy and vaginal dilators is unsuccessful, hymenectomy can restore normal coital function.

Klippel-Trenaunay syndrome complicated by ascites and vaginal lymphatic drainage in adolescence: a case report.

PubMed

Scribner, Dennis R; Lara-Torre, Eduardo; Heineck, Robert J; Weiss, Patrice M

2012-12-01

Klippel-Trenaunay syndrome is a rare disease characterized by capillary malformationsand soft tissue and bony hypertrophy and atypical varicosities. Management of this syndrome is focused primarily on treatment of the complications that arise from these malformations. Ascites and lymphedema are two of the more common complications in these patients. A 15-year-old female with Klippel-Trenaunay syndrome presented with chylous ascites, vaginal drainage, and unilateral lower extremity lymphedema. Treatment included dilation, hysteroscopy and curettage, and laparoscopic evacuation of abdomino-pelvic ascites with resolution of symptoms for 32 months. Repeat laparoscopic drainage was successful and remains symptom free after 12 months. Vaginal drainage of chylous ascites is a rare complication from Klippel-Trenaunay syndrome and can be successfully managed by techniques to remove abdomino-pelvic ascites. Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Daily temporal dynamics of vaginal microbiota before, during and after episodes of bacterial vaginosis.

PubMed

Ravel, Jacques; Brotman, Rebecca M; Gajer, Pawel; Ma, Bing; Nandy, Melissa; Fadrosh, Douglas W; Sakamoto, Joyce; Koenig, Sara Sk; Fu, Li; Zhou, Xia; Hickey, Roxana J; Schwebke, Jane R; Forney, Larry J

2013-12-02

Bacterial vaginosis (BV) is a common gynecologic diagnosis characterized by dysbiosis of the vaginal microbiota. It is often accompanied by vaginal symptoms such as odor and discharge, but can be asymptomatic. Despite over 50 years of research, the etiology of BV is not well understood, which is a major impediment to treatment and prevention of BV. Here we report on the temporal dynamics of 25 vaginal communities over a 10 week period using samples collected daily from women who were diagnosed with symptomatic BV (15 women), asymptomatic BV (6 women), and women who did not have BV (4 women). This unique resource of samples and data will contribute to a better understanding of the role that the vaginal microbes have in the natural history of BV and lead to improved diagnosis and treatment.

The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health.

PubMed

Koumans, Emilia H; Sternberg, Maya; Bruce, Carol; McQuillan, Geraldine; Kendrick, Juliette; Sutton, Madeline; Markowitz, Lauri E

2007-11-01

Bacterial vaginosis (BV), a disturbance of vaginal microflora, is a common cause of vaginal symptoms and is associated with an increased risk of acquisition of sexually transmitted infections, HIV, and with adverse pregnancy outcomes. We determined prevalence and associations with BV among a representative sample of women of reproductive age in the United States. Women aged 14-49 years participating in the National Health and Nutrition Examination Survey 2001-2004 were asked to submit a self-collected vaginal swab for Gram staining. BV, determined using Nugent's score, was defined as a score of 7-10. The prevalence of BV was 29.2% (95% confidence interval 27.2%-31.3%) corresponding to 21 million women with BV; only 15.7% of the women with BV reported vaginal symptoms. Prevalence was 51.4% among non-Hispanic blacks, 31.9% among Mexican Americans, and 23.2% among non-Hispanic whites (P <0.01 for each comparison). Although BV was also associated with poverty (P <0.01), smoking (P <0.05), increasing body mass index (chi2 P <0.0001 for trend), and having had a female sex partner (P <0.005), in the multivariate model, BV only remained positively associated with race/ethnicity, increasing lifetime sex partners (chi2 P <0.001 for trend), increasing douching frequency (chi2 P for trend <0.001), low educational attainment (P <0.01), and inversely associated with current use of oral contraceptive pills (P <0.005). BV is a common condition; 84% of women with BV did not report symptoms. Because BV increases the risk of acquiring sexually transmitted infections, BV could contribute to racial disparities in these infections.

Non-albicans Candida Vulvovaginitis: Treatment Experience at a Tertiary Care Vaginitis Center.

PubMed

Powell, Anna M; Gracely, Edward; Nyirjesy, Paul

2016-01-01

The aims of this study are to analyze a cohort of women with vulvovaginal symptoms and positive cultures for non-albicans Candida (NAC) to determine whether yeast was responsible for their symptoms and to evaluate the mycological effectiveness of various regimens. This observational study was performed from retrospective chart review of patients with positive NAC cultures between April 1, 2008, and January 31, 2011, at a tertiary care vaginitis center. Patient intake demographics were entered into a database. Follow-up visits were analyzed for data about patient treatments and outcomes. Patients were considered a clinical cure if their symptoms were significantly improved and mycologic cure (MC) if later yeast cultures were negative. If clinical symptoms improved at the same time as MC, the isolate was considered the proximate cause for the symptoms. One hundred eight patients meeting entry criteria were analyzed. Boric acid was effective at obtaining MC in 32 (78%) of 41 patients with C. glabrata, 3 of 3 patients with C. tropicalis, and 3 of 3 patients with C. lusitaniae. Fluconazole was effective as initial treatment for 3 (60%) of 5 patients with C. glabrata and 13 (81%) of 16 patients with C. parapsilosis. In 52.7% of C. glabrata, 66.7% of C. parapsilosis, and 57.1% of C. tropicalis cases, effective antifungal therapy led to symptom improvement. In a tertiary care vaginitis center, NAC, when isolated on culture, caused clinically significant infections in approximately half of symptomatic patients. A majority of infections can be effectively treated with boric acid or fluconazole regardless of the non-albicans Candida species.

Should symptomatic menopausal women be offered hormone therapy?

PubMed

Lobo, Rogerio A; Bélisle, Serge; Creasman, William T; Frankel, Nancy R; Goodman, Neil F; Hall, Janet E; Ivey, Susan Lee; Kingsberg, Sheryl; Langer, Robert; Lehman, Rebecca; McArthur, Donna Behler; Montgomery-Rice, Valerie; Notelovitz, Morris; Packin, Gary S; Rebar, Robert W; Rousseau, MaryEllen; Schenken, Robert S; Schneider, Diane L; Sherif, Katherine; Wysocki, Susan

2006-01-01

Many physicians remain uncertain about prescribing hormone therapy for symptomatic women at the onset of menopause. The American Society for Reproductive Medicine (ASRM) convened a multidisciplinary group of healthcare providers to discuss the efficacy and risks of hormone therapy for symptomatic women, and to determine whether it would be appropriate to treat women at the onset of menopause who were complaining of menopausal symptoms. Numerous controlled clinical trials consistently demonstrate that hormone therapy, administered via oral, transdermal, or vaginal routes, is the most effective treatment for vasomotor symptoms. Topical vaginal formulations of hormone therapy should be preferred when prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy. Data from the Women's Health Initiative indicate that the overall attributable risk of invasive breast cancer in women receiving estrogen plus progestin was 8 more cases per 10,000 women-years. No increased risk for invasive breast cancer was detected for women who never used hormone therapy in the past or for those receiving estrogen only. Hormone therapy is not effective for the treatment of cardiovascular disease and that the risk of cardiovascular disease with hormone therapy is principally in older women who are considerably postmenopause. Healthy symptomatic women should be offered the option of hormone therapy for menopausal symptoms. Symptom relief with hormone therapy for many younger women (at the onset of menopause) with menopausal symptoms outweighs the risks and may provide an overall improvement in quality of life. Hormone therapy should be individualized for symptomatic women. This involves tailoring the regimen and dose to individual needs.

Symptoms of reproductive tract infections and mental distress among women in low-income urban neighborhoods of Beirut, Lebanon.

PubMed

Khawaja, Marwan; Kaddour, Afamia; Zurayk, Huda; Choueiry, Nathalie; El-Kak, Faysal

2009-10-01

The aim of this study was to examine the association between symptoms of reproductive tract infections (RTIs) and mental distress among women residing in three low-income urban neighborhoods in Greater Beirut. A cross-sectional survey of currently married women aged 15-49 years (n = 1506) from the 2003 Urban Health Study was undertaken. The dependent variables were complaining of vaginal discharge, pelvic pain, and pain during intercourse. The main independent variable was mental distress, measured using the General Health Questionnaire-12 (GHQ). Other variables included decision-making power, "comfort" with husband, age, education, income, household wealth, employment, community of residence, displacement by war, presence of chronic disease, reported reproductive health problem, membership in any group, receipt of favor last month, and smoking. Analysis was conducted using logistic regression models on the complaint of any symptom of RTIs and on individual complaints. Forty-two percent of the interviewed women reported at least one symptom of RTIs. Vaginal discharge was the most commonly reported symptom, with 33% of currently married women complaining from it. Mental distress was significantly associated with any reported RTI symptom (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.09-1.83), pelvic pain (OR = 2.38; CI = 1.71-3.30), vaginal discharge (OR = 1.35; CI = 1.03-1.77), and pain during intercourse (OR = 2.37; CI = 1.66-3.40) after adjusting for demographic, socioeconomic, and health risk factors. A significant association between mental distress and reported RTI symptoms was established by this study. A new approach to gynecological morbidity is needed, one that integrates biomedical and psychosocial factors into a unified framework.

[Bacterial flora and mycosis of the vagina in women with symptoms of vaginal inflammation].

PubMed

Dybaś, Irena; Sidor-Wójtowicz, Anna; Kozioł-Montewka, Maria

2005-05-01

To estimate the microbiological profile of vaginal flora in 30 women with gynecologic problems and 20 pregnant women complaining about pathological symptoms {pruritus, burning, vaginal discharge}. The discharge from posterior vaginal vault was examined microbiologically on the Columbia Agar with sheep blood, MacConkey and Sabourand cultures incubated of 48 hours in the temperature of 37 degrees C. Bacterial infections were detected in 33 cases (66%), 12 of these women (24%) lived in urban, 21 (42%) in rural environment. From bacteria isolated from the vagina, most often because at 14 women stepped out Streptococcus agalactiae, at 11 Enterococcus faecalis at 8 Escherichia coli. In 5 cases bacterial inflammation was caused by two kinds of bacterium. At two women stepped out both Enterococcus faecalis and Escherichia coli. In single cases it was Klebsiella pneumoniae and Proteus vulgaris, Escherichia coli and Streptococcus agalactiae. In all cases of inflammation mycosis was called out by from Candida albicans. One ascertained it at 14 among all given an examination women. Mixed inflammations called out both by mycosis and bacterial stepped out in 3 cases in age of 21-30. At two women it was Candida albicans and Streptococcus agalactiae, at one inflammation mycosis accompanied Enterococcus faecalis. The common reason of vaginitis are bacterial infections caused by Streptococcus agalactiae, Enterococcus faecalis, E coli. Both, place of living and women' s age influence the type of etiological factor.

The effect of hormones on the lower urinary tract.

PubMed

Robinson, Dudley; Toozs-Hobson, Philip; Cardozo, Linda

2013-12-01

The female genital and lower urinary tracts share a common embryological origin, arising from the urogenital sinus and both are sensitive to the effects of the female sex steroid hormones throughout life. Estrogen is known to have an important role in the function of the lower urinary tract and estrogen and progesterone receptors have been demonstrated in the vagina, urethra, bladder and pelvic floor musculature. In addition estrogen deficiency occurring following the menopause is known to cause atrophic change and may be associated with lower urinary tract symptoms such as frequency, urgency, nocturia, urgency incontinence and recurrent infection. These may also co-exist with symptoms of urogenital atrophy such as dyspareunia, itching, vaginal burning and dryness. Epidemiological studies have implicated estrogen deficiency in the aetiology of lower urinary tract symptoms with 70% of women relating the onset of urinary incontinence to their final menstrual period. Whilst for many years systemic and vaginal estrogen therapy was felt to be beneficial in the treatment of lower urinary and genital tract symptoms this evidence has recently been challenged by large epidemiological studies investigating the use of systemic hormone replacement therapy as primary and secondary prevention of cardiovascular disease and osteoporosis. The aim of this paper is to examine the effect of the sex hormones, estrogen and progesterone, on the lower urinary tract and to review the current evidence regarding the role of systemic and vaginal estrogens in the management of lower urinary tract symptoms and urogenital atrophy.

[Management of vaginal infection following failure of a probabilistic treatment: is the vaginal swab really useful?].

PubMed

Bretelle, F; Chiarelli, P; Palmer, I; Glatt, N

2015-02-01

The aim of this observational national multi-centre study was to describe medical care of vaginal infections resisting a primary probabilistic treatment. Two hundred and seventy female patients were included during a 9-month period (from 2013, March 20th to 2013, December 7th) by 155 gynaecologists located throughout France. All patients were presenting a vulvo-vaginitis episode which started about three weeks ago and which was characterized by leucorrhea (93 % cases), itching (88 % cases) and/or vulvar and/or vaginal irritation (88 % cases). In most cases, this episode was previously treated by a short course of an azole antifungal medication. This treatment was initiated by the patient herself without any doctor's prescription in six out of 10 cases and had no influence on the evolution of the original clinical symptoms. Second line treatments included azole antifungal medications (56 % cases), local fixed combinations (antifungal agent and bactericidal antibiotic) (29 %), metronidazole (9 %), oral antibiotics (7.4 %). At the end of the treatment, 85 % patients recovered from vaginitis symptoms. The recovery rate was 82.6 % for patients who got a bacteriological examination and 87.6 % for patients who were treated without any bacteriological examination. The difference is not statistically significant. These results seem to show that a probabilistic medical care is as effective as (but probably more economical than) a therapeutic strategy guided by the results of further examinations in case of failure of a primary treatment. This conclusion should be confirmed by a medico-economic comparison after randomization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Semiquantitative culture of Gardnerella vaginalis in laboratory determination of nonspecific vaginitis.

PubMed Central

Ratnam, S; Fitzgerald, B L

1983-01-01

To evaluate the usefulness of quantitative cultures of Gardnerella vaginalis in the laboratory determination of nonspecific vaginitis, the actual and relative numbers of G. vaginalis in genital cultures of a general patient population were assessed semiquantitatively, and the laboratory results were then correlated with the clinical findings. Of the 1,585 women studied, 417 (26.3%) yielded G. vaginalis in culture. Of these, only 113 (27.1%) were found to have symptoms and signs consistent with nonspecific vaginitis. G. vaginalis was obtained in pure or predominant growth from 87 of 100 consecutive cases with nonspecific vaginitis and 32 of 100 consecutive cases without the symptoms or signs of vaginitis (P less than 0.001). Hence, the positive predictive value of isolation of G. vaginalis in pure and predominant growths was determined to be 73% (87 of 119). Conversely, G. vaginalis was isolated in mixed or light growth significantly more often from asymptomatic women than from symptomatic patients, i.e., 68 versus 13 cases. Therefore, the negative predictive value of isolation of G. vaginalis in mixed and light growths was found to be 84% (68 of 81). Quantitation of the relative amount of G. vaginalis growth had higher predictive values as compared with the assessment of G. vaginalis growth alone. We conclude that quantitative culture of G. vaginalis is essential to obtain maximum reliability of culture results in the laboratory determination of nonspecific vaginitis. Although quantitated cultures of G. vaginalis have high predictive values, laboratory results must be interpreted in conjunction with the clinical findings. PMID:6604735

Primary Papillary Serous Carcinoma of the Fallopian Tube Presenting as a Vaginal Mass: A Case Report and Review of the Literature.

PubMed

Kadour-Peero, Einav; Sagi-Dain, Lena; Cohen, Gil; Korobochka, Roman; Agbarya, Abed; Bejar, Jacob; Sagi, Shlomi

2018-05-07

BACKGROUND There is now evidence to support that some cases of high-grade serous papillary carcinoma arise from the fallopian tubes rather than the ovaries. Common symptoms at presentation include abdominal pain and swelling, vomiting, altered bowel habit and urinary symptoms. To our knowledge, this is the first case of serous papillary carcinoma presenting as a vaginal mass lesion. CASE REPORT A 41-year-old woman was referred to the Bnai-Zion Medical Center with the main complaint of irregular vaginal bleeding, vaginal mucous discharge, and suspected pelvic mass. Physical examination showed a soft, painless mass, measuring about 10 cm in diameter located mainly in the recto-vaginal septum, but not involving the uterus. Ultrasound examination showed no abnormal ovarian or uterine findings. Transvaginal biopsies of the mass showed a poorly differentiated serous papillary carcinoma of ovarian, tubal, or peritoneal origin. The physical examination and imaging findings strongly indicated an inoperable tumor, and the patient was treated with neoadjuvant (pre-surgical) chemotherapy. Pre-operative computed tomography (CT) imaging showed the partial involvement of the colon, and so surgical treatment included total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, partial vaginectomy, anterior rectal resection, and lymph node dissection. Histopathology of the surgical specimens showed a poorly differentiated serous carcinoma originating from the fimbria of the right fallopian tube. CONCLUSIONS To the best of our knowledge, this is the first report to describe primary fallopian tube papillary serous carcinoma presenting as a vaginal mass. Therefore, physicians should be aware of this possible diagnosis.

Vitamin D Proliferates Vaginal Epithelium through RhoA Expression in Postmenopausal Atrophic Vagina tissue

PubMed Central

Lee, Arum; Lee, Man Ryul; Lee, Hae-Hyeog; Kim, Yeon-Suk; Kim, Jun-Mo; Enkhbold, Temuulee; Kim, Tae-Hee

2017-01-01

Postmenopausal atrophic vagina (PAV) is the thinning of the walls of the vagina and decreased lugae of the vagina. PAV is caused by decreased estrogen levels in postmenopausal women. However, the harmful effects of hormone replacement therapy (HRT) have resulted in considerable caution in its use. Various estrogen agonist treatment options are available. Vitamin D is influences the regulation of differentiation and proliferation of various cells, especially tissues lining stratified squamous epithelium, such as the vaginal epithelium. In this study, we hypothesized that vitamin D could provide an alternative and a safe treatment option for PAV by promoting the proliferation and differentiation of the vaginal epithelium. Thirty six patients were enrolled in this case-control study. Vitamin D associated proteins in a vitamin D and sex hormone treated vaginal epithelial cell line as well as normal and PAV tissues were measured. To confirm of cell-to-cell junction protein expression, cell line and tissue studies included RT-PCR, immunohistochemistry staining, and immunoblot analyses. The expression of cell-to-cell junction proteins was higher in women with symptoms of atrophic vagina tissue compared to women without the symptoms. Vitamin D stimulated the proliferation of the vaginal epithelium by activating p-RhoA and Erzin through the vitamin D receptor (VDR). The results suggest that vitamin D positively regulates cell-to-cell junction by increasing the VDR/p-RhoA/p-Ezrin pathway. This is the first study to verify the relationship of the expression of RhoA and Ezrin proteins in vaginal tissue of PAV. PMID:28843271

Vitamin D Proliferates Vaginal Epithelium through RhoA Expression in Postmenopausal Atrophic Vagina tissue.

PubMed

Lee, Arum; Lee, Man Ryul; Lee, Hae-Hyeog; Kim, Yeon-Suk; Kim, Jun-Mo; Enkhbold, Temuulee; Kim, Tae-Hee

2017-09-30

Postmenopausal atrophic vagina (PAV) is the thinning of the walls of the vagina and decreased lugae of the vagina. PAV is caused by decreased estrogen levels in postmenopausal women. However, the harmful effects of hormone replacement therapy (HRT) have resulted in considerable caution in its use. Various estrogen agonist treatment options are available. Vitamin D is influences the regulation of differentiation and proliferation of various cells, especially tissues lining stratified squamous epithelium, such as the vaginal epithelium. In this study, we hypothesized that vitamin D could provide an alternative and a safe treatment option for PAV by promoting the proliferation and differentiation of the vaginal epithelium. Thirty six patients were enrolled in this case-control study. Vitamin D associated proteins in a vitamin D and sex hormone treated vaginal epithelial cell line as well as normal and PAV tissues were measured. To confirm of cell-to-cell junction protein expression, cell line and tissue studies included RT-PCR, immunohistochemistry staining, and immunoblot analyses. The expression of cell-to-cell junction proteins was higher in women with symptoms of atrophic vagina tissue compared to women without the symptoms. Vitamin D stimulated the proliferation of the vaginal epithelium by activating p-RhoA and Erzin through the vitamin D receptor (VDR). The results suggest that vitamin D positively regulates cell-to-cell junction by increasing the VDR/p-RhoA/p-Ezrin pathway. This is the first study to verify the relationship of the expression of RhoA and Ezrin proteins in vaginal tissue of PAV.

Candida vulvovaginitis: A store with a buttery and a show window.

PubMed

Donders, Gilbert G G; Sobel, Jack D

2017-02-01

Although being an utterly frequent, non-mortal, yet distressing disease, and despite good knowledge of the pathogenesis and the availability of specific and safe treatment, vulvovaginal Candida (VVC) infection remains one of the most enigmatic problems for both physicians and patients. Good treatment requires a proper diagnosis. Too many caregivers (and patients treating themselves) react too simple-minded on the symptoms of VVC and treat VVC where they see it on the vulva. In this opinion paper, we plea for a thorough examination of women with VVC, especially in those women who suffer from recurrent disease since a long time, sometimes decades, which necessitates intensive examination of the vaginal flora, as this is invariably the reservoir for relapses and recurrent vulvitis. Examination of such complicated cases requires experienced clinical judgement, expertise bedside phase contrast microscopy of fresh vaginal fluid, classical cultures on Sabouroud medium and, if still unresolved, repetitive cultures taken by the patient herself at moments of symptoms, and/or nuclear acid amplification techniques to detect Candida genes in the vaginal fluid. Even if only vulvitis is evident, thorough expert examination of vaginal fluid is obligatory to diagnose VVC. © 2016 Blackwell Verlag GmbH.

FLUCONAZOLE AND BORIC ACID FOR TREATMENT OF VAGINAL CANDIDIASIS--NEW WORDS ABOUT OLD ISSUE.

PubMed

Khameneie, K M; Arianpour, N; Roozegar, R; Aklamli, M; Amiri, M M

2013-04-01

To compare boric acid as an effective treatment for VVC compared to fluconazole. We also studied the efficiency of these drugs in preventing recurrence of VVC. A cross sectional, randomized, double-blind study. Gynaecology clinic of Imam Reza hospital, Tehran - Iran Women with signs and symptoms related to Vulvo Vaginal Candidiasis. Seventy five patients out of total 150 patients with signs and symptoms related to Vulvo Vaginal Candidiasis were treatedwith boric acidpowder everynight for a week and the remaining 75 patients received Fluconazole. The cure rate in first group was 46.7% but the cure rate in second group was 37.3%. The difference was not statistically significant (P>0.3). Difference between the efficacy of the two drugs was not significant either (P=0.47). The recurrence rate among patients in first group was 35% while it was 32% in second group. Their difference was not statistically significant (P=0.54). According to our findings, treatment of vaginal candidiasis with boric acid is as effective as fluconazole. The availability of boric acid and its relatively low cost suggests it as a safe and effective drug for treatment of candidiasis.

Phase I trial of a Lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women.

PubMed

Czaja, Christopher A; Stapleton, Ann E; Yarova-Yarovaya, Yuliya; Stamm, Walter E

2007-01-01

We performed a phase I trial to assess the safety and tolerance of a Lactobacillus vaginal suppository for prevention of recurrent UTI. Premenopausal women with a history of recurrent UTI were randomized to use L. crispatus CTV-05 or placebo vaginal suppositories daily for five days. 30 women were randomized (15 to L. crispatus CTV-05). No severe adverse events occurred. Mild to moderate vaginal discharge and genital irritation were reported by women in both study arms. Seven women randomized to L. crispatus CTV-05 developed pyuria without associated symptoms. Most women had high concentrations of vaginal H202-producing lactobacilli before randomization. L. crispatus, L. jensenii, and L. gasseri were the most common Lactobacillus species identified, with stable prevalence over time. L. crispatus CTV-05 can be given as a vaginal suppository with minimal sideeffects to healthy women with a history of recurrent UTI. Mild inflammation of the urinary tract was noted in some women.

Phase I Trial of a Lactobacillus crispatus Vaginal Suppository for Prevention of Recurrent Urinary Tract Infection in Women

PubMed Central

Czaja, Christopher A.; Stapleton, Ann E.; Yarova-Yarovaya, Yuliya; Stamm, Walter E.

2007-01-01

Objectives: We performed a phase I trial to assess the safety and tolerance of a Lactobacillus vaginal suppository for prevention of recurrent UTI. Methods: Premenopausal women with a history of recurrent UTI were randomized to use L. crispatus CTV-05 or placebo vaginal suppositories daily for five days. Results: 30 women were randomized (15 to L. crispatus CTV-05). No severe adverse events occurred. Mild to moderate vaginal discharge and genital irritation were reported by women in both study arms. Seven women randomized to L. crispatus CTV-05 developed pyuria without associated symptoms. Most women had high concentrations of vaginal H202-producing lactobacilli before randomization. L. crispatus, L. jensenii, and L. gasseri were the most common Lactobacillus species identified, with stable prevalence over time. Conclusions: L. crispatus CTV-05 can be given as a vaginal suppository with minimal sideeffects to healthy women with a history of recurrent UTI. Mild inflammation of the urinary tract was noted in some women. PMID:18288237

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

Vaginal health and hygiene practices and product use in Canada: a national cross-sectional survey.

PubMed

Crann, Sara E; Cunningham, Shannon; Albert, Arianne; Money, Deborah M; O'Doherty, Kieran C

2018-03-23

The vaginal microbiome influences quality of life and health. The composition of vaginal microbiota can be affected by various health behaviors, such as vaginal douching. The purpose of this study was to examine the types and prevalence of diverse vaginal/genital health and hygiene behaviors among participants living in Canada and to examine associations between behavioral practices and adverse gynecological health conditions. An anonymous online survey, available in English and French, was distributed across Canada. The sample consisted of 1435 respondents, 18 years or older, living in Canada. Respondents reported engaging in diverse vaginal/genital health and hygiene behavioral practices, including the use of commercially manufactured products and homemade and naturopathic products and practices. Over 95% of respondents reported using at least one product in or around the vaginal area. Common products and practices included vaginal/genital moisturizers, anti-itch creams, feminine wipes, washes, suppositories, sprays, powders, and waxing and shaving pubic hair. The majority of the sample (80%) reported experiencing one or more adverse vaginal/genital symptom in their lifetime. Participants who had used any vaginal/genital product(s) had approximately three times higher odds of reporting an adverse health condition. Several notable associations between specific vaginal/genital health and hygiene products and adverse health conditions were identified. This study is the first of its kind to identify the range and prevalence of vaginal/genital health and hygiene behaviors in Canada. Despite a lack of credible information about the impact of these behaviors on women's health, the use of commercially manufactured and homemade products for vaginal/genital health and hygiene is common. Future research can extend the current exploratory study by identifying causal relationships between vaginal/genital health and hygiene behaviors and changes to the vaginal microbiome.

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

PubMed

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

2016-11-01

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. 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. 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). 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. The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT code: 2014112220043n1. Shahrekord University of Medical Sciences supported this research (project no. 1440).

Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis.

PubMed

Yang, Shuhua; Zhang, Yuexiang; Liu, Ying; Wang, Jianhong; Chen, Shuqin; Li, Shuxia

2017-01-01

The study aimed to evaluate whether cytolytic vaginosis (CV) has important clinical implications for recurrent vulvovaginitis and to identify clinical differences between CV and vulvovaginal candidosis (VVC). Medical histories, physical examinations and laboratory findings were used to diagnose and assess the prevalence rates of various vulvovaginal infections among 536 women with recurrent vulvovaginitis. Chi-square and Fisher exact tests were used to compare age, menstrual cycle phase at episode onset, symptoms/signs of infection and discharge characteristics between CV and VVC with single infection. Among the 484 women with a single-infection recurrent vulvovaginitis, the prevalence of CV (n = 143; 26.7%) was second only to VVC (n = 196; 36.6%). CV symptoms occurred predominantly during the ovulatory and luteal phases. Meanwhile, VVC episodes were not concentrated premenstrually, but rather occurred throughout the menstrual cycle. Significant differences were found in the vaginal pH, discharge characteristics and frequency of inflammatory symptoms between the 2 groups. CV is clinically important, because it is a common cause of recurrent vulvovaginitis. To distinguish CV from VVC, gynecologists should consider the patient's medical history, physical and laboratory findings, vaginal pH and vaginal discharge characteristics. © 2016 S. Karger AG, Basel.

Microbiological findings in prepubertal girls with vulvovaginitis.

PubMed

Sikanić-Dugić, Nives; Pustisek, Nives; Hirsl-Hećej, Vlasta; Lukić-Grlić, Amarela

2009-01-01

The aim of the study was to define the most common causes, symptoms and clinical features of vulvovaginitis in prepubertal girls, and to evaluate treatment success depending on the causative agent involved. The study included 115 girls aged 2-8 (mean 4.8) years, presenting with vulvovaginitis to the Outpatient Clinic for Pediatric and Adolescent Gynecology, Zagreb Children's Hospital, between September 2006 and July 2007. Medical history data were obtained from parents. Vaginal samples were collected for microbiological culture by using cotton-tipped swabs moistened with saline. All samples were referred to microbiology laboratory, where standard microbiological diagnostic procedures were performed. Selective and non-selective media were used. Of 115 study patients, 43 (37.4%) had received antibiotic therapy more than one month prior to their visit to the Clinic, mainly for upper respiratory tract infection. The most common presenting symptom was increased vaginal discharge usually noticed on the pants or diaper, found in 26 of 115 (22.6%) patients, followed by vulvar redness in 16 (13.9%), burning in seven (6.1%), itching in the vulvovaginal area in seven (6.1%), soreness in six (5.2%), odor in three (2.6%) patients, and two or more of these symptoms in another 50 (43.5%) patients. Fifty-nine of 115 children had normal clinical finding on gynecologic examination. Among the remaining 56 children, the most common finding was erythema observed in 19, vaginal discharge in ten, and a combination of discharge and erythema in 13 patients. Of 115 study patients, causative agents were isolated from vaginal culture in 38 (33%) cases. Of these, 21 grew group A beta hemolytic streptococcus, five patients Haemophilus influenzae, three Escherichia coli, two Enterococcus spp., and one each Staphylococcus aureus, Proteus mirabilis, and Streptococcus pneumoniae. Antibiotic therapy was administered in 31 of these 38 patients, except for those cases where intestinal bacteria and Staphylococcus aureus were isolated and topical therapy and hygienic measures were applied alone. Accordingly, vulvovaginitis in girls was most commonly caused by pathogens originating from the patient upper respiratory tract, accompanied by the symptoms of redness and vaginal discharge. In these cases, antibiotic treatment was administered. In the majority of prepubertal girls with either vulvitis or normal genital finding, simple measures to improve hygiene will lead to resolution of all symptoms.

The Women's EMPOWER Survey: Identifying Women's Perceptions on Vulvar and Vaginal Atrophy and Its Treatment.

PubMed

Kingsberg, Sheryl A; Krychman, Michael; Graham, Shelli; Bernick, Brian; Mirkin, Sebastian

2017-03-01

Vulvar and vaginal atrophy (VVA) affects up to two thirds of postmenopausal women, but most symptomatic women do not receive prescription therapy. To evaluate postmenopausal women's perceptions of VVA and treatment options for symptoms in the Women's EMPOWER survey. The Rose Research firm conducted an internet survey of female consumers provided by Lightspeed Global Market Insite. Women at least 45 years of age who reported symptoms of VVA and residing in the United States were recruited. Survey results were compiled and analyzed by all women and by treatment subgroups. Respondents (N = 1,858) had a median age of 58 years (range = 45-90). Only 7% currently used prescribed VVA therapies (local estrogen therapies or oral selective estrogen receptor modulators), whereas 18% were former users of prescribed VVA therapies, 25% used over-the-counter treatments, and 50% had never used any treatment. Many women (81%) were not aware of VVA or that it is a medical condition. Most never users (72%) had never discussed their symptoms with a health care professional (HCP). The main reason for women not to discuss their symptoms with an HCP was that they believed that VVA was just a natural part of aging and something to live with. When women spoke to an HCP about their symptoms, most (85%) initiated the discussion. Preferred sources of information were written material from the HCP's office (46%) or questionnaires to fill out before seeing the HCP (41%).The most negative attributes of hormonal products were perceived risk of systemic absorption, messiness of local creams, and the need to reuse an applicator. Overall, HCPs only recommended vaginal estrogen therapy to 23% and oral hormone therapies to 18% of women. When using vaginal estrogen therapy, less than half of women adhered to and complied with posology; only 33% to 51% of women were very to extremely satisfied with their efficacy. The Women's EMPOWER survey showed that VVA continues to be an under-recognized and under-treated condition, despite recent educational initiatives. A disconnect in education, communication, and information between HCPs and their menopausal patients remains prevalent. Kingsberg S, Krychman M, Graham S, et al. The Women's EMPOWER Survey: Identifying Women's Perceptions on Vulvar and Vaginal Atrophy and Its Treatment. J Sex Med 2017;14:413-424. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The Formation of Galactic Bulges

NASA Astrophysics Data System (ADS)

Carollo, C. Marcella; Ferguson, Henry C.; Wyse, Rosemary F. G.

2000-03-01

Part I. Introduction: What are galactic bulges?; Part II. The Epoch of Bulge Formation: Origin of bulges; Deep sub-mm surveys: High-z ULIRGs and the formation of spheroids; Ages and metallicities for stars in the galactic bulge; Integrated stellar populations of bulges: First results; HST-NICMOS observations of galactic bulges: Ages and dust; Inside-out bulge formation and the origin of the Hubble sequence; Part III. The Timescales of Bulge Formation: Constraints on the bulge formation timescale from stellar populations; Bulge building with mergers and winds; Role of winds, starbursts, and activity in bulge formation; Dynamical timescales of bulge formation; Part IV. Physical Processes in Bulge Formation: the role of bars for secular bulge formation; Bars and boxy/peanut-shaped bulges: an observational point of view; Boxy- and peanut-shaped bulges; A new class of bulges; The role of secondary bars in bulge formation; Radial transport of molecular gas to the nuclei of spiral galaxies; Dynamical evolution of bulge shapes; Two-component stellar systems: Phase-space constraints; Central NGC 2146 - a firehose-type bending instability?; Bulge formation: the role of the multi-phase ISM; Global evolution of a self-gravitating multi-phase ISM in the central kpc region of galaxies; Part V. Bulge Phenomenology: Bulge-disk decomposition of spiral galaxies in the near-infrared; The triaxial bulge of NGC 1371; The bulge-disk orthogonal decoupling in galaxies: NGC 4698 and NGC 4672; The kinematics and the origin of the ionized gas in NGC 4036; Optically thin thermal plasma in the galactic bulge; X-ray properties of bulges; The host galaxies of radio-loud AGN; The centers of radio-loud early-type galaxies with HST; Central UV spikes in two galactic spheroids; Conference summary: where do we stand?

Choriocarcinoma

MedlinePlus

... or genital tumor . Symptoms A possible symptom is abnormal or irregular vaginal bleeding in a woman who recently had a hydatidiform ... blood count Kidney function tests Liver function tests Imaging tests that may be done include: CT scan MRI You should be carefully monitored after a hydatidiform ...

Deciding about hormone therapy

MedlinePlus

... symptoms may last 5 or more years, including: Hot flashes and sweats, usually at their worst for the first 1 to 2 years after your last period Vaginal dryness Mood swings Sleep problems Less interest in sex HT can be used to treat menopause symptoms. ...

Microbiological/clinical characteristics and validation of topical therapy with kanamycin in aerobic vaginitis: a pilot study.

PubMed

Tempera, G; Bonfiglio, G; Cammarata, E; Corsello, S; Cianci, A

2004-07-01

The term 'aerobic vaginitis' defines a 'new' vaginal pathology that is neither classifiable as specific vaginitis nor as bacterial vaginosis. We studied a sample of 30 women with a clinical and microbiological diagnosis of aerobic vaginitis and compared the efficacy and tolerability of kanamycin and meclocycline, two products commercially available in Italy in the form of vaginal pessaries. In chronological order of enrollment, the patients were alternately treated with kanamycin or meclocycline; the dose of administration in both groups was of one pessary per day for 6 days. The evaluation of the therapeutic efficacy was carried out both at the first check-up (7th-8th day) and at a second check-up (13th-16th day). At the first follow-up carried out immediately at the end of therapy, the percentage of normalisation of clinical signs and symptoms was increased independently of the type of treatment in the case of moderate grade aerobic vaginitis, while kanamycin was produced a better effect in the group with severe aerobic vaginitis. Furthermore, at the second follow-up, a direct correlation with recovery of vaginal homeostasis was demonstrated by the normalisation of the vaginal pH and by the presence of lactobacilli, only in kanamycin treated group. In conclusion, our results showed the validity of the treatment with kanamycin intravaginally in this recently recognised disease.

Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study.

PubMed

Nygaard, Ingrid E; Clark, Erin; Clark, Lauren; Egger, Marlene J; Hitchcock, Robert; Hsu, Yvonne; Norton, Peggy; Sanchez-Birkhead, Ana; Shaw, Janet; Sheng, Xiaoming; Varner, Michael

2017-01-10

Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. The University of Utah and Intermountain Healthcare Institutional Review Boards approved this study. Data are stored in a secure password-protected database. Papers summarising the primary results and ancillary analyses will be published in peer-reviewed journals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors.

PubMed

Carter, Jeanne; Stabile, Cara; Seidel, Barbara; Baser, Raymond E; Goldfarb, Shari; Goldfrank, Deborah J

2017-04-01

We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program and identify improvements of physical symptoms, per patient and clinical evaluation. Evaluability criteria included gynecologic exam at initial visit, at least one follow-up with gynecologic exam within 8 months of initial visit, and all consecutive follow-ups <6 months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least one follow-up from 09/12 to 10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n = 90, 53 %), gynecologic (n = 54, 32 %), or colorectal/anal (n = 15, 9 %) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes. Mean number of visits was 3.43. Mean age was 55.4 years; 92 % (n = 155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises, and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy, and function) associated with cancer treatment and support. At last assessment, 89 % had complied with the clinical recommendation (moisturize 2-5+ times/week). Vaginal pH scores >6.5 declined over time (p = 0.03). VAS scores improved by last assessment (p < 0.001), as did VuAS scores (p = 0.001). Sexual function scores significantly improved (p < 0.001), confidence about future sexual activity increased (p = 0.004), and sexual/vaginal health concerns decreased (p = 0.00003). Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and increased intimacy confidence. These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting.

A novel approach to mesh revision after sacrocolpopexy.

PubMed

Dawson, Melissa L; Rebecca, Rinko; Shah, Nima M; Whitmore, Kristene E

2016-01-01

Pelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery.

Correlation of pelvic organ prolapse quantification system scores with obstetric parameters and lower urinary tract symptoms in primiparae postpartum.

PubMed

Liang, Ching-Chung; Tseng, Ling-Hong; Horng, Shang-Gwo; Lin, I-wen; Chang, Shuenn-Dhy

2007-05-01

This study investigated the correlation between results of the pelvic organ prolapse quantification (POPQ) system at 3 days and at 2 months postpartum with obstetric parameters and lower urinary tract symptoms (LUTS) in 125 primiparae with vaginal delivery. The clinical characteristics, prevalence of pregnancy-related LUTS, and POPQ scores were evaluated. Regarding the relationship of obstetric parameters with POPQ scoring, the gh was found positively correlated with the body mass index and vaginal laceration at 2 months postpartum. The POPQ evaluation did not find the LUTS to be significantly related to the prolapse score. The mean scores of points C and D were significantly increased, and gh, pb, and tvl were significantly decreased between the initial and 2-month follow-up scores. Our results revealed that a decrease in vaginal size is the principal change during the first 2 months postpartum and that with the exception of gh, neither the obstetric parameters nor the LUTS were associated with the POPQ scoring system.

Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis.

PubMed

Esim Buyukbayrak, Esra; Kars, Bulent; Karsidag, Ayse Yasemin Karageyim; Karadeniz, Bernan Ilkay; Kaymaz, Ozge; Gencer, Serap; Pirimoglu, Zehra Meltem; Unal, Orhan; Turan, Mehmet Cem

2010-11-01

The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present. Premenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv). 460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections. Clinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.

Highlights Regarding Host Predisposing Factors to Recurrent Vulvovaginal Candidiasis: Chronic Stress and Reduced Antioxidant Capacity.

PubMed

Akimoto-Gunther, Luciene; Bonfim-Mendonça, Patrícia de Souza; Takahachi, Gisele; Irie, Mary Mayumi T; Miyamoto, Sônia; Consolaro, Márcia Edilaine Lopes; Svidzinsk, Terezinha I Estivalet

2016-01-01

We studied host factors that could predispose women to develop recurrent vulvovaginal candidiasis (RVVC), including glycemia, insulin resistance, chronic stress, antioxidant capacity, overall immune status, local inflammation and vaginal microbiota. The presence of yeasts in vaginal culture was screened in 277 women, with or without signs and symptoms of VVC and RVVC. The presence of an inflammatory process and microbiota were analyzed through vaginal bacterioscopy and cervical-vaginal cytology, respectively. Fasting-blood samples were collected by standard venipuncture for biochemical analyses. Flow cytometry was employed to obtain the T helper/T cytotoxic lymphocyte ratio, and insulin resistance was assessed by the HOMA index (HI). Yeasts were isolated from 71 (26%) women: 23 (32.4%) with a positive culture but without symptoms (COL), 22 (31%) in an acute episode (VVC), and 26 (36.6%) with RVVC. C. albicans was the main yeast isolated in all clinical profiles. The control group (negative culture) comprised 206 women. Diabetes mellitus and insulin resistance were more associated with the positive-culture groups (COL, VVC and RVVC) than with negative ones. The RVVC group showed lower mean levels of cortisol than the control group and lower antioxidant capacity than all other groups. The T Helper/T cytotoxic lymphocyte ratio was similar in all groups. The RVVC group showed a similar level of vaginal inflammation to the control group, and lower than in the COL and VVC groups. Only the CVV group showed a reduction in vaginal lactobacillus microbiota. Our data suggest that both chronic stress (decreased early-morning cortisol levels) and reduced antioxidant capacity can be host predisposing factors to RVVC.

Highlights Regarding Host Predisposing Factors to Recurrent Vulvovaginal Candidiasis: Chronic Stress and Reduced Antioxidant Capacity

PubMed Central

Akimoto-Gunther, Luciene; Bonfim-Mendonça, Patrícia de Souza; Takahachi, Gisele; Irie, Mary Mayumi T.; Miyamoto, Sônia; Consolaro, Márcia Edilaine Lopes; Svidzinsk, Terezinha I. Estivalet

2016-01-01

We studied host factors that could predispose women to develop recurrent vulvovaginal candidiasis (RVVC), including glycemia, insulin resistance, chronic stress, antioxidant capacity, overall immune status, local inflammation and vaginal microbiota. The presence of yeasts in vaginal culture was screened in 277 women, with or without signs and symptoms of VVC and RVVC. The presence of an inflammatory process and microbiota were analyzed through vaginal bacterioscopy and cervical-vaginal cytology, respectively. Fasting-blood samples were collected by standard venipuncture for biochemical analyses. Flow cytometry was employed to obtain the T helper/T cytotoxic lymphocyte ratio, and insulin resistance was assessed by the HOMA index (HI). Yeasts were isolated from 71 (26%) women: 23 (32.4%) with a positive culture but without symptoms (COL), 22 (31%) in an acute episode (VVC), and 26 (36.6%) with RVVC. C. albicans was the main yeast isolated in all clinical profiles. The control group (negative culture) comprised 206 women. Diabetes mellitus and insulin resistance were more associated with the positive-culture groups (COL, VVC and RVVC) than with negative ones. The RVVC group showed lower mean levels of cortisol than the control group and lower antioxidant capacity than all other groups. The T Helper/T cytotoxic lymphocyte ratio was similar in all groups. The RVVC group showed a similar level of vaginal inflammation to the control group, and lower than in the COL and VVC groups. Only the CVV group showed a reduction in vaginal lactobacillus microbiota. Our data suggest that both chronic stress (decreased early-morning cortisol levels) and reduced antioxidant capacity can be host predisposing factors to RVVC. PMID:27415762

Are the women with Sjögren's Syndrome satisfied with their sexual activity?

PubMed

Isik, Hatice; Isik, Metin; Aynioglu, Oner; Karcaaltincaba, Deniz; Sahbaz, Ahmet; Beyazcicek, Tugba; Harma, Mehmet Ibrahim; Demircan, Nejat

Females with Sjögren's Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p<0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p<0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p<0.001). Life quality scores were significantly lower in patients with SS than the controls (p<0.001). Vaginal dryness was negatively correlated with FSFI total (r=-0.312, p=0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r=0.449, p=0.002, r=0.371, p=0.011, r=0.299, p=0.043, respectively). Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management. Copyright © 2017 Elsevier Editora Ltda. All rights reserved.

Geriatric Pelvic Organ Prolapse Surgery: Going the Extra Mile.

PubMed

Krishnan, Seethalakshmi

2017-12-01

To assess the quality of life in geriatric patients after reconstructive and obliterative vaginal surgery for advanced pelvic organ prolapse (POP). Prospective observational study was conducted between January 2009 and December 2014 at the department of Urogynaecology, Government Kasturbha Gandhi Hospital. A total of 424 women (between the age group of 60 and 94 years) with advanced pelvic organ prolapse underwent vaginal hysterectomy along with vaginal apical suspension procedures which were McCalls culdoplasty (35.02%), sacrospinous ligament suspension (8.3%), high uterosacral ligament suspension (26.2%), iliococcygeus fixation (4.6%) for stage 3-4 POP. Abdominal sacrocolpopexy (3.2%) was done for stage 3-4 vaginal vault prolapse. Patients with medical comorbidities underwent Leeforts partial colpocleisis (8.1%) and total colpocleisis (2%) for stage 3 and 4 POP. Site-specific repair (12.5%) was done for stage 3/4 cystocele and rectocele. The main outcomes measured were subjective cure (no prolapse), subjective improvements in pelvic floor symptoms as per the pelvic floor impact questionnaire, and objective cure (no prolapse of vaginal segment on maximum straining). Mean age of the patient was 64.29 years. The major complication rates were less than 1%. 85% were examined at 3 and 12 months. The subjective cure rate at 12 months is 92% and the objective cure rate is 94.5%. The geriatric patients who underwent either reconstructive or obliterative procedures were relieved of their preoperative symptoms and their quality of life had greatly improved.

Long term subjective cure rate, urinary tract symptoms and dyspareunia following mesh augmented anterior vaginal wall prolapse repair.

PubMed

Weintraub, A Y; Friedman, T; Baumfeld, Y; Neuman, M; Krissi, H

2015-12-01

The aim of this study was to assess patient-centered long term outcomes following anterior vaginal repair with mesh. In January 2015, we identified 124 women who underwent anterior pelvic floor repair with mesh between January 2006 and February 2009. Patient records were reviewed and demographic, clinical, intra-operative and post-operative follow-up data retrieved. Telephone interviews were conducted to access information on clinical outcomes. Associations between baseline characteristics and long term symptoms were assessed by multivariable logistic regression models. Seventy-nine women were reached and consented to participate. Patients were interviewed 79-104 months after surgery. Their mean age at the time of surgery was 62.48 ± 9.53 years; all had stage III cystocele with a mean POP Q point Ba of 5.32 ± 1.47. Twenty-four (30%) had a previous hysterectomy and 26 (33%) had a previous pelvic organ prolapse or stress urinary incontinence operation. At telephone interviews, recurrence of prolapse symptoms was reported by 11 (13.9%) patients, mostly in the posterior compartment. Only 6 needed a corrective procedure. One patient had her mesh removed due to dyspareunia. Eleven (13.9%) reported lower urinary tract symptoms other than prolapse, as follows: stress urinary incontinence (1), overactive bladder (8) and dyspareunia (2). Long term rates of recurrent prolapse, dyspareunia and lower urinary tract symptoms were low for patients who underwent anterior vaginal wall mesh augmentation surgery for symptomatic cystoceles. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Effect of tension-free vaginal tape and TVT-obturator on lower urinary tract symptoms other than stress urinary incontinence.

PubMed

Ballert, Katie N; Kanofsky, Jamie A; Nitti, Victor W

2008-03-01

Variable effects on lower urinary tract symptoms (LUTS) other than stress urinary incontinence (SUI) have been reported after tension-free vaginal tape (TVT). We measured the effect of TVT on LUTS using the American Urological Association Symptom Index (AUASI). Patients undergoing TVT completed the AUASI pre- and post-operatively. Total scores (TS), storage scores (SS), and voiding scores (VS) were compared overall and among patients with SUI vs mixed urinary incontinence (MUI) and those who underwent TVT vs TVT-obturator (TVT-O). The mean change in TS and SS was -3.6 and -3.0. Mean reductions in TS and SS were significant in all patient subsets with no change in VS. There was no significant difference in the mean changes in TS between patients with SUI vs MUI or those undergoing TVT vs TVT-O. LUTS are improved after TVT in most patients. In general, voiding symptoms were not adversely affected.

Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis.

PubMed

Ghazanfarpour, M; Sadeghi, R; Roudsari, R Latifnejad; Khorsand, I; Khadivzadeh, T; Muoio, B

2016-01-01

This study evaluated the efficacy of red clover to relieve hot flashes and menopausal symptoms in peri/postmenopausal women. Electronic databases (MEDLINE, Scopus and the Cochrane Library) were searched. The mean frequency of hot flashes in red clover groups was lower compared with that in the control groups (close to statistical significance). Difference in means (MD) of hot flashes frequency was - 1.99 (- 4.12-0.139; p = 0.067; heterogeneity P > 0.01; I(2) = 94.93%; Random effect model). Subjective (vaginal dryness) and objective (maturation value) symptoms of vaginal atrophy showed a significant improvement with 80-mg dose of red clover. Red clover showed less therapeutic effect on psychology status, sexual problems and sleeping disorders. Red clover consumption may decrease frequency of hot flashes, especially in women with severe hot flashes (≥ 5 per day). Red clover may reduce other menopausal symptoms. Further trials are needed to confirm the current systematic review findings.

["Mixed" and "miscellaneous" vulvovaginitis: diagnostics and therapy of vaginal administration of nystatin and nifuratel].

PubMed

Cepický, P; Malina, J; Líbalová, Z; Kuzelová, M

2005-05-01

The evaluation of combined and miscellaneous vulvovaginal infections incidence and their treatment with combined vaginal products containing nifuratel and nystatin. Prospective study. Gynecologic outpatient department LEVRET, Prague; Laboratories of Microbiology AescuLab, Prague. 70 consecutive patients were examined with complaint of vaginal fluor and/or pruritus. We established macroscopic features of fluor, pH, amine test and mounts stained with Giemsa and Gram. We qualified the cases with more diagnostic criteria (mycosis, lactobacillosis, anaerobic vaginosis, aerobic vaginitis) as combined infection, those with no diagnostic criteria as miscellaneous. We treated all patients with vaginal tablets nystatin + nifuratel (Macmiror complex). We prescribed clotrimazol cream, if pruritus was present. We evaluated withdrawals of symptoms and relapses during 3 months after treatment. Combined infection was found in 21 patients from 70 (30%). The most frequent combination was that of mycosis and aerobic vaginitis (13/70, 18.6%) or mycosis and anaerobic vaginosis (4/70, 5.7%); 11 patients fulfilled criteria of no diagnosis. We concluded them as "miscelaneous". The treatment was successful in all cases, 10 women relapsed in 3 months. Combined vaginal infection findings are present very often (30%), likewise miscellaneous ones (15%) occur. The treatment of these women in successful with vaginal tablets with nystatin + nifuratel.

[Utilize the simplified POP-Q system in the clinical practice of staging for pelvic organ prolapse: comparative analysis with standard POP-Q system].

PubMed

Zhang, H; Zhu, L; Xu, T; Lang, J H

2016-07-25

To determine the association between simplified pelvic organ prolapse quantification system(S-POP-Q)and the standard pelvic organ prolapse quantification system(POP-Q)in describing pelvic organ prolapse. This was an observational study. From Jan. 2010 to Jan. 2014, 256 subjects with pelvic floor disorder symptoms underwent two exams: a POP-Q exam and a S-POP-Q exam. For the S-POP-Q system, vaginal segments of the exam were defined using points Ba, Bp, C, and D. For the POP-Q system vaginal segments of the exam were defined using points Aa, Ba, Ap, Bp, C, and D. The inter-system consistency between the overall ordinal stages, the anterior vaginal wall stages, the posterior vaginal wall stages, the cervix stages, the posterior fornix or vaginal cuff stages from each two kind of exam were compared. The Kendall tau-b correlation coefficient for overall stage was 0.81, the Kendall tau-b correlation coefficients were 0.81, 0.81, 0.85, 0.88 for the anterior vaginal wall, for the posterior vaginal wall, for the cervix, for the posterior fornix or vaginal cuff, respectively. There is almost perfect association between S-POP-Q and POP-Q in describing pelvic organ prolapse.

The vaginal microbiota, host defence and reproductive physiology

PubMed Central

Smith, Steven B

2016-01-01

Abstract 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. PMID:27373840

Advanced topical drug delivery system for the management of vaginal candidiasis.

PubMed

Johal, Himmat Singh; Garg, Tarun; Rath, Goutam; Goyal, Amit Kumar

2016-01-01

Vaginal candidiasis or vulvovaginal candidiasis (VC) is a common mucosal infection of vagina, mainly caused by Candida species. The major symptoms of VC are dyspareunia, pruritis, itching, soreness, vagina as well as vulvar erythema and edema. Most common risk factors that lead to the imbalance in the vaginal micro biota are the use of antibiotics, pregnancy, diabetes mellitus, immuno suppression as in AIDS or HIV patients, frequent sexual intercourse, spermicide and intra-uterine devices and vaginal douching. Various anti-fungal drugs are available for effective treatment of VC. Different conventional vaginal formulations (creams, gels, suppositories, powder, ointment, etc.) for VC are available today but have limited efficacy because of lesser residence time on vaginal epithelium due to self-cleansing action of vagina. So to overcome this problem, an extended and intimate contact with vaginal mucosa is desired; which can be accomplished by utilizing mucoadhesive polymers. Mucoadhesive polymers have an excellent binding capacity to mucosal tissues for considerable period of time. This unique property of these polymers significantly enhances retention time of different formulations on mucosal tissues. Currently, various novel formulations such as liposomes, nano- and microparticles, micro-emulsions, bio-adhesive gel and tablets are used to control and treat VC. In this review, we focused on current status of vaginal candidiasis, conventional and nanotechnology inspired formulation approaches.

A new reconstructive technique for posterior vaginal wall defects, a case report.

PubMed

Zetlitz, Elisabeth; Manook, Miriam; MacLeod, Alison; Hamilton, Stuart

2013-10-01

Post-partum vaginal laxity is a problem encountered by many women. More uncommon is a resulting vaginal defect. In most cases of laxity, a period of extensive physiotherapy can strengthen the pelvic muscles enough for symptoms to be minimized. However, this is not the case once there is a tissue defect. To present a new reconstructive method for patients with posterior vaginal wall defects. We present a case of a 38-year-old female who, 12 years prior to presentation, had a vaginal delivery. Due to complications during the delivery, she sustained pelvic trauma and developed a posterior vaginal wall defect. She had a sizable soft tissue defect, causing sexual, urinary, and confidence problems. Fat was harvested from the patient's abdomen and injected into the defect after more conservative treatment options were exhausted. The defect was corrected successfully using the minimally invasive Coleman fat grafting technique. This is to our knowledge the first case in the literature where a posterior vaginal defect has been corrected using Coleman fat grafting, and we believe that this treatment method may be of benefit to more patients. © 2013 International Society for Sexual Medicine.

Vaginitis: diagnosis and management.

PubMed

Faro, S

1996-01-01

The various conditions that give rise to vaginitis include specific and nonspecific entities, such as candidiasis, trichomoniasis, bacterial vaginosis, group B streptococcal vaginitis, purulent vaginitis, volvodynia, and vestibulitis. The patient with chronic vaginitis usually develops this condition because of a misdiagnosis. It is critical that patients who have chronic vaginitis be thoroughly evaluated to determine if there is a specific etiology and whether their condition is recurrent or persistent, or is a reinfection. This also must include obtaining a detailed history, beginning with the patient's best recollection of when she felt perfectly normal. The physician must have an understanding of a healthy vaginal ecosystem and what mechanisms are in place to maintain the equilibrium. The vaginal ecosystem is a complex system of micro-organisms interacting with host factors to maintain its equilibrium. The endogenous microflora consists of a variety of bacteria, which include aerobic, facultative and obligate anaerobic bacteria. These organisms exist in a commensal, synergistic or antagonistic relationship. Therefore, it is important to understand what factors control the delicate equilibrium of the vaginal ecosystem, and which factors, both endogenous and exogenous, can disrupt this system. It is also important for the physician to understand that when a patient has symptoms of vaginitis it is not always due to an infectious etiology. There are situations in which an inflammatory reaction occurs but the specific etiology may not be determined. Thus, it is important that the physician not rush through the history or the examination.

Topical kanamycin: an effective therapeutic option in aerobic vaginitis.

PubMed

Tempera, G; Abbadessa, G; Bonfiglio, G; Cammarata, E; Cianci, A; Corsello, S; Raimondi, A; Ettore, G; Nicolosi, D; Furneri, P M

2006-08-01

Eighty-one patients with clinical diagnosis of aerobic vaginitis (AV) were included in the study. The patients were randomized for treatment, 45 with kanamycin (100 mg vaginal ovules for 6 days, consecutively) and 36 with meclocycline (35 mg vaginal ovules for 6 days, consecutively). The patients were examined before starting the study, 1-2 days after treatment and 30 days after the end of the study. At the first follow-up the patients showed different levels of symptom reduction. Reduction in the presence of leukocytes, vaginal mucosa burning and itching were statistically significant in the group treated with kanamycin with respect to the group treated with meclocycline. Moreover, there was also reduced isolation of Enterobacteriaeae (97%) in the group treated with kanamycin versus those treated with meclocycline (76%). At the second follow-up, vaginal homeostasis (normalization of pH and presence of lactobacilli) was more evident in the kanamycin-treated group. In conclusion, our data suggest that the topical use of kanamycin could be considered a specific antibiotic for the therapy of this new pathology.

Resolution of subchorionic hematoma and symptoms of threatened miscarriage using vaginal alpha lipoic acid or progesterone: clinical evidences.

PubMed

Costantino, M; Guaraldi, C; Costantino, D

2016-04-01

Alpha Lipoic Acid (ALA) is a safe natural molecule that exerts a selective immunomodulating activity with antioxidant and anti-inflammatory properties. This randomized controlled clinical trial (RCT) tested the effect of the vaginal administration with ALA or Progesterone, in subchorionic hematoma resorption in women with threatened miscarriage. 400 mg of vaginal Progesterone or 10 mg of vaginal ALA were administered to sixty-two pregnant women, in the first trimester of gestation with threatened miscarriage and subchorionic hematoma. Controls were patients who chose not to receive any treatment. In the ALA group the subchorionic hematoma was reabsorbed more quickly in comparison with the progression detected in Progesterone group (p ≤ 0.05). The other parameters checked (pelvic pain and vaginal bleeding) did not show any significant difference and a smaller number of miscarriages was recorded in the ALA group, compared to Progesterone group. Our data provides the first evidence of the efficacy of ALA, administered by vaginal route, in the healing process of patients with threatened miscarriage, thus supporting the normal course of pregnancy. NCT02601898 (ClinicalTrials.gov registry).

Self Test Kit: Rapid Diagnosis of Urogenital Infections in Military Women

DTIC Science & Technology

2000-09-01

asymptomatic bacteriuria and symptoms from their cervical/vaginal infection. In many cases treatment of their cervical/vaginal infection would also...technology required for rapid diagnosis and treatment of these conditions may not always be readily available to deployed military women especially while...6 In another study of 476 asymptomatic active duty army women presenting for routine pap smears, 39(8.2%) tested positive for chlamydia. This is a

Self-Test Kit: Rapid Diagnosis of Urogenital Infections in Military Women

DTIC Science & Technology

1998-09-01

tract infections or asymptomatic bacteriuria and symptoms from their cervical/vaginal infection. In many cases treatment of their cervical/vaginal...during the second year. We have thus far tested the kit in 234 women with genital complaints. The self-test kit results suggested appropriate treatment in...evaluation, diagnosis and treatment . All of these factors may significantly impact the ability and readiness of military women to perform their assigned

Clinical trial shows lasting function of a new moisturizing cream against vaginal dryness.

PubMed

Henneicke-von Zepelin, Hans-Heinrich; Williams, Ragna; Havemeister, Wiebke; Wigger-Alberti, Walter; Nolte, Klaus-Ulrich

2017-05-01

Vaginal dryness and associated symptoms may occur in women of any age and are a frequent burden after menopause. The North American Menopause Society recommends long-acting non-hormonal vaginal creams as first-line therapy. A new type of such creams was developed (Remifemin® FeuchtCreme in Austria and Germany). This hormone-free cream contains hamamelis virginiana distillate and well-established vaginal cream ingredients. We explored its physical function and tolerability in an open interventional clinical trial. 20 postmenopausal women (54 to 76 years, median 60) treated their vaginal dryness using this cream once daily for 7 days and reported about their symptoms before, 4 to 8 h after first and 14 to 22 h after last application. A physician assessed tolerability and local physical function. All patients completed the study. Local physical function significantly improved from dryness at baseline (mean 4.0 ± SD 1.8) to a normal moisture level, on average (6.3 ± 2.1 after first, 6.7 ± 2.1 after last application, p = 0.0001). Subjective assessment of a feeling vaginal dryness showed a significant improvement at both times (p = 0.0001). Onset and duration of feeling moisturized were reported to be 0 to 2 min and 11.3 ± 6.9 h after application. All women reported vaginal dryness at baseline. 55 and 80% of patients reported no dryness after first application and at the end of the investigation. The cream was seen at the application site for up to 21 h. Tolerability assessments did not reveal any relevant change over time. There were four adverse events in 4 patients, all not serious and of mild intensity: urinary urgency (2), diarrhoea (1) and mild spotting after first application (1). The latter was caused by the dry surface of the applicator and was avoided by moisturizing the surface of the applicator at subsequent applications. In conclusion, these study results indicate a well-tolerated and long-acting function of this new vaginal moisturizing cream. Further clinical research in more patients will follow.

Outcome prediction of third ventriculostomy: a proposed hydrocephalus grading system.

PubMed

Kehler, U; Regelsberger, J; Gliemroth, J; Westphal, M

2006-08-01

An important factor in making a recommendation for different treatment modalities in hydrocephalus patients (VP shunt versus endoscopic third ventriculostomy) is the definition of the underlying pathology which determines the prognosis/outcome of the surgical procedure. Third ventriculostomies (3rd VS) are successful mainly in obstructive hydrocephalus but also in some subtypes of communicating hydrocephalus. A simple, easily applicable grading system that is designed to predict the outcome of 3rd VS is proposed. The hydrocephalus is graded on the basis of the extent of downward bulging of the floor of the third ventricle, which reflects the pressure gradient between the 3rd ventricle and the basal cisterns, presence of directly visualised CSF pathway obstruction in MRI, and the progression of the clinical symptoms resulting in five different grades. In this proposed grading system, grade 1 hydrocephalus subtype shows no downward bulged floor of the 3rd ventricle, no obstruction of the CSF pathway, and no progressive symptoms of hydrocephalus. There is no indication for 3rd VS. Grades 2 to 4 show different combinations of the described parameters. Grade 5 subtype shows a markedly downward bulged floor of the 3rd ventricle and direct detection of the CSF pathway obstruction (i.e., aqueductal stenosis) with progressive clinical deterioration. Retrospective application of this grading scheme to a series of 72 3rd VS has demonstrated a high correlation with the outcome: The success rate in grade 3 reached 40%, in grade 4: 58%, and in grade 5: 95%. This standardised grading system predicts the outcome of 3rd VS and helps in decision making for 3rd VS versus VP shunting.

The vaginal mycobiome: A contemporary perspective on fungi in women's health and diseases.

PubMed

Bradford, L Latéy; Ravel, Jacques

2017-04-03

Most of what is known about fungi in the human vagina has come from culture-based studies and phenotypic characterization of single organisms. Though valuable, these approaches have masked the complexity of fungal communities within the vagina. The vaginal mycobiome has become an emerging field of study as genomics tools are increasingly employed and we begin to appreciate the role these fungal communities play in human health and disease. Though vastly outnumbered by its bacterial counterparts, fungi are important constituents of the vaginal ecosystem in many healthy women. Candida albicans, an opportunistic fungal pathogen, colonizes 20% of women without causing any overt symptoms, yet it is one of the leading causes of infectious vaginitis. Understanding its mechanisms of commensalism and patho-genesis are both essential to developing more effective therapies. Describing the interactions between Candida, bacteria (such as Lactobacillus spp.) and other fungi in the vagina is funda-mental to our characterization of the vaginal mycobiome.

[POLYGYNAX IN THE TREATMENT OF VAGINAL INFECTIONS IN PREGNANT AND NON-PREGNANT WOMEN--CLINICAL EXPERIENCE].

PubMed

Popovski, N; Popovski, K; Nedelkovski, V

2016-01-01

Vaginal infections /VI/ represent some of the most common diseases by infection of FGS. The aim of this study is to analyze clinical and bacteriological efficacy of Polygynax in the treatment of vaginal infections and to take into account the correlation between the results of microbiological controls and reduction of clinical symptoms. The study included 100 patients, including 50 pregnant and non-pregnant 50 for a period of 3 months. All of them was diagnosed with vaginitis clinical examination, taken material from vagina for microbiological testing. The studied women was conducted targeted therapy Polygynax 12 capsules, in the form of vaginal capsules for 12 days, after which the sample control microbiology. Behind the subjective complaints of the patient and to reduce them as a result of treatment. The effective implementation of Polygynax 12 capsules is equally good as in non-pregnant and pregnant women. In a summary of the survey data to make relevant analyzes and conclusions from the results.

The vaginal mycobiome: A contemporary perspective on fungi in women's health and diseases

PubMed Central

2017-01-01

ABSTRACT Most of what is known about fungi in the human vagina has come from culture-based studies and phenotypic characterization of single organisms. Though valuable, these approaches have masked the complexity of fungal communities within the vagina. The vaginal mycobiome has become an emerging field of study as genomics tools are increasingly employed and we begin to appreciate the role these fungal communities play in human health and disease. Though vastly outnumbered by its bacterial counterparts, fungi are important constituents of the vaginal ecosystem in many healthy women. Candida albicans, an opportunistic fungal pathogen, colonizes 20% of women without causing any overt symptoms, yet it is one of the leading causes of infectious vaginitis. Understanding its mechanisms of commensalism and patho-genesis are both essential to developing more effective therapies. Describing the interactions between Candida, bacteria (such as Lactobacillus spp.) and other fungi in the vagina is funda-mental to our characterization of the vaginal mycobiome. PMID:27657355

Structural Reorganization of the Vaginal Mucosa in Stress Urinary Incontinence under Conditions of Er:YAG Laser Treatment.

PubMed

Lapii, G A; Yakovleva, A Yu; Neimark, A I

2017-02-01

Structural characteristics of the vaginal mucosa in stress incontinence and its correction by IncontiLase technology were studied. Studies of vaginal biopsy specimens before the exposure showed degenerative and atrophic changes in the stratified squamous epithelium, disorganization of fibrillar structures of the intercellular matrix, and microcirculatory disorders. Studies after Er:YAG laser exposure showed signs of neocollagenogenesis and elastogenesis, foci of neoangiogenesis, reduction of epithelial degeneration and atrophy, and an increase of the fibroblast population. Morphometry showed that the volume density of blood capillaries and the thickness of the epithelial layer increased by 61.1 and 64.5%, respectively. The use of IncontiLase technology in stress incontinence led to structural reorganization of the vaginal mucosa, improving its morphology and function and alleviating the symptoms of incontinence.

Guideline vulvovaginal candidosis (2010) of the German Society for Gynecology and Obstetrics, the Working Group for Infections and Infectimmunology in Gynecology and Obstetrics, the German Society of Dermatology, the Board of German Dermatologists and the German Speaking Mycological Society.

PubMed

Mendling, W; Brasch, J

2012-07-01

Candida (C.) species colonize the estrogenized vagina in at least 20% of all women. This statistic rises to 30% in late pregnancy and in immunosuppressed patients. The most often occurring species is Candida albicans. Host factors, especially local defense deficiencies, gene polymorphisms, allergic factors, serum glucose levels, antibiotics, psychosocial stress and estrogens influence the risk for a Candida vulvovaginitis. In less than 10% of all cases, non-albicans species, especially C. glabrata, but in rare cases also Saccharomyces cerevisiae, cause a vulvovaginitis, often with fewer clinical signs and symptoms. Typical symptoms include premenstrual itching, burning, redness and non-odorous discharge. Although pruritus and inflammation of the vaginal introitus are typical symptoms, only less than 50% of women with genital pruritus suffer from a Candida vulvovaginitis. Diagnostic tools are anamnesis, evaluation of clinical signs, the microscopic investigation of the vaginal fluid by phase contrast (400 x), vaginal pH-value and, in clinically and microscopically uncertain or in recurrent cases, yeast culture with species determination. The success rate for treatment of acute vaginal candidosis is approximately 80%. Vaginal preparations containing polyenes, imidazoles and ciclopiroxolamine or oral triazoles, which are not allowed during pregnancy, are all equally effective. C. glabrata is resistant to the usual dosages of all local antimycotics. Therefore, vaginal boric acid suppositories or vaginal flucytosine are recommended, but not allowed or available in all countries. Therefore, high doses of 800 mg fluconazole/day for 2-3 weeks are recommended in Germany. Due to increasing resistence, oral posaconazole 2 × 400 mg/day plus local ciclopiroxolamine or nystatin for 15 days was discussed. C. krusei is resistant to triazoles. Side effects, toxicity, embryotoxicity and allergy are not clinically important. A vaginal clotrimazole treatment in the first trimester of pregnancy has shown to reduce the rate of preterm births in two studies. Resistance of C. albicans does not play a clinically important role in vulvovaginal candidosis. Although it is not necessary to treat vaginal candida colonization in healthy women, it is recommended in the third trimester of pregnancy in Germany, because the rate of oral thrush and diaper dermatitis in mature healthy newborns, induced by the colonization during vaginal delivery, is significantly reduced through prophylaxis. Chronic recurrent vulvovaginal candidosis requires a "chronic recurrent" suppression therapy, until immunological treatment becomes available. Weekly to monthly oral fluconazole regimes suppress relapses well, but cessation of therapy after 6 or 12 months leads to relapses in 50% of cases. Decreasing-dose maintenance regime of 200 mg fluconazole from an initial 3 times a week to once monthly (Donders 2008) leads to more acceptable results. Future studies should include candida autovaccination, antibodies against candida virulence factors and other immunological trials. Probiotics should also be considered in further studies. Over the counter (OTC) treatment must be reduced. © 2012 Blackwell Verlag GmbH.

Vulval and Vaginal Rhabdomyosarcoma in Children: Update and Reappraisal of Institut Gustave Roussy Brachytherapy Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Magne, Nicolas; Oberlin, Odile; Martelli, Helene

2008-11-01

Purpose: To report the Institut Gustave Roussy brachytherapy (BT) experience in the management of vulval and vaginal rhabdomyosarcoma with special emphasis on long-term outcome. Patients and Methods: Between 1971 and 2005, the data concerning 39 girls who had undergone BT as a part of their treatment were retrospectively analyzed. Of the 39 girls, 20 had been treated before 1990, when the BT volume encompassed the initial tumor extension. After 1990, only residual disease was included in the BT volume. Side effects were classified using the Common Terminology Criteria for Adverse Events, version 3.0. Results: The median age was 16.3 monthsmore » at diagnosis. Vaginal or vulvar rhabdomyosarcoma was diagnosed in 26 and 6 patients, respectively. The median follow-up was 8.4 years. The 5-year overall survival rate was 91%. Of the 39 patients, 6 developed a relapse. Of the 20 patients treated before 1990, 6 experienced Grade 1-2 renal/genitourinary function symptoms and 75% developed sequelae, in the form of vaginal or urethral sclerosis or stenosis. Four patients received follow-up treatment for psychological disorders. Of the 19 patients treated after 1990, 2 developed acute side effects, with maximal Grade 1-2 renal/genitourinary function symptoms, and 20% developed vaginal or urethral sclerosis or stenosis. Two cases of psychological disturbances were also documented. Conclusion: Reducing the BT volume coverage, better indications for surgery, and more efficient chemotherapy, all combined within a multidisciplinary approach, tended to improve results in terms of both survival and long-term sequelae.« less

Time-dependent dose-response relation for absence of vaginal elasticity after gynecological radiation therapy.

PubMed

Alevronta, Eleftheria; Åvall-Lundqvist, Elisabeth; Al-Abany, Massoud; Nyberg, Tommy; Lind, Helena; Waldenström, Ann-Charlotte; Olsson, Caroline; Dunberger, Gail; Bergmark, Karin; Steineck, Gunnar; Lind, Bengt K

2016-09-01

To investigate the dose-response relation between the dose to the vagina and the patient-reported symptom 'absence of vaginal elasticity' and how time to follow-up influences this relation. The study included 78 long-term gynecological cancer survivors treated between 1991 and 2003 with external beam radiation therapy. Of those, 24 experienced absence of vaginal elasticity. A normal tissue complication model is introduced that takes into account the influence of time to follow-up on the dose-response relation and the patient's age. The best estimates of the dose-response parameters were calculated using Probit, Probit-Relative Seriality (RS) and Probit-time models. Log likelihood (LL) values and the Akaike Information Criterion (AIC) were used to evaluate the model fit. The dose-response parameters for 'absence of vaginal elasticity' according to the Probit and Probit-time models with the 68% Confidence Intervals (CI) were: LL=-39.8, D 50 =49.7 (47.2-52.4) Gy, γ 50 =1.40 (1.12-1.70) and LL=-37.4, D 50 =46.9 (43.5-50.9) Gy, γ 50 =1.81 (1.17-2.51) respectively. The proposed model, which describes the influence of time to follow-up on the dose-response relation, fits our data best. Our data indicate that the steepness of the dose-response curve of the dose to the vagina and the symptom 'absence of vaginal elasticity' increases with time to follow-up, while D 50 decreases. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Population-based genetic epidemiologic analysis of Chlamydia trachomatis serotypes and lack of association between ompA polymorphisms and clinical phenotypes.

PubMed

Millman, Kim; Black, Carolyn M; Stamm, Walter E; Jones, Robert B; Hook, Edward W; Martin, David H; Bolan, Gail; Tavaré, Simon; Dean, Deborah

2006-03-01

Chlamydia trachomatis is the leading cause of bacterial sexually transmitted diseases worldwide. Urogenital strains are classified into serotypes and genotypes based on the major outer membrane protein and its gene, ompA, respectively. Studies of the association of serotypes with clinical signs and symptoms have produced conflicting results while no studies have evaluated associations with ompA polymorphisms. We designed a population-based cross-sectional study of 344 men and women with urogenital chlamydial infections (excluding co-pathogen infections) presenting to clinics serving five U.S. cities from 1995 to 1997. Signs, symptoms and sequelae of chlamydial infection (mucopurulent cervicitis, vaginal or urethral discharge; dysuria; lower abdominal pain; abnormal vaginal bleeding; and pelvic inflammatory disease) were analyzed for associations with serotype and ompA polymorphisms. One hundred and fifty-three (44.5%) of 344 patients had symptoms consistent with urogenital chlamydial infection. Gender, reason for visit and city were significant independent predictors of symptom status. Men were 2.2 times more likely than women to report any symptoms (P=0.03) and 2.8 times more likely to report a urethral discharge than women were to report a vaginal discharge in adjusted analyses (P=0.007). Differences in serotype or ompA were not predictive except for an association between serotype F and pelvic inflammatory disease (P=0.046); however, the number of these cases was small. While there was no clinically prognostic value associated with serotype or ompA polymorphism for urogenital chlamydial infections except for serotype F, future studies might utilize multilocus genomic typing to identify chlamydial strains associated with clinical phenotypes.

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.

Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis.

PubMed

McClelland, R Scott; Richardson, Barbra A; Hassan, Wisal M; Graham, Susan M; Kiarie, James; Baeten, Jared M; Mandaliya, Kishorchandra; Jaoko, Walter; Ndinya-Achola, Jeckoniah O; Holmes, King K

2009-06-15

It has been suggested that vaginal colonization with lactobacilli may reduce the risk of vulvovaginal candidiasis (VVC), but supporting data are limited. Our objective was to determine the relationship between vaginal bacterial flora and VVC. We conducted a prospective cohort analysis that involved 151 Kenyan sex workers. At monthly follow-up visits, VVC was defined as the presence of yeast buds, pseudohyphae, or both on a wet preparation (including potassium hydroxide preparation) of vaginal secretions. Generalized estimating equations were used to identify correlates of VVC. Participants returned for a median of 12 visits (interquartile range, 11-12 visits). VVC was identified at 162 visits, including 26 involving symptomatic VVC. Bacterial vaginosis was associated with fewer episodes of VVC (adjusted odds ratio [aOR], 0.29 [95% confidence interval {CI}, 0.16-0.50]). After excluding women with concurrent bacterial vaginosis, another possible cause of vaginal symptoms, the likelihood of symptomatic VVC was higher among those who had had yeast identified on wet preparation of vaginal secretions during the past 60 days (aOR, 4.06 [95% CI, 1.12-14.74]) and those with concurrent vaginal Lactobacillus colonization (aOR, 3.75 [95% CI, 1.30-10.83]). Contrary to the commonly posited hypothesis that vaginal Lactobacillus colonization has a protective effect, we found that such colonization was associated with a nearly 4-fold increase in the likelihood of symptomatic VVC.

A Prospective Study of Vaginal Bacterial Flora and Other Risk Factors for Vulvovaginal Candidiasis

PubMed Central

McClelland, R. Scott; Richardson, Barbra A.; Hassan, Wisal M.; Graham, Susan M.; Kiarie, James; Baeten, Jared M.; Mandaliya, Kishorchandra; Jaoko, Walter; Ndinya-Achola, Jeckoniah O.; Holmes, King K.

2009-01-01

Background: It has been suggested that vaginal lactobacilli may reduce the risk of vulvovaginal candidiasis (VVC), but supporting data are limited. Our objective was to determine the relationship between vaginal bacterial flora and VVC. Methods: We conducted a prospective cohort analysis among 151 Kenyan sex workers. At monthly follow-up, VVC was defined as the presence of yeast buds, pseudohyphae, or both on vaginal wet preparation or KOH preparation. Generalized estimating equations were used to identify correlates of VVC. Results: Participants returned for a median of 12 (interquartile range 11-12) visits. Vulvovaginal candidiasis was present at 162 visits, including 26 with symptomatic VVC. Bacterial vaginosis (BV) was associated with fewer episodes of VVC (adjusted odds ratio [aOR] 0.29, 95% confidence interval [CI] 0.16-0.50). After excluding women with concurrent BV, another possible cause of vaginal symptoms, the likelihood of symptomatic VVC was higher in those with yeast on vaginal wet preparation in the past 60 days (aOR 4.06, 95% CI 1.12-14.74) and those with concurrent vaginal Lactobacillus colonization (aOR 3.75, 95% CI 1.30-10.83). Conclusions: Contrary to a commonly posed hypothesis of a protective effect, we found that vaginal Lactobacillus colonization was associated with a >4-fold increase in the likelihood of symptomatic VVC. PMID:19456235

Pilot randomized trial for treatment of bacterial vaginosis using in situ forming metronidazole vaginal gel.

PubMed

Shaaban, Omar M; Fetih, Gihan N; Abdellah, Noura H; Ismail, Saeyd; Ibrahim, Maggie A; Ibrahim, El-sayed A

2011-07-01

To compare the efficacy of a novel vaginal delivery system for metronidazole (0.8% MTZ in situ gel) versus a conventional MTZ vaginal gel product in the treatment of bacterial vaginosis (BV). All consecutive patients who presented to a tertiary care hospital with symptoms suggestive of BV were approached to participate in the study. Forty-two eligible participants were randomly assigned to either MTZ in situ gel or a conventional vaginal gel product twice daily for 5 days. All participants were re-examined after one and 4 weeks of the beginning of treatment to ensure cure of infection and any side-effects. Demographic criteria of the participants were comparable in the two treatment groups. The cure rate after one week from the treatment was 85% in the in situ gel group and 71.4% in the conventional vaginal gel group (P = 0.294), while after 4 weeks, the cure rate showed significant difference in the in situ gel group as compared to the conventional vaginal gel group (16/20 [80%]) and (9/19 [47.4%]), respectively (P = 0.034). Pilot testing showed that in situ MTZ vaginal gel is more effective than the conventional vaginal gel for long-term cure of BV. These findings suggest a novel and efficient long-term treatment of BV. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Bladder function after sacrospinous hysteropexy and vaginal wall repair in women with uterovaginal prolapse.

PubMed

Sayed Ahmed, Waleed A; Taha, Omima T; Hamdy, Mostafa A; Ibrahim, Zakia M; Elshahat, Amal M

2018-05-01

To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy and vaginal wall repair on the bladder function. The study was conducted at the urogynecology clinic of Suez Canal University Hospitals, Ismailia from January 2014 to March 2016. This study included women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri. Bladder function was evaluated through assessment of urological symptoms using a standardized questionnaire - the urogenital distress inventory (UDI-6) - in addition to urodynamic studies just before and six-months after the sacrospinous hysteropexy ± associated vaginal wall repair operation. Twenty-seven patients completed the study with a mean age of 36.5 ± 4 years. Only 3 women had sacrospinous hysteropexy with no additional procedures. Other procedures included anterior colporrhaphy (12), posterior colporrhaphy (9) and perineorrhaphy (15). Based on UDI-6, there was no significant difference between the pre- and post-operative symptoms of stress urinary incontinence (SUI) [8/27 (29.6%) vs. 9/27 (33.3%) respectively; p value = 0.7]. The pre- and post-operative symptoms of urge urinary incontinence were also insignificantly different [13/27 (48.1%) vs. 15/27 (55.5%); p value = 0.5]. The total score of UDI-6 increased from 24.5 ± (14.2) to 32.8 ± (29.4) which was not statistically significant (p value = 0.12). Urodynamically, voiding dysfunction was found less frequently after the operation, however the difference was statistically insignificant [9/27 (33.3%) vs. 8/27 (29.6%); p value = 0.7]. Sacrospinous hysteropexy and associated vaginal wall repair do not affect the bladder function either subjectively or objectively. Copyright © 2018. Published by Elsevier B.V.

Multimodal vaginal toning for bladder symptoms and quality of life in stress urinary incontinence.

PubMed

de la Torre, Sarah; Miller, Larry E

2017-08-01

Treatment options for women with stress urinary incontinence (SUI) have limitations. We hypothesized that multimodal vaginal toning therapy would improve bladder symptoms and quality of life in women with postpartum SUI and sexual function complaints. Patients self-administered 24 sessions of multimodal vaginal toning therapy lasting 10 min each over 50 days. Outcomes included 1-h pad weight test, Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), Female Sexual Distress Scale-Revised 2005 (FSDS-R), Female Sexual Function Index (FSFI), pelvic floor muscle strength, patient satisfaction, and adverse events. Of the 55 patients enrolled (safety population), 48 completed the study per-protocol (PP population). A total of 38 (79%) patients had a positive 1-h pad weight test at baseline. In this group, urine leakage was moderate or severe in 82% of patients at baseline, but in only 18% after treatment. Treatment success was 84%, defined as >50% improvement in pad weight relative to baseline. In the PP population, mean UDI-6 score improved by 50% (p < 0.001) and IIQ-7 score improved by 69% (p < 0.001). Sexual function quality of life improved by 54% for FSDS-R and 15% for FSFI (both p < 0.001). Pelvic floor muscle strength significantly improved (p < 0.001). Patient satisfaction with therapy was reported in 83% of patients. In the safety population, 2 (3.6%) adverse events were reported-1 urinary tract infection and 1 report of discomfort due to excessive warmth. Multimodal vaginal toning therapy yields clinically meaningful improvements in bladder symptoms, pelvic floor muscle strength, and quality of life in women with SUI.

Recurrent vaginal discharge in children.

PubMed

McGreal, Sharon; Wood, Paul

2013-08-01

Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Pediatric and Adolescent Gynecology (PAG) service at Kettering General Hospital was established in 1993 and provides a specialized service that meets the needs of children with gynaecological conditions. To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time. Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually. 110 patients were identified; 85% were referred from primary care. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. The commonest cause of discharge was vulvovaginitis (82%). Other important causes included suspected sexual abuse (5%), foreign body (3%), labial adhesions (3%), vaginal agenesis (2%). 35% of patients were admitted for vaginoscopy. Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures. Awareness of the less common causes of vaginal discharge is essential. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Safety of a silicone elastomer vaginal ring as potential microbicide delivery method in African women: A Phase 1 randomized trial.

PubMed

Nel, Annaléne; Martins, Janine; Bekker, Linda-Gail; Ramjee, Gita; Masenga, Gileard; Rees, Helen; van Niekerk, Neliëtte

2018-01-01

Women in sub-Saharan Africa are in urgent need of female-initiated human immunodeficiency virus (HIV) preventative methods. Vaginal rings are one dosage form in development for delivery of HIV microbicides. However, African women have limited experience with vaginal rings. This Phase I, randomized, crossover trial assessed and compared the safety, acceptability and adherence of a silicone elastomer placebo vaginal ring, intended as a microbicide delivery method, inserted for a 12-week period in healthy, HIV-negative, sexually active women in South Africa and Tanzania. 170 women, aged 18 to 35 years were enrolled with 88 women randomized to Group A, using a placebo vaginal ring for 12 weeks followed by a 12-week safety observation period. 82 women were randomized to Group B and observed for safety first, followed by a placebo vaginal ring for 12 weeks. Safety was assessed by clinical laboratory assessments, pelvic/colposcopy examinations and adverse events. Possible carry-over effect was addressed by ensuring no signs or symptoms of genital irritation at crossover. No safety concerns were identified for any safety variables assessed during the trial. No serious adverse events were reported considered related to the placebo vaginal ring. Vaginal candidiasis was the most common adverse event occurring in 11% of participants during each trial period. Vaginal discharge (2%), vaginal odour (2%), and bacterial vaginitis (2%) were assessed as possibly or probably related to the vaginal ring. Thirty-four percent of participants had sexually transmitted infections (STIs) at screening, compared to 12% of participants who tested positive for STIs at crossover and the final trial visit. Three participants (2%) tested HIV positive during the trial. The silicone elastomer vaginal ring had no safety concerns, demonstrating a profile favorable for further development for topical release of antiretroviral-based microbicides.

Safety of a silicone elastomer vaginal ring as potential microbicide delivery method in African women: A Phase 1 randomized trial

PubMed Central

Nel, Annaléne; Bekker, Linda-Gail; Ramjee, Gita; Masenga, Gileard; Rees, Helen; van Niekerk, Neliëtte

2018-01-01

Background Women in sub-Saharan Africa are in urgent need of female-initiated human immunodeficiency virus (HIV) preventative methods. Vaginal rings are one dosage form in development for delivery of HIV microbicides. However, African women have limited experience with vaginal rings. Objectives This Phase I, randomized, crossover trial assessed and compared the safety, acceptability and adherence of a silicone elastomer placebo vaginal ring, intended as a microbicide delivery method, inserted for a 12-week period in healthy, HIV-negative, sexually active women in South Africa and Tanzania. Methods 170 women, aged 18 to 35 years were enrolled with 88 women randomized to Group A, using a placebo vaginal ring for 12 weeks followed by a 12-week safety observation period. 82 women were randomized to Group B and observed for safety first, followed by a placebo vaginal ring for 12 weeks. Safety was assessed by clinical laboratory assessments, pelvic/colposcopy examinations and adverse events. Possible carry-over effect was addressed by ensuring no signs or symptoms of genital irritation at crossover. Results No safety concerns were identified for any safety variables assessed during the trial. No serious adverse events were reported considered related to the placebo vaginal ring. Vaginal candidiasis was the most common adverse event occurring in 11% of participants during each trial period. Vaginal discharge (2%), vaginal odour (2%), and bacterial vaginitis (2%) were assessed as possibly or probably related to the vaginal ring. Thirty-four percent of participants had sexually transmitted infections (STIs) at screening, compared to 12% of participants who tested positive for STIs at crossover and the final trial visit. Three participants (2%) tested HIV positive during the trial. Conclusions The silicone elastomer vaginal ring had no safety concerns, demonstrating a profile favorable for further development for topical release of antiretroviral-based microbicides. PMID:29813074

[Vulvovaginitis in premenarche girls. A preliminary study].

PubMed

Jiménez Fernández, F; Cermeño, P C; Pescador Abad, F J; Ruano Gil, M; Mora Guio, F; Martín Pérez, C

1991-11-01

The study population consisted of 832 premenarcheal girls. Vaginal cultures are performed on 40 premenarcheal girls suffering from vulvovaginitis. All were less than 7 years old. This patients were seen in primary cares. In 23 cases (57.5%) E. coli was isolated, Enterococcus (30%), mixed flora (10%) and G. vaginalis (2.5%). Common clinical characteristics were pruritus (97.5%), vaginal discharge (67.5%). Dysuria and abdominal pain constituted accompanying symptoms. Only in one case masturbation was observed.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention

MedlinePlus

... early menopause. Symptoms of menopause include the following: Hot flashes . Night sweats. Trouble sleeping. Mood changes. Decreased sex drive . Heart disease. Vaginal dryness. Frequent urination. Osteoporosis ( ...

THE X-SHAPED BULGE OF THE MILKY WAY REVEALED BY WISE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ness, Melissa; Lang, Dustin, E-mail: ness@mpia-hd.mpg.de

2016-07-01

The Milky Way bulge has a boxy/peanut morphology and an X-shaped structure. This X-shape has been revealed by the “split in the red clump” from star counts along the line of sight toward the bulge, measured from photometric surveys. This boxy, X-shaped bulge morphology is not unique to the Milky Way and such bulges are observed in other barred spiral galaxies. N -body simulations show that boxy and X-shaped bulges are formed from the disk via dynamical instabilities. It has also been proposed that the Milky Way bulge is not X-shaped, but rather, the apparent split in the red clumpmore » stars is a consequence of different stellar populations, in an old classical spheroidal bulge. We present a Wide-Field Infrared Survey Explorer ( WISE ) image of the Milky Way bulge, produced by downsampling the publicly available “unWISE” coadds. The WISE image of the Milky Way bulge shows that the X-shaped nature of the Milky Way bulge is self-evident and irrefutable. The X-shape morphology of the bulge in itself and the fraction of bulge stars that comprise orbits within this structure has important implications for the formation history of the Milky Way, and, given the ubiquity of boxy X-shaped bulges, spiral galaxies in general.« less

Pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence: randomized controlled pilot trial of supervised versus unsupervised training.

PubMed

Kim, Eun-Young; Kim, Suhn-Yeop; Oh, Duck-Won

2012-02-01

To investigate the effect of supervised and unsupervised pelvic floor muscle exercises utilizing trunk stabilization for treating postpartum urinary incontinence and to compare the outcomes. Randomized, single-blind controlled study. Outpatient rehabilitation hospital. Eighteen subjects with postpartum urinary incontinence. Subjects were randomized to either a supervised training group with verbal instruction from a physiotherapist, or an unsupervised training group after undergoing a supervised demonstration session. Bristol Female Lower Urinary Tract Symptom questionnaire (urinary symptoms and quality of life) and vaginal function test (maximal vaginal squeeze pressure and holding time) using a perineometer. The change values for urinary symptoms (-27.22 ± 6.20 versus -18.22 ± 5.49), quality of life (-5.33 ± 2.96 versus -1.78 ± 3.93), total score (-32.56 ± 8.17 versus -20.00 ± 6.67), maximal vaginal squeeze pressure (18.96 ± 9.08 versus 2.67 ± 3.64 mmHg), and holding time (11.32 ± 3.17 versus 5.72 ± 2.29 seconds) were more improved in the supervised group than in the unsupervised group (P < 0.05). In the supervised group, significant differences were found for all variables between pre- and post-test values (P < 0.01), whereas the unsupervised group showed significant differences for urinary symptom score, total score and holding time between the pre- and post-test results (P < 0.05). These findings suggest that exercising the pelvic floor muscles by utilizing trunk stabilization under physiotherapist supervision may be beneficial for the management of postpartum urinary incontinence.

Candidiasis During Pregnancy May Result From Isogenic Commensal Strains

PubMed Central

Daniels, Wayne; Glover, Douglas D.; Essmann, Michael

2001-01-01

Objective: Our laboratory previously demonstrated that asymptomatic vaginal colonization during pregnancy is a factor predisposing patients to subsequent symptomatic vulvovaginal candidiasis. It is unknown whether symptoms result from strain replacement or a change in host relationship to the original colonizing strain. This study was undertaken to determine whether Candida albicans isolates from asymptomatic women could be responsible for subsequent symptomatic vaginitis. Methods: We retained isolates of C. albicans from women followed longitudinally through pregnancy, and identified six pairs of cultures from women who were colonized without symptoms and who later became symptomatic (average time 14 weeks). We used a random amplification of polymorphic DNA (RAPD) analysis to determine whether isolates from our study patients were genetically similar or dissimilar. Results: Analysis of these pairs of yeast strains by RAPD revealed that five of the six women had symptoms apparently due to the same yeast strain that was found initially as a commensal strain. To increase the power of these observations, we also performed RAPD analysis on six randomly selected yeast strains from other women in this study who had not become symptomatic to determine whether any of these unrelated strains matched strains from those women who became symptomatic. Conclusion: Symptomatic yeast vaginitis is usually due to strains of C. albicans already carried in the lower genital tract, underscoring the need to understand regulation of growth and virulence of the organism in vivo. PMID:11495556

Cervicitis

MedlinePlus

... vagina. Possible symptoms of cervicitis include bleeding between menstrual periods, pain with intercourse or during a cervical ... Frequent, painful urination Pain during intercourse Bleeding between menstrual periods Vaginal bleeding after intercourse, not associated with ...

Uterine Polyps

MedlinePlus

... Signs and symptoms of uterine polyps include: Irregular menstrual bleeding — for example, having frequent, unpredictable periods of variable length and heaviness Bleeding between menstrual periods Excessively heavy menstrual periods Vaginal bleeding after ...

Estrogen

MedlinePlus

... life', the end of monthly menstrual periods). Some brands of estrogen are also used to treat vaginal ... prevent osteoporosis should consider a different treatment. Some brands of estrogen are also to relieve symptoms of ...

Antibiotic Safety

MedlinePlus

... specific to women Antibiotics can lead to vaginal yeast infections. This happens because antibiotics kill the normal bacteria in the vagina and this causes yeast to grow rapidly. Symptoms of a yeast infection ...

Miconazole

MedlinePlus

... athlete's foot and jock itch and for vaginal yeast infections.This medication is sometimes prescribed for other ... has told you before that you had a yeast infection and you have the same symptoms again, ...

Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm.

PubMed

Coleman, Tanner J; Nygaard, Ingrid E; Holder, Dannielle N; Egger, Marlene J; Hitchcock, Robert

2015-08-01

The objective was to describe the intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22-59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. There were no statistically significant differences in the mean maximal IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean maximal IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand, but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). Our results support recommending this series of introductory Pilates exercises, including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long-term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health.

Intra-abdominal Pressure during Pilates: Unlikely to Cause Pelvic Floor Harm

PubMed Central

Coleman, Tanner J.; Holder, Dannielle N.; Egger, Marlene J.; Hitchcock, Robert

2015-01-01

Aims To describe intra-abdominal pressures (IAP) generated during Pilates Mat and Reformer activities, and determine whether these activities generate IAP above a sit-to-stand threshold. Methods Twenty healthy women with no symptomatic vaginal bulge, median age 43 (range 22 – 59 years), completed Pilates Mat and Reformer exercise routines each consisting of 11 exercises. IAP was collected by an intra-vaginal pressure transducer, transmitted wirelessly to a base station, and analyzed for maximal and area under the curve (AUC) IAP. Results There were no statistically significant differences in mean max IAP between sit-to-stand and any of the Mat or Reformer exercises in the study population. Six to twenty-five percent of participants exceeded their individual mean max IAP sit-to-stand thresholds for 10 of the 22 exercises. When measuring AUC from 0 cm H2O, half the exercises exceeded the mean AUC of sit-to-stand but only Pilates Reformer and Mat roll-ups exceeded the mean AUC of sit-to-stand when calculated from a threshold of 40 cm H2O (consistent with, for example, walking). Conclusion Our results support recommending this series of introductory Pilates exercises including five Mat exercises and six Reformer exercises to women desiring a low IAP exercise routine. More research is needed to determine the long term effects of Pilates exercise on post-surgical exercise rehabilitation and pelvic floor health. PMID:25672647

Recognition of DNA/RNA bulges by antimicrobial and antitumor metallohelices.

PubMed

Malina, Jaroslav; Scott, Peter; Brabec, Viktor

2015-09-07

Bulged structures have been identified in nucleic acids and have been shown to be linked to biomolecular processes involved in numerous diseases. Thus, chemical agents with affinity for bulged nucleic acids are of general biological significance. Herein, the mechanism of specific recognition and stabilization of bulged DNA and RNA by helical bimetallic species was established through detailed molecular biophysics and biochemistry assays. These agents, known as 'flexicates', are potential mimetics of α-helical peptides in cancer treatment, exhibiting antimicrobial and antitumor effects. The flexicates have positive impacts on the thermal stability of DNA duplexes containing bulges, which means that the flexicates interact with the duplexes containing bulges, and that these interactions stabilize the secondary structures of these duplexes. Notably, the stabilising effect of the flexicates increases with the size of the bulge, the maximal stabilization is observed for the duplexes containing a bulge composed of at least three bases. The flexicates bind most preferentially to the bulges composed of pyrimidines flanked on both sides also by pyrimidines. It is suggested that it is so because these bulges exhibit greatest conformational variability in comparison with other combinations of bases in the bulge loop and bases flanking the bulge. Finally, the results indicate that there is only one dominant binding site for the flexicates on the DNA and RNA bulges and that the flexicates bind directly to the bulge or in its close proximity. It is also shown that the flexicates effectively bind to RNA duplexes containing the bulged region of HIV-1 TAR RNA.

Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial.

PubMed

Heczko, Piotr B; Tomusiak, Anna; Adamski, Paweł; Jakimiuk, Artur J; Stefański, Grzegorz; Mikołajczyk-Cichońska, Aleksandra; Suda-Szczurek, Magdalena; Strus, Magdalena

2015-12-03

This multicentre, randomised, double-blind, placebo-controlled trial was performed to determine whether the use of oral probiotic preparation (prOVag®) containing three Lactobacillus strains together with standard metronidazole treatment and also targeted antibiotic treatment (following the failure of metronidazole therapy) could reduce the recurrence rates of bacterial vaginosis (BV) and aerobic vaginitis (AV). Patients at private gynaecological clinics in Poland with histories of recurrent BV/AV and current symptoms were randomly allocated to receive metronidazole and probiotic or placebo, and assessed monthly on visits II and III-V. The total number of study visits was 5-6 (I, II, II bis - if applicable, III, IV, V). One probiotic or placebo capsule was administered with metronidazole/targeted antibiotic twice daily for 10 days; during follow up, patients took one capsule daily for 10 days perimenstrually. Clinical examination and vaginal swabbing were performed at each visit. Primary outcomes were clinical or microbiological BV/AV recurrence and probiotic safety. Secondary outcomes were vaginal pH, Nugent score, and Lactobacillus counts in the vaginal microbiota. Safety analysis was performed in 578 (probiotic, n = 285; placebo, n = 293) 18-50-year-old women who were randomised. BV/AV was confirmed microbiologically in 241 (probiotic, n = 118; placebo, n = 123) participants, who continued the trial. Data from 154 (probiotic, n = 73; placebo, n = 81) participants who completed the study were analysed to determine the efficacy of prOVag. Additional analyses included 37 (probiotic, n = 22; placebo, n = 15) participants who received targeted antibiotics and probiotics or placebo. prOVag lengthened the time to clinical relapse of BV/AV symptoms up to 51 % (p < 0.05) compared with placebo; AV relapse was delayed by up to 76 % (p < 0.05). Probiotic use also reduced and maintained low vaginal pH and Nugent score, and increased vaginal Lactobacillus counts following standard treatment. This study demonstrated that oral probiotics lengthened remission in patients with recurrent BV/AV and improved clinical and microbiological parameters. NCT01993524 ; 20 November 2013.

Female sexual arousal disorder with and without a distress criterion: prevalence and correlates in a representative Czech sample.

PubMed

Weiss, Petr; Brody, Stuart

2009-12-01

Sexual medicine would benefit from large representative surveys examining the prevalence of genital female sexual arousal disorder (FSAD) symptoms (with and without the increasingly controversial distress criterion), as well as novel FSAD correlates and potential "protective" factors. To examine the extent to which genital FSAD symptoms, with and without a distress criterion, are associated with both historical and current aspects of sexual behavior. In a representative sample of the Czech population (aged 15-88), 1,000 women were asked whether they currently have impaired lubrication and vaginal swelling (and if so, if this produces marked distress or interpersonal difficulty). They provided details of vaginal orgasm (induced by penile-vaginal intercourse [PVI] without clitoral masturbation) consistency, feelings during their first PVI, estimates of their typical foreplay and PVI durations, their degree of mental focus on vaginal sensations during PVI, among other factors. The current prevalence of FSAD with and without a distress criterion and their associations with current and antecedent sexual behaviors and responses. The current prevalence of FSAD was 10.3% without, plus 7.5% with a distress criterion (which tended to be associated with more impairments than without distress). History of vaginal orgasm (odds ratio = 2.78), never masturbating (odds ratio = 2.4), not having felt pain and discomfort on first PVI (odds ratio = 2.27), and not having frequent anal intercourse are protective against FSAD with distress, but not without distress. Age (especially over 50) and inadequate focusing of mental attention on vaginal sensations during PVI are associated with increased FSAD risk both with and without distress. FSAD with and without distress appear to be different entities to some extent, with the distressed group showing more long-term signs of psychosexual impairment. We suggest that FSAD with and without distress be considered two different disorders.

Vulvar Vestibulitis—A Complex Clinical Entity

PubMed Central

Kessler, Alan; Leonard, Garrick H.; Witkin, Steven S.

1996-01-01

Objective: This study aims to determine the pathophysiology of vulvar vestibulitis and to evaluate currently used treatment options. Methods: Two hundred twenty women with vulvar vestibulitis were seen between October 1987 and March 1995. Every patient had vulvar pain when they attempted intercourse, 75% had excessive vaginal discharge, 36.4% had constant or recurring vulvar burning, and 10.9% had symptoms suggestive of cystitis. All were cultured for the presence of Candida albicans. One hundred sixty-one (73.2%) were also tested for vaginal IgE and prostaglandin E2 (PGE2); 72 (32.7%) had a vulvar biopsy performed as well. Results: A wide range of variants were noted: 53 (24.1%) had a human papilloma virus (HPV) infection, 25 (11.4%) had a Candida vulvovaginitis, 43 (19.5%) had a vaginal allergy, 15 (6.8%) had vaginal PGE2 present, 14 (6.4%) had elevated urinary oxalate excretion, and 29 (13.2%) had a variety of diagnosed variants. In 81 (36.8%) no underlying diagnosis was made. This understates the numbers and varieties of vulvar vaginal diagnoses, for not all patients received a vaginal fluid analysis, a vulvar biopsy, or a 24 h urine screen for oxalates. A variety of medical and operative interventions was used. Symptoms were relieved in 65.9% of patients. The degree of sueeess varied. Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate supplementation, 16% with anti-Candida treatment, 48.1% with antihistamines, 77% with vulvar injection of interferon, 83% with operative removal of inflamed vulvar tissue, and a posterior colporrhaphy used to cover the cutaneous defect. Conclusions: The diagnosis of vulvar vestibulitis is easy to make. An etiology for this chronic condition will not be achieved in every patient. A majority of patients can get relief by a variety of medical and operative interventions. PMID:18476106

The REJOICE trial: a phase 3 randomized, controlled trial evaluating the safety and efficacy of a novel vaginal estradiol soft-gel capsule for symptomatic vulvar and vaginal atrophy

PubMed Central

Constantine, Ginger D.; Simon, James A.; Pickar, James H.; Archer, David F.; Kushner, Harvey; Bernick, Brian; Gasper, Gina; Graham, Shelli; Mirkin, Sebastian

2017-01-01

Abstract Objective: To evaluate the safety and efficacy of TX-004HR vaginal estradiol soft-gel capsules for moderate-to-severe dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Methods: In this randomized, double-blind, placebo-controlled, phase 3 study, postmenopausal women with a self-identified most bothersome symptom of dyspareunia received 4, 10, or 25 μg TX-004HR or placebo for 12 weeks. Four co-primary efficacy endpoints were change from baseline to week 12 in percentages of superficial and parabasal cells, vaginal pH, and severity of dyspareunia. Secondary endpoints included severity of vaginal dryness and vulvar and/or vaginal itching or irritation. Endometrial histology and adverse events (AEs) were included in the safety endpoints. Results: In all, 764 women were randomized (modified intent-to-treat population, n = 747; mean age 59 y). Compared with placebo, all three doses of TX-004HR significantly improved the four co-primary endpoints (P < 0.0001 for all, except dyspareunia with 4 μg, P = 0.0149). Changes in cytology, pH, and dyspareunia were also significant at weeks 2, 6, and 8. Vaginal dryness and vaginal itching/irritation improved. Sex hormone binding globulin concentrations did not change with treatment. TX-004HR was well-tolerated, with no clinically meaningful differences in treatment-emergent AEs versus placebo, and no treatment-related serious AEs or deaths. Conclusions: TX-004HR (4, 10, and 25 μg) was safe, well-tolerated, and effective for treating moderate-to-severe dyspareunia within 2 weeks with minimal systemic estrogen exposure. This novel product may be a potential new treatment option for women experiencing postmenopausal vulvar and vaginal atrophy. PMID:27922936

Ischiorectal abscess and ischiorectal-vaginal fistula as delayed complications of posterior intravaginal slingplasty: a case report.

PubMed

Chen, Heidi Wen-Chu; Guess, Marsha K; Connell, Kathleen A; Bercik, Richard S

2009-10-01

Synthetic meshes have been used extensively to augment surgical management of pelvic organ prolapses. Posterior intravaginal sling (IVS) is a technique used for correcting vaginal vault/apical prolapse, posterior vaginal prolapse or rectocele. There are limited data on long-term safety of this procedure. In a subanalysis of the IVS tapes from the SUSPEND trial performed secondary to the large number of patients with complications of suburethral sling erosions after IVS, it was noted that the sling erosion tended to have a delayed presentation secondary to poor incorporation of the mesh. A 48-year-old woman with cystocele, uterine prolapse and rectocele had undergone total vaginal hysterectomy, mesh-augmented anterior repair, posterior colporrhaphy and posterior intravaginal slingplasty (IVS) in July 2005. Thirty months after the surgery, she presented with gradual symptoms of copious vaginal discharge for several weeks followed by constant right buttock pain and swelling. Examination was notable for intact mesh with no signs of erosion and a 3-cm induration deep within the right buttock. Computed tomography suggested a pelvic abscess. Magnetic resonance imaging confirmed a right ischiorectal fossa abscess and a vaginal fistula. The patient underwent sling excision, right ischiorectal fossa exploration and vaginal fistula repair. A fistulous tract was found to extend along the intact sling from the vaginal epithelium toward the right ischiorectal fossa. At 2 months' followup, there were no recurrences or other complications. This is the first report of a delayed complication of an ischiorectal abscess associated with an ischiorectal-vaginal fistula that presented 30 months after the placement of a posterior IVS.

Maternal morbidity in early pregnancy in rural northern Bangladesh.

PubMed

Kim, Julia M; Labrique, Alain; West, Keith P; Rashid, Mahbubur; Shamim, Abu A; Ali, Hasmot; Ullah, Barkat; Wu, Lee; Massie, Allan; Mehra, Sucheta; Klemm, Rolf; Christian, Parul

2012-12-01

To determine the burden of maternal morbidity in early pregnancy in rural northern Bangladesh. A cross-sectional analysis was performed on baseline morbidity data from 42 896 pregnant women enrolled in a vitamin A supplementation trial. One-week histories for 31 defined symptoms were collected at 5-12 weeks of gestation. Ten illnesses were defined, compatible with ICD-10 diagnoses and WHO definitions. Prevalence, duration, and treatment-seeking behaviors were determined for each symptom and illness. Risk of wasting malnutrition was compared between symptomatic and asymptomatic women. In total, 93.1% of women reported at least 1 symptom. The most frequent symptoms were poor appetite (53.3%), vaginal discharge (48.7%), and nausea (48.1%), each of which lasted 22-27 days. The most prevalent illnesses were anemia (36.4%), morning sickness (17.2%), excessive vomiting (7.0%), and reproductive tract infections (6.7%). Symptoms that prompted treatment seeking included jaundice, high-grade fever, and swelling of hands and face. Odds ratios for malnutrition were higher among women with symptoms of anemia (1.30; 95% confidence interval [CI], 1.24-1.36), vaginal discharge (1.37; 95% CI, 1.31-1.43), and high-grade fever (1.23; 95% CI, 1.10-1.37) than among those without symptoms. Women in rural Bangladesh report substantial morbidity in the first trimester. Copyright © 2012 International Federation of Gynecology and Obstetrics. All rights reserved.

Estrogen Injection

MedlinePlus

... used to treat hot flushes (hot flashes; sudden strong feelings of heat and sweating) and/or vaginal ... the symptoms of certain types of prostate (a male reproductive organ) cancer. The conjugated estrogens form of ...

Uterine Cancer

MedlinePlus

... is pregnant. There are different types of uterine cancer. The most common type starts in the endometrium, ... the uterus. This type is also called endometrial cancer. The symptoms of uterine cancer include Abnormal vaginal ...

Difficulty in the management of pregnancy after vaginal radical trachelectomy.

PubMed

Takada, Sakura; Ishioka, Shin-Ichi; Endo, Toshiaki; Baba, Tsuyoshi; Morishita, Miyuki; Akashi, Yushi; Mizuuchi, Masahito; Adachi, Hidefumi; Kim, Miseon; Saito, Tsuyoshi

2013-12-01

We have performed 26 vaginal radical trachelectomies (RTs) for patients with early invasive uterine cervical cancer since 2003 and, to date, have experienced 8 deliveries. The procedure has a high risk for preterm labor and the subsequent occurrence of preterm premature rupture of membranes (pPROM). We report the present situation and the limits of follow-up of pregnancy after vaginal RT. Our operative procedure is based on that of Dargent et al. We usually amputate the cervix approximately 10 mm below the isthmus. To remove the parametrium, we cut at the level of type II hysterectomy. Pregnancy courses after vaginal RT were studied in 8 patients with respect to symptoms, cervical length, and several infectious signs. We recommended that patients enter hospital early in their second trimester, and prophylactic daily vaginal disinfection with povidone-iodine and an ulinastatin vaginal suppository were administered. Careful checking for vaginal infectious signs, as well as cervical length and abdominal tension of patients was also performed. Four patients followed up with this modality were able to continue their pregnancies until late in the third trimester. However, this follow-up modality was not effective for patients who showed cervical incompetence due to slack cervical cerclage. They suffered from pPROM at 26 and 19 weeks of gestation. We need a new approach for the management of pregnant patients after vaginal RT with cervical incompetence due to slack cervical cerclage to prevent cervical infection.

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis

PubMed Central

Gaydos, Charlotte A.; Nyirjesy, Paul; Paradis, Sonia; Kodsi, Salma; Cooper, Charles K.

2018-01-01

ABSTRACT Vaginitis is a common complaint, diagnosed either empirically or using Amsel's criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States). Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Clinician diagnosis and in-clinic testing (Amsel's test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes. All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2, and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis. The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing. The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis. PMID:29643195

Resolution of hematocolpos in adolescents affected with Graft Versus Host Disease.

PubMed

Michala, Lina; Vlachopapadopoulou, Elpis; Tsimaris, Pandelis; Papaioannou, Georgia; Paisiou, Anna; Peristeri, Ioulia; Michalacos, Stephanos; Kitra, Vassiliki

2018-05-29

Bone Marrow Transplant (BMT) is a lifesaving procedure for a range of serious benign or malignant hematological conditions. A proportion of patients however will develop Graft Versus Host Disease (GVHD), acute or chronic, with serious long term sequalae. We present two cases of hematocolpos that developed in adolescence because of vaginal synechiae due to GVHD. The condition was initially asymptomatic, resolved spontaneously at first and recurred. In one girl blunt lysis of the adhesions was performed under general anesthetic, followed thereafter by local hydrocortisone and estriol treatment. Genital symptoms may not be readily reported by adolescents post BMT. Physicians should be aware of possible late effects of GVHD on genitalia, inquire about symptoms and be acquainted with addressing complications, such as vaginal obstruction. Copyright © 2018. Published by Elsevier Inc.

The intrinsic shape of bulges in the CALIFA survey

NASA Astrophysics Data System (ADS)

Costantin, L.; Méndez-Abreu, J.; Corsini, E. M.; Eliche-Moral, M. C.; Tapia, T.; Morelli, L.; Dalla Bontà, E.; Pizzella, A.

2018-02-01

Context. The intrinsic shape of galactic bulges in nearby galaxies provides crucial information to separate bulge types. Aims: We aim to derive accurate constraints to the intrinsic shape of bulges to provide new clues on their formation mechanisms and set new limitations for future simulations. Methods: We retrieved the intrinsic shape of a sample of CALIFA bulges using a statistical approach. Taking advantage of GalMer numerical simulations of binary mergers we estimated the reliability of the procedure. Analyzing the i-band mock images of resulting lenticular remnants, we studied the intrinsic shape of their bulges at different galaxy inclinations. Finally, we introduced a new (B/A, C/A) diagram to analyze possible correlations between the intrinsic shape and the properties of bulges. Results: We tested the method on simulated lenticular remnants, finding that for galaxies with inclinations of 25° ≤ θ ≤ 65° we can safely derive the intrinsic shape of their bulges. We found that our CALIFA bulges tend to be nearly oblate systems (66%), with a smaller fraction of prolate spheroids (19%), and triaxial ellipsoids (15%). The majority of triaxial bulges are in barred galaxies (75%). Moreover, we found that bulges with low Sérsic indices or in galaxies with low bulge-to-total luminosity ratios form a heterogeneous class of objects; additionally, bulges in late-type galaxies or in less massive galaxies have no preference for being oblate, prolate, or triaxial. On the contrary, bulges with high Sérsic index, in early-type galaxies, or in more massive galaxies are mostly oblate systems. Conclusions: We concluded that various evolutionary pathways may coexist in galaxies, with merging events and dissipative collapse being the main mechanisms driving the formation of the most massive oblate bulges and bar evolution reshaping the less massive triaxial bulges.

Use of the VS-sense swab in diagnosing vulvovaginitis.

PubMed

Sobel, Jack D; Nyirjesy, Paul; Kessary, Hadar; Ferris, Daron G

2009-09-01

Although pH assessment of vaginal secretions is beneficial for diagnosing vaginitis, it is not commonly done. The purpose of this study was to determine the performance characteristics of the VS-Sense (pH test) swab (Common Sense, Ltd., Caesarea, Israel) in augmenting the diagnosis of vaginitis. We prospectively studied 193 women with acute vulvovaginal symptoms and 74 asymptomatic controls at three medical centers. The VS-Sense swab was administered intravaginally, and results were interpreted by a nurse. These results were compared with final clinical and laboratory diagnoses. In women with an elevated pH caused by bacterial vaginosis (BV), trichomonas, and other types of vaginitis, the VS-Sense test sensitivity and specificity were 82.3% (102 of 124) (95% CI 74.4%-88.5%) and 94.2% (129 of 137) (95% CI 88.8%-97.4%), respectively. There was an 86.2% (95% CI 81.3%-90.1%) overall agreement between pH paper and VS-Sense swab results. The VS-Sense test offers an alternative approach to measuring vaginal pH with nitrazine paper. Use of this simple, more rapid test may facilitate the diagnosis of vulvovaginitis.

Safety and tolerability of BufferGel, a novel vaginal microbicide, in women in the United States.

PubMed

Mayer, K H; Peipert, J; Fleming, T; Fullem, A; Moench, T; Cu-Uvin, S; Bentley, M; Chesney, M; Rosenberg, Z

2001-02-01

BufferGel (ReProtect, LLC) is a vaginal gel with an acidic buffering action that was designed to prevent vaginal neutralization by semen. The purpose of this study was to evaluate the safety and tolerability of BufferGel (ReProtect, Limited Liability Company) applied vaginally either once or twice daily by 27 women who were at low risk for acquisition of human immunodeficiency virus (HIV). Participants initially used the product once daily for 14 days and then twice daily for 14 days; they underwent colposcopy before and after product exposure. BufferGel was well tolerated, although two-thirds of the participants reported at least 1 mild or moderate adverse experience. The most common adverse events were irritative genitourinary symptoms. Product use was discontinued after 3 adverse events. BufferGel was well tolerated in women at low risk for acquisition of HIV; toxicity was limited and occurred at frequencies similar to those in women who did not use any vaginal product and at levels lower than in women who used detergent-based microbicides.

Assessment of posterior vaginal wall prolapse: comparison of physical findings to cystodefecoperitoneography.

PubMed

Altman, Daniel; López, Annika; Kierkegaard, Jonas; Zetterström, Jan; Falconer, Christian; Pollack, Johan; Mellgren, Anders

2005-01-01

The aim of the present study was to compare clinical and radiological findings when assessing posterior vaginal wall prolapse. Defecography can be used to complement the clinical evaluation in patients with posterior vaginal wall prolapse. Further development of the defecography technique, using contrast medium in the urinary bladder and intraperitoneally, have resulted in cystodefecoperitoneography (CDP). Thirty-eight women underwent clinical examination using the pelvic organ prolapse quantification system (POP-Q) followed by CDP. All patients answered a standardized bowel function questionnaire. Statistical analysis measuring correlation between POP-Q and CDP using Pearson's correlation coefficient (r) and Spearman's rank order correlation coefficient (rs) demonstrated a poor to moderate correlation, r=0.49 and rs=0.55. Although there was a strong association between large rectoceles (>3 cm) at CDP and symptoms of rectal emptying difficulties (p<0.001), severity and prevalence of bowel dysfunction showed poor coherence with clinical prolapse staging and findings at radiological imaging. Vaginal topography and POP-Q staging predict neither radiological size nor visceral involvement in posterior vaginal wall prolapse. Radiological evaluation may therefore be a useful complement in selected patients.

[Recurrent miscarriage turns out to be lung cancer].

PubMed

Ebisch, Inge M W; Limonard, Gijs J M; Vreuls, Willem; Sporken, Jan M J

2013-01-01

If a positive pregnancy test is followed by profuse vaginal bleeding, the diagnosis of miscarriage can generally be made. Sometimes, however, elevated hCG levels may be associated with a phantom pregnancy, which may be a paraneoplastic symptom. A 27-year-old woman was referred for a diagnosis after having experienced 3 consecutive miscarriages. The diagnostic workup could not identify an underlying cause. After 3 more biochemical miscarriages, the original diagnosis was called into question and extensive testing for ectopic hCG production was performed. It appeared that the false pregnancies were paraneoplastic symptoms of an hCG-producing non-small cell lung cancer. After a lobectomy, the hCG levels returned to normal and a spontaneous pregnancy and uncomplicated delivery followed. Phantom pregnancy as a paraneoplastic symptom is extremely rare, but should be considered in patients presenting with recurrent, non-objectifiable miscarriages. Careful documentation of the menstrual cycle is necessary for early detection of the condition. The fact is that vaginal bleeding after a positive pregnancy test can still be a normal menstruation.

[Bacterial vaginosis and trichomononiasis. Fundamental world guidelines on management and therapy of the patients].

PubMed

Gomberg, M A

2013-01-01

The vaginal discharge is one of the most frequent symptoms requiring medical advise. Vaginal discharges are mainly associated with three diseases: bacterial vaginosis, trichomononiasis and candidiasis. The review is concerned with up-to-date approaches to the treatment of females with bacterial vaginosis and trichomononiasis, diseases different by the etiology and pathogenesis, but at the same time similar with respect to the treatment. The analysis is in compliance with the principles of the two fundamental world guidelines.

Why are classical bulges more common in S0 galaxies than in spiral galaxies?

NASA Astrophysics Data System (ADS)

Mishra, Preetish K.; Wadadekar, Yogesh; Barway, Sudhanshu

2018-07-01

In this paper, we try to understand why the classical bulge fraction observed in S0 galaxies is significantly higher than that in spiral galaxies. We carry out a comparative study of the bulge and global properties of a sample of spiral and S0 galaxies in a fixed environment. Our sample is flux limited and contains 262 spiral and 155 S0 galaxies drawn from the Sloan Digital Sky Survey. We have classified bulges into classical and pseudo-bulge categories based on their position on the Kormendy diagram. Dividing our sample into bins of galaxy stellar mass, we find that the fraction of S0 galaxies hosting a classical bulge is significantly higher than the classical bulge fraction seen in spirals even at fixed stellar mass. We have compared the bulge and the global properties of spirals and S0 galaxies in our sample and find indications that spiral galaxies which host a classical bulge, preferentially get converted into S0 population as compared to pseudo-bulge hosting spirals. By studying the star formation properties of our galaxies in the NUV-r colour-mass diagram, we find that the pseudo-bulge hosting spirals are mostly star forming while the majority of classical bulge host spirals are in the green valley or in the passive sequence. We suggest that some internal process, such as AGN feedback or morphological quenching due to the massive bulge, quenches these classical bulge hosting spirals and transforms them into S0 galaxies, thus resulting in the observed predominance of the classical bulge in S0 galaxies.

[The Life Impacts and Symptom Distress in Women With Pelvic Organ Prolapse Syndrome Before Pelvic Reconstruction Surgery].

PubMed

Ko, I-Chen; Lo, Tsia-Shu; Lu, Yu-Ying; Tsao, Lee-Ing

2017-02-01

The decision whether or not to undergo pelvic reconstructive surgery is difficult for women suffering from pelvic organ prolapse. However, little research has examined the symptom distress and life impacts that these women face prior to this surgery. Thus, it is crucial that gynecology nurses learn about these life impacts and symptom distresses in order to help these women make the best decisions with regard to surgery. To explore the life impacts and degree of symptom distress in pre-surgery women with pelvic organ prolapse; to explore the relationships between demographic data and the variables of life impact and degree of symptom distress; and to identify the factors that relate to the explainable variance in the life impacts of these women. A cross-sectional and correlational research design was used and a total of 110 women with pelvic organ prolapse who had not yet undergone pelvic reconstruction surgery were recruited in the gynecological clinics of one medical center in Taiwan. Daytime urination frequency was the most prevalent urinary tract symptom noted by the participants; vaginal protrusion was the most prevalent pelvis-related symptom noted; and depression and anxiety were the most prevalent life impacts noted. Moreover, greater lower-urinary-tract symptom distress was associated with greater pelvic-symptom distress. Furthermore, greater lower urinary tract and pelvic symptom distresses were associated with a greater negative impact on life. Education background and pelvis-related symptoms were the explained variances in pre-surgery life impacts. Women with pelvic organ prolapse should pay particular attention to symptoms that include: daytime urinary frequency, vaginal protrusion, and emotional problems including depression and anxiety. Education background and level of symptom distress should be taken into consideration when caring for the life impacts of this vulnerable group of women.

Comparing the effects of Calendula officinalis and clotrimazole on vaginal Candidiasis: A randomized controlled trial.

PubMed

Saffari, Elnaz; Mohammad-Alizadeh-Charandabi, Sakineh; Adibpour, Mohammad; Mirghafourvand, Mojgan; Javadzadeh, Yousef

2017-01-01

This triple-blind trial examined the effects of Calendula officinalis vaginal cream on the treatment of vaginal Candidiasis (primary outcome) and sexual function (secondary outcome). Married women aged 18-45 years with vaginal Candidiasis (n = 150) were recruited from April to October 2014 and randomized into Calendula and clotrimazole groups, using 5-g vaginal cream every night for seven nights. Clinical and laboratory assessments were conducted at 10-15 and 30-35 days after intervention and the female sexual function index was assessed at 30-35 days. Six women were lost to follow-up. The frequency of testing negative for Candidiasis in the Calendula group was significantly lower at the first (49% vs. 74%; odds ratio (OR) 0.32; 95% confidence interval (CI) 0.16-0.67) but higher at the second (77% vs. 34%; OR 3.1; 95% CI 1.5-6.2) follow-up compared to the clotrimazole group. The frequency of most signs and symptoms were almost equal in the two groups at the first follow-up, but were significantly lower in the Calendula group at the second follow-up. Sexual function had almost equal significant improvement in both groups. Calendula vaginal cream appears to have been effective in the treatment of vaginal Candidiasis and to have a delayed but greater long-term effect compared to clotrimazole.

Prevalence of vaginal infections and associated lifestyles of students in the university of Cape Coast, Ghana

PubMed Central

Aubyn, Gloria Baaba; Tagoe, Daniel Nii Aryee

2013-01-01

Objective To determine the prevalence of vaginal infections and associated lifestyles of students visiting the University of Cape Coast Hospital. Methods Fifty female students presenting with clinical symptoms of vaginitis were sampled. One hundred samples made up of 50 urine and 50 higher vaginal swabs (HVS) were obtained from patients and questionnaire administered. Samples were wet prepared, examined microscopically, and cultured on blood and chocolate agars for 24 h at (35±2) °C. Colonial morphology, Gram reactions and biochemical tests were used for the identification of isolates. Results There were high percentages of pus cells (64%), epithelial cells (62%) and yeast cells (56%) in all urine samples. Bacterial isolates included Staphylococcus aureus (28%) and (22%), Klebsiella spp. (6%) and (4%) in urine and HVS samples respectively; Escherichia coli in urine (18%) and Candida in HVS (16%). The overall prevalence of vaginitis was 66%, including bacterial vaginosis 28%, Candida infection 22% and co-infection of bacterial and Candida 16%. Lifestyle data showed all sampled students were sexually active, 48% used contraceptives, 54% used antimicrobial agents, and 92% prefered wearing of trousers and shorts. Conclusions The present study indicates prevalence of vaginal infection among female students, which strongly correlates with student lifestyle. Education on lifestyle modifications will go a long way in reducing the prevalence of vaginitis.

Ultrasound-Guided Drainage of Supralevator Hematoma in a Hemodynamically Stable Patient.

PubMed

Mukhopadhyay, Debjani; Jennings, Paul E; Banerjee, Mamta; Gada, Ruta

2015-12-01

Paravaginal hematomas can be life-threatening. In patients with intact vaginal walls and perineum, they may pose a diagnostic and therapeutic challenge. Supralevator hematomas are much less common than infralevator hematomas. We present a case of puerperal hemorrhagic shock after a normal vaginal delivery in a low-risk parous woman resulting from an occult supralevator hematoma. Because the woman was hemodynamically unstable initially, she underwent a vaginal surgical drainage. A week later, the supravaginal hematoma reformed. At this time the patient was hemodynamically stable, and ultrasound-guided drainage was performed, which resulted in complete resolution of the hematoma within 10 days. In a clinically stable puerperal patient, ultrasound-guided drainage of a supralevator hematoma resulted in rapid and complete resolution of symptoms.

Signs and Symptoms of Early Pregnancy Loss

PubMed Central

Sapra, Katherine J.; Joseph, K.S.; Galea, Sandro; Bates, Lisa M.; Louis, Germaine M. Buck; Ananth, Cande V.

2016-01-01

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss. PMID:27342274

Signs and Symptoms of Early Pregnancy Loss.

PubMed

Sapra, Katherine J; Joseph, K S; Galea, Sandro; Bates, Lisa M; Louis, Germaine M Buck; Ananth, Cande V

2017-04-01

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss.

Solving the Mystery of Galaxy Bulges and Bulge Substructure

NASA Astrophysics Data System (ADS)

Erwin, Peter

2017-08-01

Understanding galaxy bulges is crucial for understanding galaxy evolution and the growth of supermassive black holes (SMBHs). Recent studies have shown that at least some - perhaps most - disk-galaxy bulges are actually composite structures, with both classical-bulge (spheroid) and pseudobulge (disky) components; this calls into question the standard practice of using simple, low-resolution bulge/disk decompositions to determine spheroid and SMBH mass functions. We propose WFC3 optical and near-IR imaging of a volume- and mass-limited sample of local disk galaxies to determine the full range of pure-classical, pure-pseudobulge, and composite-bulge frequencies and parameters, including stellar masses for classical bulges, disky pseudobulges, and boxy/peanut-shaped bulges. We will combine this with ground-based spectroscopy to determine the stellar-kinematic and population characteristics of the different substructures revealed by our WFC3 imaging. This will help resolve growing uncertainties about the status and nature of bulges and their relation to SMBH masses, and will provide an essential local-universe reference for understanding bulge (and SMBH) formation and evolution.

Age bimodality in the central region of pseudo-bulges in S0 galaxies

NASA Astrophysics Data System (ADS)

Mishra, Preetish K.; Barway, Sudhanshu; Wadadekar, Yogesh

2017-11-01

We present evidence for bimodal stellar age distribution of pseudo-bulges of S0 galaxies as probed by the Dn(4000) index. We do not observe any bimodality in age distribution for pseudo-bulges in spiral galaxies. Our sample is flux limited and contains 2067 S0 and 2630 spiral galaxies drawn from the Sloan Digital Sky Survey. We identify pseudo-bulges in S0 and spiral galaxies, based on the position of the bulge on the Kormendy diagram and their central velocity dispersion. Dividing the pseudo-bulges of S0 galaxies into those containing old and young stellar populations, we study the connection between global star formation and pseudo-bulge age on the u - r colour-mass diagram. We find that most old pseudo-bulges are hosted by passive galaxies while majority of young bulges are hosted by galaxies that are star forming. Dividing our sample of S0 galaxies into early-type S0s and S0/a galaxies, we find that old pseudo-bulges are mainly hosted by early-type S0 galaxies while most of the pseudo-bulges in S0/a galaxies are young. We speculate that morphology plays a strong role in quenching of star formation in the disc of these S0 galaxies, which stops the growth of pseudo-bulges, giving rise to old pseudo-bulges and the observed age bimodality.

Pregnancy Complications: Bacterial Vaginosis

MedlinePlus

... symptoms, but you may have: Thin white or grey vaginal discharge Strong, fishy odor, especially after having ... or gel that you put into your vagina. Treatment with antibiotics for BV is safe for your ...

Streptococcus agalactiae: a vaginal pathogen?

PubMed

Maniatis, A N; Palermos, J; Kantzanou, M; Maniatis, N A; Christodoulou, C; Legakis, N J

1996-03-01

The significance of Streptococcus agalactiae as an aetiological agent in vaginitis was evaluated. A total of 6226 samples from women who presented with vaginal symptoms was examined. The presence of >10 leucocytes/high-power field (h.p.f.) was taken to be the criterion of active infection. S. agalactiae was isolated from 10.1% of these samples. The isolation rates of other common pathogens such as Candida spp., Gardnerella vaginalis and Trichomonas spp. were 54.1%, 27.2% and 4.2%, respectively, in the same group of patients. In contrast, the isolation rates of these micro-organisms in the group of patients who had no infection (<10 leucocytes/h.p.f.) were 4.2%, 38.3%, 33% and 0.5%, respectively. In the majority of samples from which S. agalactiae was isolated, it was the sole pathogen isolated (83%) and its presence was associated with an inflammatory response in 80% of patients. Furthermore, the relative risk of vaginal infection with S. agalactiae (2.38) in patients with purulent vaginal discharge was greater than that of Candida spp. infection (1.41) and lower than that of Trichomonas spp. infection (8.32). These data suggest that S. agalactiae in symptomatic women with microscopic evidence of inflammation should be considered a causative agent of vaginitis.

Effects of vaginal progesterone on pain and uterine contractility in patients with threatened abortion before twelve weeks of pregnancy.

PubMed

Palagiano, A; Bulletti, C; Pace, M C; DE Ziegler, D; Cicinelli, E; Izzo, A

2004-12-01

Fifty women with previous diagnosis of inadequate luteal phase and threatened abortion underwent a prospective, randomized, double-blind study in one medical center carried out with a parallel trial. The primary objective was to establish the effects of vaginal progesterone (Crinone 8%) in reducing both pain and uterine contractions (UCs). The gel with or without (placebo) vaginal progesterone was administered once a day since the diagnosis of threatened abortion and for 5 days. The efficacy on pain symptom amelioration was evaluated by a 5-score intensity gradation, while the UCs were evaluated by ultrasound. The secondary objective of the study was to evaluate the outcome of the pregnancies. The use of progesterone was effective both on pain relief and on the frequency of the UCs that decreased after 5 days of vaginal progesterone administration (P < 0.005). The evaluation of the ongoing pregnancy and spontaneous abortion in both study groups after 60 days showed that 4 patients of group A and 8 patients of group B miscarried (P < 0.05). In conclusion, patients with threatened abortion benefit from vaginal progesterone by a reduction of UCs and pain. The use of vaginal progesterone improved the outcome of pregnancies complicated by threatened abortion and previous diagnosis of inadequate luteal phase.

Ultrasound-guided trans-rectal high-intensity focused ultrasound (HIFU) for advanced cervical cancer ablation is feasible: a case report.

PubMed

Abel, M; Ahmed, H; Leen, E; Park, E; Chen, M; Wasan, H; Price, P; Monzon, L; Gedroyc, W; Abel, P

2015-01-01

High-intensity focused ultrasound (HIFU) is an ablative treatment undergoing assessment for the treatment of benign and malignant disease. We describe the first reported intracavitary HIFU ablation for recurrent, unresectable and symptomatic cervical cancer. A 38 year old woman receiving palliative chemotherapy for metastatic cervical adenocarcinoma was offered ablative treatment from an intracavitary trans-rectal HIFU device (Sonablate® 500). Pre-treatment symptoms included vaginal bleeding and discharge that were sufficient to impede her quality of life. No peri-procedural adverse events occurred. Symptoms resolved completely immediately post-procedure, reappeared at 7 days, increasing to pre-procedural levels by day 30. This first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity. Ethical approval had also been granted for the use of per-vaginal access if appropriate. This route, alone or in combination with the rectal route, may provide increased accessibility in future patients with a redesigned device more suited to trans-vaginal ablations. Intracavitary HIFU is a potentially safe procedure for the treatment of cervical cancer and able to provide symptomatic improvement in the palliative setting.

Six-day randomized safety trial of intravaginal lime juice.

PubMed

Mauck, Christine K; Ballagh, Susan A; Creinin, Mitchell D; Weiner, Debra H; Doncel, Gustavo F; Fichorova, Raina N; Schwartz, Jill L; Chandra, Neelima; Callahan, Marianne M

2008-11-01

Nigerian women reportedly apply lime juice intravaginally to protect themselves against HIV. In vitro data suggest that lime juice is virucidal, but only at cytotoxic concentrations. This is the first controlled, randomized safety trial of lime juice applied to the human vagina. Forty-seven women were randomized to apply water or lime juice (25%, 50%, or undiluted) intravaginally twice daily for two 6-day intervals, separated by a 3-week washout period. Product application also was randomized: during 1 interval, product was applied using a saturated tampon and in the other by douche. Vaginal pH, symptoms, signs of irritation observed via naked eye examination and colposcopy, microflora, and markers of inflammation in cervicovaginal lavages were evaluated after 1 hour and on days 3 and 7. The largest reduction in pH was about one-half a pH unit, seen 1 hour after douching with 100% lime juice. We observed a dose-dependent pattern of symptoms and clinical and laboratory findings that were consistent with a compromised vaginal barrier function. The brief reduction in pH after vaginal lime juice application is unlikely to be virucidal in the presence of semen. Lime juice is unlikely to protect against HIV and may actually be harmful.

Prevalence of Trichomonas vaginalis infection and protozoan load in South African women: a cross-sectional study.

PubMed

de Waaij, Dewi J; Dubbink, Jan Henk; Ouburg, Sander; Peters, Remco P H; Morré, Servaas A

2017-10-08

Trichomonas vaginalis is thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load of T. vaginalis infection in South African women. A cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district). T. vaginalis DNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, the T. vaginalis infection was investigated in relation to demographic characteristics, medical history and behavioural factors. The T. vaginalis load was determined as the logarithm of DNA copies per microlitre sample solution. Collected vaginal and rectal swabs were tested for T. vaginalis DNA. Prevalence of vaginal T. vaginalis was 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated with T. vaginalis infection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginal T. vaginalis infection were more likely to have concurrent Chlamydia trachomatis rectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher median T. vaginalis load was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025). Vaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota.

PubMed

O'Hanlon, Deirdre E; Moench, Thomas R; Cone, Richard A

2013-01-01

Lactic acid at sufficiently acidic pH is a potent microbicide, and lactic acid produced by vaginal lactobacilli may help protect against reproductive tract infections. However, previous observations likely underestimated healthy vaginal acidity and total lactate concentration since they failed to exclude women without a lactobacillus-dominated vaginal microbiota, and also did not account for the high carbon dioxide, low oxygen environment of the vagina. Fifty-six women with low (0-3) Nugent scores (indicating a lactobacillus-dominated vaginal microbiota) and no symptoms of reproductive tract disease or infection, provided a total of 64 cervicovaginal fluid samples using a collection method that avoided the need for sample dilution and rigorously minimized aerobic exposure. The pH of samples was measured by microelectrode immediately after collection and under a physiological vaginal concentration of CO2. Commercial enzymatic assays of total lactate and total acetate concentrations were validated for use in CVF, and compared to the more usual HPLC method. The average pH of the CVF samples was 3.5 ± 0.3 (mean ± SD), range 2.8-4.2, and the average total lactate was 1.0% ± 0.2% w/v; this is a five-fold higher average hydrogen ion concentration (lower pH) and a fivefold higher total lactate concentration than in the prior literature. The microbicidal form of lactic acid (protonated lactic acid) was therefore eleven-fold more concentrated, and a markedly more potent microbicide, than indicated by prior research. This suggests that when lactobacilli dominate the vaginal microbiota, women have significantly more lactic acid-mediated protection against infections than currently believed. Our results invite further evaluations of the prophylactic and therapeutic actions of vaginal lactic acid, whether provided in situ by endogenous lactobacilli, by probiotic lactobacilli, or by products that reinforce vaginal lactic acid.

Differential expression of lactic acid isomers, extracellular matrix metalloproteinase inducer, and matrix metalloproteinase-8 in vaginal fluid from women with vaginal disorders.

PubMed

Beghini, J; Linhares, I M; Giraldo, P C; Ledger, W J; Witkin, S S

2015-11-01

Do metabolites in vaginal samples vary between women with different vaginal disorders. Cross-sectional study. Campinas, Brazil. Seventy-seven women (39.9%) with no vaginal disorder, 52 women (26.9%) with vulvovaginal candidiasis (VVC), 43 women (22.3%) with bacterial vaginosis (BV), and 21 women (10.9%) with cytolytic vaginosis (CTV). Concentrations of D- and L-lactic acid, extracellular matrix metalloproteinase inducer (EMMPRIN), and matrix metalloproteinase-8 (MMP-8), and the influence of Candida albicans on EMMPRIN production by cultured vaginal epithelial cells, were determined by enzyme-linked immunosorbent assay (ELISA). Associations were determined by the Mann-Whitney U-test and by Spearman's rank correlation test. Metabolite levels and their correlation with diagnoses. Vaginal concentrations of D- and L-lactic acid were reduced from control levels in BV (P < 0.0001); L-lactic acid levels were elevated in CTV (P = 0.0116). EMMPRIN and MMP-8 concentrations were elevated in VVC (P < 0.0001). EMMPRIN and L-lactic acid concentrations (P ≤ 0.008), but not EMMPRIN and D-lactic acid, were correlated in all groups. EMMPRIN also increased in proportion with the ratio of L- to D-lactic acid in controls and in women with BV (P ≤ 0.009). Concentrations of EMMPRIN and MMP-8 were correlated in controls and women with VVC (P ≤ 0.0002). Candida albicans induced EMMPRIN release from vaginal epithelial cells. Vaginal secretions from women with BV are deficient in D- and L-lactic acid, women with VVC have elevated EMMPRIN and MMP-8 levels, and women with CTV have elevated L-lactic acid levels. These deviations may contribute to the clinical signs, symptoms, and sequelae that are characteristic of these disorders. © 2014 Royal College of Obstetricians and Gynaecologists.

Prevalence of Trichomonas vaginalis infection and protozoan load in South African women: a cross-sectional study

PubMed Central

de Waaij, Dewi J

2017-01-01

Objectives Trichomonas vaginalis is thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load of T. vaginalis infection in South African women. Methods A cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district). T. vaginalis DNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, the T. vaginalis infection was investigated in relation to demographic characteristics, medical history and behavioural factors. The T. vaginalis load was determined as the logarithm of DNA copies per microlitre sample solution. Results Collected vaginal and rectal swabs were tested for T. vaginalis DNA. Prevalence of vaginal T. vaginalis was 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated with T. vaginalis infection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginal T. vaginalis infection were more likely to have concurrent Chlamydia trachomatis rectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher median T. vaginalis load was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025). Conclusions Vaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms. PMID:28993385

BULGES OF NEARBY GALAXIES WITH SPITZER: SCALING RELATIONS IN PSEUDOBULGES AND CLASSICAL BULGES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisher, David B.; Drory, Niv, E-mail: dbfisher@astro.as.utexas.ed

2010-06-20

We investigate scaling relations of bulges using bulge-disk decompositions at 3.6 {mu}m and present bulge classifications for 173 E-Sd galaxies within 20 Mpc. Pseudobulges and classical bulges are identified using Sersic index, Hubble Space Telescope morphology, and star formation activity (traced by 8 {mu}m emission). In the near-IR pseudobulges have n{sub b} < 2 and classical bulges have n{sub b} >2, as found in the optical. Sersic index and morphology are essentially equivalent properties for bulge classification purposes. We confirm, using a much more robust sample, that the Sersic index of pseudobulges is uncorrelated with other bulge structural properties, unlikemore » for classical bulges and elliptical galaxies. Also, the half-light radius of pseudobulges is not correlated with any other bulge property. We also find a new correlation between surface brightness and pseudobulge luminosity; pseudobulges become more luminous as they become more dense. Classical bulges follow the well-known scaling relations between surface brightness, luminosity, and half-light radius that are established by elliptical galaxies. We show that those pseudobulges (as indicated by Sersic index and nuclear morphology) that have low specific star formation rates are very similar to models of galaxies in which both a pseudobulge and classical bulge exist. Therefore, pseudobulge identification that relies only on structural indicators is incomplete. Our results, especially those on scaling relations, imply that pseudobulges are very different types of objects than elliptical galaxies.« less

Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause.

PubMed

Labrie, Fernand; Archer, David F; Koltun, William; Vachon, Andrée; Young, Douglas; Frenette, Louise; Portman, David; Montesino, Marlene; Côté, Isabelle; Parent, Julie; Lavoie, Lyne; Beauregard, Adam; Martel, Céline; Vaillancourt, Mario; Balser, John; Moyneur, Érick

2016-03-01

The aim of this study is to confirm the local beneficial effects of intravaginal dehydroepiandrosterone (DHEA, Prasterone) on moderate to severe dyspareunia or pain at sexual activity, the most frequent symptom of vulvovaginal atrophy due to menopause or genitourinary syndrome of menopause (GSM). In a prospective, randomized, double-blind, and placebo-controlled phase III clinical trial, the effect of daily intravaginal 0.50% DHEA (6.5 mg) (Prasterone, EndoCeutics) was examined on four coprimary objectives, namely percentage of parabasal cells, percentage or superficial cells, vaginal pH, and moderate to severe pain at sexual activity (dyspareunia) identified by the women as their most bothersome vulvovaginal atrophy symptom. The intent-to-treat population included 157 and 325 women in the placebo and DHEA-treated groups, respectively. After daily intravaginal administration of 0.50% DHEA for 12 weeks, when compared to baseline by the analysis of covariance test, the percentage of parabasal cells decreased by 27.7% over placebo (P < 0.0001), whereas the percentage of superficial cells increased by 8.44% over placebo (P < 0.0001), vaginal pH decreased by 0.66 pH unit over placebo (P < 0.0001), and pain at sexual activity decreased by 1.42 severity score unit from baseline or 0.36 unit over placebo (P = 0.0002). On the other hand, moderate to severe vaginal dryness present in 84.0% of women improved at 12 weeks by 1.44 severity score unit compared to baseline, or 0.27 unit over placebo (P = 0.004). At gynecological evaluation, vaginal secretions, epithelial integrity, epithelial surface thickness, and color all improved by 86% to 121% over the placebo effect (P < 0.0001 for all comparisons with placebo). Serum steroid levels remained well within the normal postmenopausal values according to the involved mechanisms of intracrinology. The only side effect reasonably related to treatment is vaginal discharge due to melting of the vehicle at body temperature and this was reported in about 6% of the participants. The daily intravaginal administration of 0.50% (6.5 mg) DHEA (Prasterone) has shown clinically and highly statistically significant effects on the four coprimary parameters suggested by the US Food and Drug Administration. The strictly local action of Prasterone is in line with the absence of significant drug-related adverse events, thus showing the high benefit-to-risk ratio of this treatment based upon the novel understanding of the physiology of sex steroids in women.

Management of sexual dysfunction in postmenopausal breast cancer patients taking adjuvant aromatase inhibitor therapy

PubMed Central

Derzko, C.; Elliott, S.; Lam, W.

2007-01-01

Treatment with aromatase inhibitors for postmenopausal women with breast cancer has been shown to reduce or obviate invasive procedures such as hysteroscopy or curettage associated with tamoxifen-induced endometrial abnormalities. The side effect of upfront aromatase inhibitors, diminished estrogen synthesis, is similar to that seen with the natural events of aging. The consequences often include vasomotor symptoms (hot flushes) and vaginal dryness and atrophy, which in turn may result in cystitis and vaginitis. Not surprisingly, painful intercourse (dyspareunia) and loss of sexual interest (decreased libido) frequently occur as well. Various interventions, both non-hormonal and hormonal, are currently available to manage these problems. The purpose of the present review is to provide the practitioner with a wide array of management options to assist in treating the sexual consequences of aromatase inhibitors. The suggestions in this review are based on recent literature and on the recommendations set forth both by the North American Menopause Association and in the clinical practice guidelines of the Society of Gynaecologists and Obstetricians of Canada. The complexity of female sexual dysfunction necessitates a biopsychosocial approach to assessment and management alike, with interventions ranging from education and lifestyle changes to sexual counselling, pelvic floor therapies, sexual aids, medications, and dietary supplements—all of which have been reported to have a variable, but often successful, effect on symptom amelioration. Although the use of specific hormone replacement—most commonly local estrogen, and less commonly, systemic estrogen with or without an androgen, progesterone, or the additional of an androgen in an estrogenized woman (or a combination)—may be highly effective, the concern remains that in patients with estrogen-dependent breast cancer, including those receiving anti-estrogenic adjuvant therapies, the use of these hormones may be attended with potential risk. Therefore, non-hormonal alternatives should in all cases be initially tried with the expectation that symptomatic relief can often be achieved. First-line therapy for urogenital symptoms, notably vaginal dryness and dyspareunia, should be the non-hormonal group of preparations such as moisturizers and precoital vaginal lubricants. In patients with estrogen-dependent breast cancer (notably those receiving anti-estrogenic adjuvant therapies) and severely symptomatic vaginal atrophy that fails to respond to non-hormonal options, menopausal hormone replacement or prescription vaginal estrogen therapy may considered. Systemic estrogen may be associated with risk and thus is best avoided. Judicious use of hormones may be appropriate in the well-informed patient who gives informed consent, but given the potential risk, these agents should be prescribed only after mutual agreement of the patient and her oncologist. PMID:18087605

Diabetes and Menopause: A Twin Challenge

MedlinePlus

... it tougher to manage your blood sugar level. Sexual problems. Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of ...

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis.

PubMed

Schwebke, Jane R; Gaydos, Charlotte A; Nyirjesy, Paul; Paradis, Sonia; Kodsi, Salma; Cooper, Charles K

2018-06-01

Vaginitis is a common complaint, diagnosed either empirically or using Amsel's criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States). Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis Clinician diagnosis and in-clinic testing (Amsel's test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes. All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2 , and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing. The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis. Copyright © 2018 Schwebke et al.

The role of nurses in the management of women with pelvic organ prolapse.

PubMed

Richardson, Karen; Hagen, Suzanne

Pelvic organ prolapse is a common female complaint, with 50% of women experiencing some degree of pelvic relaxation, although not all have any symptoms. Prolapse is found most commonly in the anterior vaginal walls. Posterior vaginal wall and apical prolapse are the other, less common, categories. There are a large number of potential risk factors, but increased age, parity and body mass index are most consistently reported. A variety of symptoms may be experienced, including a feeling of something coming down, pelvic heaviness, urinary, bowel and sexual dysfunction. Two main treatment options exist, conservative management (pessary or pelvic floor rehabilitation) or surgical repair, however the evidence-base for treatment is weak. The specialist nurse is well-placed to contribute to the initial assessment, management and ongoing support of women with prolapse.

Microbiological aspects of vulvovaginitis in prepubertal girls.

PubMed

Ranđelović, Gordana; Mladenović, Vesna; Ristić, Ljiljana; Otašević, Suzana; Branković, Sofija; Mladenović-Antić, Snežana; Bogdanović, Milena; Bogdanović, Dragan

2012-08-01

This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2-12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p < 0.001). In symptomatic girls, the following pathogenic bacteria were isolated: Streptococcus pyogenes (4.2%), Haemophilus influenzae (0.4%), and Staphylococcus aureus (5.8%). Bacteria of fecal origin were found in vaginal introitus swabs in 33.8% of cases, most commonly Proteus mirabilis (14.4%), Enterococcus faecalis (12.2%), and Escherichia coli (7.0%). The finding of fecal flora was more common compared to controls, reaching a statistical significance (p < 0.05), as well as in girls aged up to 6 years (p < 0.001). Candida species were found in 2.4% of girls with vulvovaginitis symptoms. The microbial ecosystem in girls with clinical signs of vulvovaginitis is complex and variable, and the presence of a microorganism does not necessarily imply that it is the cause of infection. The diagnosis of vulvovaginitis in prepubertal girls requires a complex and comprehensive approach, and microbiological findings should be interpreted in the context of clinical findings.

Bacterial vaginosis a "broad overview".

PubMed

González Pedraza Avilés, A; Ortíz Zaragoza, M C; Irigoyen Coria, A

1999-01-01

Bacterial vaginosis (BV) was first reported in 1995 by Gardner and Dukes, who described the unique clinical signs and symptoms and the distinctive nature of the vaginal discharge associated with it. They also described a "new" causative organism, which they named "Haemophilus vaginalis", subsequently renamed Gardnerella vaginalis. BV is currently the most prevalent cause of infectious vaginitis among women attending for genitourinary diseases. BV has a complex microbiology. Lactobacillus populations, which are usually dominant in healthy women, are replaced by a polymicrobial group of organisms that includes G. vaginalis, anaerobic Gram-negative rods such as Prevotella species, Peptostreptococcus species, Mycoplasma hominis, Ureaplasma urealyticum, and often Mobiluncus species. Anaerobic bacteria produce enzymes, aminopeptidases, that degrade protein and decarboxylases that convert amino acids and other compounds to amines. Those amines contribute to the signs and symptoms associated with the syndrome, raising the vaginal pH and producing a discharge odor. The excessive amounts of bacteria characteristic of the syndrome attach to epithelial cell surfaces, resulting in "clue cell". Nearly half the patients report no noticeable symptoms, but many develop a characteristic copious, malodorous discharge if untreated. Results from epidemiologic studies have associated BV with serious upper genital tract infections and adverse pregnancy outcome. In particular, the presence of BV in pregnant women increases the risk of preterm delivery, and evidence is now compelling that BV is a cause of preterm delivery. The interest in potential invasiveness of G. vaginalis has increased. However, virulence determinants have not been studied enough. The most important therapy includes clindamycin and metronidazole.

Recognition of DNA bulges by dinuclear iron(II) metallosupramolecular helicates.

PubMed

Malina, Jaroslav; Hannon, Michael J; Brabec, Viktor

2014-02-01

Bulged DNA structures are of general biological significance because of their important roles in a number of biochemical processes. Compounds capable of targeting bulged DNA sequences can be used as probes for studying their role in nucleic acid function, or could even have significant therapeutic potential. The interaction of [Fe(2)L(3)](4+) metallosupramolecular helicates (L = C(25)H(20)N(4)) with DNA duplexes containing bulges has been studied by measurement of the DNA melting temperature and gel electrophoresis. This study was aimed at exploring binding affinities of the helicates for DNA bulges of various sizes and nucleotide sequences. The studies reported herein reveal that both enantiomers of [Fe(2)L(3)](4+) bind to DNA bulges containing at least two unpaired nucleotides. In addition, these helicates show considerably enhanced affinity for duplexes containing unpaired pyrimidines in the bulge and/or pyrimidines flanking the bulge on both sides. We suggest that the bulge creates the structural motif, such as the triangular prismatic pocket formed by the unpaired bulge bases, to accommodate the [Fe(2)L(3)](4+) helicate molecule, and is probably responsible for the affinity for duplexes with a varying number of bulge bases. Our results reveal that DNA bulges represent another example of unusual DNA structures recognized by dinuclear iron(II) ([Fe(2)L(3)](4+)) supramolecular helicates. © 2013 FEBS.

BULGES OF NEARBY GALAXIES WITH SPITZER: THE GROWTH OF PSEUDOBULGES IN DISK GALAXIES AND ITS CONNECTION TO OUTER DISKS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisher, David B.; Drory, Niv; Fabricius, Maximilian H.

2009-05-20

We study star formation rates (SFRs) and stellar masses in bulges of nearby disk galaxies. For this we construct a new SFR indicator that linearly combines data from the Spitzer Space Telescope and the Galaxy Evolution Explorer. All bulges are found to be forming stars irrespective of bulge type (pseudobulge or classical bulge). At present-day SFR the median pseudobulge could have grown the present-day stellar mass in 8 Gyr. Classical bulges have the lowest specific SFR implying a growth times that are longer than a Hubble time, and thus the present-day SFR does not likely play a major role inmore » the evolution of classical bulges. In almost all galaxies in our sample the specific SFR (SFR per unit stellar mass) of the bulge is higher than that of the outer disk. This suggests that almost all galaxies are increasing their B/T through internal star formation. The SFR in pseudobulges correlates with their structure. More massive pseudobulges have higher SFR density, this is consistent with that stellar mass being formed by moderate, extended star formation. Bulges in late-type galaxies have similar SFRs as pseudobulges in intermediate-type galaxies, and are similar in radial size. However, they are deficient in mass; thus, they have much shorter growth times, {approx}2 Gyr. We identify a class of bulges that have nuclear morphology similar to pseudobulges, significantly lower specific SFR than pseudobulges, and are closer to classical bulges in structural parameter correlations. These are possibly composite objects, evolved pseudobulges or classical bulges experiencing transient, enhanced nuclear star formation. Our results are consistent with a scenario in which bulge growth via internal star formation is a natural, and near ubiquitous phenomenon in disk galaxies. Those galaxies with large classical bulges are not affected by the in situ bulge growth, likely because the majority of their stellar mass comes from some other phenomenon. Yet, those galaxies without a classical bulge, over long periods of extended star formation are able to growth a pseudobulge. Though cold accretion is not ruled out, for pseudobulge galaxies an addition of stellar mass from mergers or accretion is not required to explain the bulge mass. In this sense, galaxies with pseudobulges may very well be bulgeless (or 'quasi-bulgeless') galaxies, and galaxies with classical bulges are galaxies in which both internal evolution and hierarchical merging are responsible for the bulge mass by fractions that vary from galaxy to galaxy.« less

A new operation technique for uterine prolapse: Vaginally-assisted laparoscopic sacrohysteropexy

PubMed Central

Sanverdi, İlhan; Kılıççı, Çetin; Polat, Mesut; Özkaya, Enis; Kılıç, Sami Gökhan; Dizdar, Merve; Karateke, Ateş

2017-01-01

Objective: To describe the new surgical technique and report the safety and feasibility of vaginally-assisted laparoscopic sacrohysteropexy (VALSH). Materials and Methods: Thirty-three women with stage 3 or more uterine prolapse underwent VALSH operation. Patients were followed up for 12 months for mesh-related complications and improvements of symptoms. The operation had three sections; 1st laparoscopic, 2nd vaginal, 3rd laparoscopic. Results: The mean age, gravidity, and parity of the study population were 46.5 years (range, 25-68 years), 4.3 (1-9), and 2.9 (1-6), respectively. The mean duration of operation was 59.5 min (range, 20-120 min). There were significant differences between the pre- and post-operative values of pelvic organ prolapse quantification parameters, which were favorable in the latter evaluation (p<0.001); total vaginal length was preserved after surgery (p>0.05). Conclusion: VALSH is a safe and minimally-invasive procedure in uterovaginal prolapse, with favorable anatomic and functional outcomes at 12 months post-operatively. PMID:29085709

The patient observer: eye-movement desensitization and reprocessing for the treatment of posttraumatic stress following childbirth.

PubMed

Stramrood, Claire A I; van der Velde, Janneke; Doornbos, Bennard; Marieke Paarlberg, K; Weijmar Schultz, Willibrord C M; van Pampus, Maria G

2012-03-01

No standard intervention with proved effectiveness is available for women with posttraumatic stress following childbirth because of insufficient research. The objective of this paper was to evaluate the possibility of using eye-movement desensitization and reprocessing treatment for women with symptoms of posttraumatic stress disorder following childbirth. The treatment is internationally recognized as one of the interventions of choice for the condition, but little is known about its effects in women who experienced the delivery as traumatic. Three women suffering from posttraumatic stress symptoms following the birth of their first child were treated with eye-movement desensitization and reprocessing during their next pregnancy. Patient A developed posttraumatic stress symptoms following the lengthy labor of her first child that ended in an emergency cesarean section after unsuccessful vacuum extraction. Patient B suffered a second degree vaginal rupture, resulting in pain and inability to engage in sexual intercourse for years. Patient C developed severe preeclampsia postpartum requiring intravenous treatment. Patients received eye-movement desensitization and reprocessing treatment during their second pregnancy, using the standard protocol. The treatment resulted in fewer posttraumatic stress symptoms and more confidence about their pregnancy and upcoming delivery compared with before the treatment. Despite delivery complications in Patient A (secondary cesarean section due to insufficient engaging of the fetal head); Patient B (second degree vaginal rupture, this time without subsequent dyspareunia); and Patient C (postpartum hemorrhage, postpartum hypertension requiring intravenous treatment), all three women looked back positively at the second delivery experience. Treatment with eye-movement desensitization and reprocessing reduced posttraumatic stress symptoms in these three women. They were all sufficiently confident to attempt vaginal birth rather than demanding an elective cesarean section. We advocate a large-scale, randomized controlled trial involving women with postpartum posttraumatic stress disorder to evaluate the effect of eye-movement desensitization and reprocessing in this patient group. © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

Local Oestrogen for Pelvic Floor Disorders: A Systematic Review

PubMed Central

Weber, M. A.; Kleijn, M. H.; Langendam, M.; Limpens, J.; Heineman, M. J.; Roovers, J. P.

2015-01-01

Objective The decline in available oestrogen after menopause is a possible etiological factor in pelvic floor disorders like vaginal atrophy (VA), urinary incontinence (UI), overactive bladder (OAB) and pelvic organ prolapse (POP). This systematic review will examine the evidence for local oestrogen therapy in the treatment of these pelvic floor disorders. Evidence Acquisition We performed a systematic search in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the non-MEDLINE subset of PubMed from inception to May 2014. We searched for local oestrogens and VA (I), UI/OAB (II) and POP (III). Part I was combined with broad methodological filters for randomized controlled trials (RCTs) and secondary evidence. For part I and II two reviewers independently selected RCTs evaluating the effect of topical oestrogens on symptoms and signs of VA and UI/OAB. In part III all studies of topical oestrogen therapy in the treatment of POP were selected. Data extraction and the assessment of risk of bias using the Cochrane Risk of Bias Tool was undertaken independently by two reviewers. Evidence Synthesis The included studies varied in ways of topical application, types of oestrogen, dosage and treatment durations. Objective and subjective outcomes were assessed by a variety of measures. Overall, subjective and urodynamic outcomes, vaginal maturation and vaginal pH changed in favor of vaginal oestrogens compared to placebo. No obvious differences between different application methods were revealed. Low doses already seemed to have a beneficial effect. Studies evaluating the effect of topical oestrogen in women with POP are scarce and mainly assessed symptoms and signs associated with VA instead of POP symptoms. Conclusion Topical oestrogen administration is effective for the treatment of VA and seems to decrease complaints of OAB and UI. The potential for local oestrogens in the prevention as well as treatment of POP needs further research. PMID:26383760

Women's attitude and perceptions towards menopause in different cultures. Cross-cultural and intra-cultural comparison of pre-menopausal and post-menopausal women in Germany and in Papua New Guinea.

PubMed

Kowalcek, Ingrid; Rotte, Doerte; Banz, Constanze; Diedrich, Klaus

2005-07-16

To study cross-cultural and intra-cultural differences between the perception and the experience of menopause in pre-menopausal and post-menopausal German and Papua New Guineas women. Concepts concerning menopause and the experience of the menopause were assessed by the symptom categories (i.e. hot flashes, cardiac or sleeping disorders, depression, irritability, lack of drive, vaginal dryness, painful joints or muscles) according to the Menopause Rating Scale (MRS). In addition to the translated English version, a questionnaire in Pidgin-English was offered. Questions about positive and negative expectations of menopause and the acceptance of hormonal replacement therapy were included. Statistical analysis was performed using Chi-square test and the Mann-Whitney U-test as indicated. One hundred and one pre-menopausal and 40 post-menopausal women in Germany as well as 36 pre-menopausal and 41 post-menopausal women in Papua New Guinea were questioned. The expectations regarding the menopause differed significantly in favor of a higher trait intensity concerning the item of hot flashes in Germany and a significantly higher trait intensity in the items cardiac trouble, lack of drive, urological symptoms, vaginal dryness, joint and muscle symptoms in Papua New Guinea. In the menopause experience, significant differences between the cultures are confirmed in favor of a higher trait intensity in Papua New Guinea concerning experienced depression, drop in performance, sexual disturbances and vaginal dryness. The intra-cultural comparison between the concepts concerning menopause and the menopause experience in Germany shows a significantly higher trait intensity with regard to the expected disturbance from hot flashes, depression, agitation, lack of drive and sexual problems as compared to the experienced disturbances. In Papua New Guinea, the survey showed a difference in expected and experienced vaginal dryness. Perception and concepts concerning illness and health are based on culturally produced patterns.

Can group B streptococci cause symptomatic vaginitis?

PubMed Central

Honig, E; Mouton, J W; van der Meijden, W I

1999-01-01

BACKGROUND: Maternal cervicovaginal colonization with Lancefield group B streptococci (GBS) is an important risk factor for neonatal morbidity and mortality. About 15% of women are carriers of GBS. Usually, they are asymptomatic. CASES: We describe two patients with symptomatic vaginitis for which no apparent cause was found. Both patients were heavily colonized with GBS. After antibiotic treatment, both became asymptomatic and culture negative, but after recolonization with GBS, symptoms resumed. This phenomenon was repeatedly observed. After emergence of resistance to antibiotics, local application of chlorhexidine appeared to be the only useful treatment. CONCLUSION: We hypothesize that GBS-vaginitis may be a possible disease entity. Although at present it is not clear why some patients become symptomatic, we speculate that the immunologic response is somehow selectively hampered in such patients. PMID:10449271

[Indications of mesh in surgical treatment of pelvic organ prolapse by vaginal route: expert consensus from the French College of Gynecologists and Obstetricians (CNGOF)].

PubMed

Deffieux, X; Sentilhes, L; Savary, D; Letouzey, V; Marcelli, M; Mares, P; Pierre, F

2013-11-01

To determine the indications and contraindications concerning prosthetic surgery by vaginal route for pelvic organ prolapse. Literature review and rating of proposals using a formal consensus method. Before surgery for genital prolapse, the patient should be counselled about the different existing techniques (abdominal and vaginal surgery with and without mesh), the reasons why the surgeon offered her the placement of a synthetic mesh and also other nonsurgical treatments (pelvic floor rehabilitation and pessary). The intervention must be preceded by an assessment of bothersome pelvic, urinary, digestive and sexual symptoms. For the surgical treatment of cystocele, the use of a synthetic mesh placed by vaginal route is not recommended routinely. It should be discussed on a case by case considering the risk/benefit ratio. In patients presenting with cystocele recurrence, the placement of a synthetic mesh is a reasonable option, in order to reduce the risk of cystocele recurrence. With the exception of a few situations (rectocele recurrence), the placement of a synthetic mesh is not recommended as first-line therapy for the surgical treatment of rectocele by vaginal route. In case of uterine or vaginal vault prolapse, repositioning the vaginal vault or uterus using synthetic mesh arms is not recommended as first-line surgical therapy. Surgeons should implement established preventive recommendations that may reduce the risk of complications. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

General or Spinal Anaesthetic for Vaginal Surgery in Pelvic Floor Disorders (GOSSIP): a feasibility randomised controlled trial.

PubMed

Purwar, B; Ismail, K M; Turner, N; Farrell, A; Verzune, M; Annappa, M; Smith, I; El-Gizawy, Zeiad; Cooper, J C

2015-08-01

Spinal anaesthesia (SA) and general anaesthesia (GA) are widely used techniques for vaginal surgery for pelvic floor disorders with inconclusive evidence of the superiority of either. We conducted a randomised controlled trial (RCT) to assess the feasibility of a full scale RCT aiming to examine the effect of anaesthetic mode for vaginal surgery on operative, patient reported and length of hospital stay (LOHS) outcomes. Patients undergoing vaginal surgery, recruited through a urogynaecology service in a University teaching hospital, were randomised to receive either GA or SA. Patients were followed up for 12 weeks postoperatively. Pain was measured on a visual analogue scale; nausea was assessed with a four-point verbal rating scale. Patient's subjective perception of treatment outcome, quality of life (QoL) and functional outcomes were assessed using the International Consultation on Incontinence Modular Questionnaire (ICIQ) on vaginal symptoms and the SF-36 questionnaire. Sixty women were randomised, 29 to GA and 31 to SA. The groups were similar in terms of age and type of vaginal surgery performed. No statistically significant differences were noted between the groups with regard to pain, nausea, quality of life (QoL), functional outcomes as well as length of stay in the postoperative recovery room, use of analgesia postoperatively and LOHS. This study has demonstrated that a full RCT is feasible and should focus on the length of hospital stay in a subgroup of patients undergoing vaginal surgery where SA may help to facilitate enhanced recovery or day surgery.

Erosion of pelvicol used in sacrocolpopexy.

PubMed

Mukati, Marium S; Shobeiri, S Abbas

2013-01-01

Biologic graft materials are used more frequently in pelvic reconstructive surgeries. We describe here the complete process of removal of such a biologic graft in the office. We report a case of a 69-year-old woman with pig dermal graft erosion 1 year after placement. The patient presented with complaints of vaginal discharge. Upon examination, the graft material was seen eroding through the vaginal apex. The pig tissue was removed whole and intact in the office without complications. Transvaginal removal of pig tissue in the office relieved the patient's symptoms.

Structural basis for bifunctional zinc(II) macrocyclic complex recognition of thymine bulges in DNA.

PubMed

del Mundo, Imee Marie A; Siters, Kevin E; Fountain, Matthew A; Morrow, Janet R

2012-05-07

The zinc(II) complex of 1-(4-quinoylyl)methyl-1,4,7,10-tetraazacyclododecane (cy4q) binds selectively to thymine bulges in DNA and to a uracil bulge in RNA. Binding constants are in the low-micromolar range for thymine bulges in the stems of hairpins, for a thymine bulge in a DNA duplex, and for a uracil bulge in an RNA hairpin. Binding studies of Zn(cy4q) to a series of hairpins containing thymine bulges with different flanking bases showed that the complex had a moderate selectivity for thymine bulges with neighboring purines. The dissociation constants of the most strongly bound Zn(cy4q)-DNA thymine bulge adducts were 100-fold tighter than similar sequences with fully complementary stems or than bulges containing cytosine, guanine, or adenine. In order to probe the role of the pendent group, three additional zinc(II) complexes containing 1,4,7,10-tetraazacyclododecane (cyclen) with aromatic pendent groups were studied for binding to DNA including 1-(2-quinolyl)methyl-1,4,7,10-tetraazacyclododecane (cy2q), 1-(4-biphenyl)methyl-1,4,7,10-tetraazacyclododecane (cybp), and 5-(1,4,7,10-tetraazacyclododecan-1-ylsulfonyl)-N,N-dimethylnaphthalen-1-amine (dsc). The Zn(cybp) complex binds with moderate affinity but little selectivity to DNA hairpins with thymine bulges and to DNA lacking bulges. Similarly, Zn(dsc) binds weakly both to thymine bulges and hairpins with fully complementary stems. The zinc(II) complex of cy2q has the 2-quinolyl moiety bound to the Zn(II) center, as shown by (1)H NMR spectroscopy and pH-potentiometric titrations. As a consequence, only weak (500 μM) binding is observed to DNA with no appreciable selectivity. An NMR structure of a thymine-bulge-containing hairpin shows that the thymine is extrahelical but rotated toward the major groove. NMR data for Zn(cy4q) bound to DNA containing a thymine bulge is consistent with binding of the zinc(II) complex to the thymine N3(-) and stacking of the quinoline on top of the thymine. The thymine-bulge bound zinc(II) complex is pointed into the major groove, and there are interactions with the guanine positioned 5' to the thymine bulge.

Hormone Replacement Therapy: Can It Cause Vaginal Bleeding?

MedlinePlus

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What Are the Treatments for Other Symptoms of Menopause?

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[Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension].

PubMed

Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Shen, Keng

2014-08-01

To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension. Case-control and questionnaire- based method was employed in this study. Thirty-one patients of early-stage (I b1-I b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group, while 28 patients with matching factors and RH only during the same period were allocated to control group. There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis, tumor stage and follow-up time (P > 0.05). Patients were assessed retrospectively by validated self-reported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment. Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0 ± 1.3) cm and (5.9 ± 1.0)cm in study group and control group respectively (P = 0.000). Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview, and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively, in which there was not statistical significance (P > 0.05). No difference was observed regarding pelvic floor symptoms (P > 0.05) while difficulty emptying bladder, incomplete emptying and constipation were most commonly reported. Both group presented with hypoactive sexual desire disorder [88% (52/59)], orgasm dysfunction [72% (28/39)] and low enjoyment or relaxation after sex [51% (20/39)], which was not statistically significant (P > 0.05). Reduced vagina size and shorter vagina was more prominent in control group (12/18) than that in study group [19% (4/21)] with statistical significance (P < 0.05), while no difference in sexual desire, vaginal lubrication, dyspareunia and sexual enjoyment (P > 0.05). Patients with peritoneovaginoplasty following RH had much longer vagina and less self-perceived short vagina. Vaginal extension following RH does not worsen the pelvic floor symptoms.

Selecting anti-microbial treatment of aerobic vaginitis.

PubMed

Donders, Gilbert G G; Ruban, Katerina; Bellen, Gert

2015-05-01

Aerobic vaginitis (AV) is a vaginal infectious condition which is often confused with bacterial vaginosis (BV) or with the intermediate microflora as diagnosed by Nugent's method to detect BV on Gram-stained specimens. However, although both conditions reflect a state of lactobacillary disruption in the vagina, leading to an increase in pH, BV and AV differ profoundly. While BV is a noninflammatory condition composed of a multiplex array of different anaerobic bacteria in high quantities, AV is rather sparely populated by one or two enteric commensal flora bacteria, like Streptococcus agalactiae, Staphylocuccus aureus, or Escherichia coli. AV is typically marked by either an increased inflammatory response or by prominent signs of epithelial atrophy or both. The latter condition, if severe, is also called desquamative inflammatory vaginitis. As AV is per exclusionem diagnosed by wet mount microscopy, it is a mistake to treat just vaginal culture results. Vaginal cultures only serve as follow-up data in clinical research projects and are at most used in clinical practice to confirm the diagnosis or exclude Candida infection. AV requires treatment based on microscopy findings and a combined local treatment with any of the following which may yield the best results: antibiotic (infectious component), steroids (inflammatory component), and/or estrogen (atrophy component). In cases with Candida present on microscopy or culture, antifungals must be tried first in order to see if other treatment is still needed. Vaginal rinsing with povidone iodine can provide rapid relief of symptoms but does not provide long-term reduction of bacterial loads. Local antibiotics most suitable are preferably non-absorbed and broad spectrum, especially those covering enteric gram-positive and gram-negative aerobes, like kanamycin. To achieve rapid and short-term improvement of severe symptoms, oral therapy with amoxyclav or moxifloxacin can be used, especially in deep dermal vulvitis and colpitis infections with group B streptococci or (methicillin resistant) Staphylococcus aureus. Since the latter colonizations are frequent, but seldom inflammatory infections, we in general discourage the use of oral antibiotics in women with AV. In cases with a severe atrophy component (more than 10 % of epithelial cells are of the parabasal type), local estrogens can be used; and in postmenopausal or breast cancer patients with a contraindication for estrogens, even a combination of probiotics with an ultra-low dose of local estriol may be considered.

Nuclear starburst activity induced by elongated bulges in spiral galaxies

NASA Astrophysics Data System (ADS)

Kim, Eunbin; Kim, Sungsoo S.; Choi, Yun-Young; Lee, Gwang-Ho; de Grijs, Richard; Lee, Myung Gyoon; Hwang, Ho Seong

2018-06-01

We study the effects of bulge elongation on the star formation activity in the centres of spiral galaxies using the data from the Sloan Digital Sky Survey Data Release 7. We construct a volume-limited sample of face-on spiral galaxies with Mr < -19.5 mag at 0.02 ≤z< 0.055 by excluding barred galaxies, where the aperture of the SDSS spectroscopic fibre covers the bulges of the galaxies. We adopt the ellipticity of bulges measured by Simard et al. (2011) who performed two-dimensional bulge+disc decompositions using the SDSS images of galaxies, and identify nuclear starbursts using the fibre specific star formation rates derived from the SDSS spectra. We find a statistically significant correlation between bulge elongation and nuclear starbursts in the sense that the fraction of nuclear starbursts increases with bulge elongation. This correlation is more prominent for fainter and redder galaxies, which exhibit higher ratios of elongated bulges. We find no significant environmental dependence of the correlation between bulge elongation and nuclear starbursts. These results suggest that non-axisymmetric bulges can efficiently feed the gas into the centre of galaxies to trigger nuclear starburst activity.

Trajectories of Cepheid variable stars in the Galactic nuclear bulge

NASA Astrophysics Data System (ADS)

Matsunaga, Noriyuki

2012-06-01

The central region of our Galaxy provides us with a good opportunity to study the evolution of galactic nuclei and bulges because we can observe various phenomena in detail at the proximity of 8 kpc. There is a hierarchical alignment of stellar systems with different sizes; from the extended bulge, the nuclear bulge, down to the compact cluster around the central supermassive blackhole. The nuclear bulge contains stars as young as a few Myr, and even hosts the ongoing star formation. These are in contrast to the more extended bulge which are dominated by old stars, 10Gyr. It is considered that the star formation in the nuclear bulge is caused by fresh gas provided from the inner disk. In this picture, the nuclear bulge plays an important role as the interface between the gas supplier, the inner disk, and the galactic nucleus. Kinematics of young stars in the nuclear bulge is important to discuss the star forming process and the gas circulation in the Galactic Center. We here propose spectroscopic observations of Cepheid variable stars, 25 Myr, which we recently discovered in the nuclear bulge. The spectra taken in this proposal will allow timely estimates of the systemic velocities of the variable stars.

A combined photometric and kinematic recipe for evaluating the nature of bulges using the CALIFA sample

NASA Astrophysics Data System (ADS)

Neumann, J.; Wisotzki, L.; Choudhury, O. S.; Gadotti, D. A.; Walcher, C. J.; Bland-Hawthorn, J.; García-Benito, R.; González Delgado, R. M.; Husemann, B.; Marino, R. A.; Márquez, I.; Sánchez, S. F.; Ziegler, B.; Califa Collaboration

2017-07-01

Understanding the nature of bulges in disc galaxies can provide important insights into the formation and evolution of galaxies. For instance, the presence of a classical bulge suggests a relatively violent history. In contrast, the presence of an inner disc instead (also referred to as a "pseudobulge") indicates the occurrence of secular evolution processes in the main disc. However, we still lack criteria to effectively categorise bulges, limiting our ability to study their impact on the evolution of the host galaxies. Here we present a recipe to separate inner discs from classical bulges by combining four different parameters from photometric and kinematic analyses: the bulge Sérsic index nb, the concentration index C20,50, the Kormendy (1977, ApJ, 217, 406) relation and the inner slope of the radial velocity dispersion profile ∇σ. With that recipe we provide a detailed bulge classification for a sample of 45 galaxies from the integral-field spectroscopic survey CALIFA. To aid in categorising bulges within these galaxies, we perform 2D image decomposition to determine bulge Sérsic index, bulge-to-total light ratio, surface brightness and effective radius of the bulge and use growth curve analysis to derive a new concentration index, C20,50. We further extract the stellar kinematics from CALIFA data cubes and analyse the radial velocity dispersion profile. The results of the different approaches are in good agreement and allow a safe classification for approximately 95% of the galaxies. In particular, we show that our new "inner" concentration index performs considerably better than the traditionally used C50,90 when yielding the nature of bulges. We also found that a combined use of this index and the Kormendy relation gives a very robust indication of the physical nature of the bulge.

[Alarm symptoms of meningitis in children with fever].

PubMed

Geurts, Dorien H F; Moll, Henriette A

2011-01-01

A 15-year-old girl presented with fever and pain in her legs. A viral infection was suspected, but within 24 hours she became confused and developed meningeal signs, based on which she was diagnosed as having meningitis. Within a few hours a 6-month-old boy developed fever, a grey colour, bulging fontanel, cold hands and feet, and was groaning. He too appeared to have meningitis. It is important to recognize this serious infection in children with fever, since delay of diagnosis and treatment may result in serious complications. Recognition is difficult because of non-specific symptoms on presentation and a lack of alarm symptoms early in the course of the disease. Alarm symptoms of serious infection in children are cyanosis, rapid breathing, decreased capillary refill, petechial rash, meningeal signs, leg pain and decreased consciousness. If serious infection is uncertain in a child with fever, parents should be advised on the potential course of the disease, the alarm symptoms and the need to seek medical help in time.

Science Brought by JASMINE Data

NASA Astrophysics Data System (ADS)

Tsujimoto, T.

The planned astrometric space mission JASMINE will provide the exact positions, distances, and proper motions of the bulge stars. These data will certainly reveal the origin and evolution of the Galactic bulge. In fact, the formation process of the bulge is still veiled. It is generally believed that the Galactic bulge possesses a simple old population. On the other hand, the Galactic bulge has a bar with some kinematic implications for a secular evolution. Here we review some evidences for the recent star formation in the Galactic bulge, that will be verified by JASMINE.

Effects of De-spinning and Lithosphere Thickening on the Lunar Fossil Bulge

NASA Astrophysics Data System (ADS)

Zhong, S.; Qin, C.; Phillips, R. J.

2016-12-01

The Moon has abnormally large degree-2 anomalies in gravity and shape (or bulge). The degree-2 gravity coefficients C20 and C22 are, respectively, 22 and 7 times greater than expected from the Moon's current orbital and rotational states. One prevalent hypothesis, called the fossil bulge hypothesis, interprets the current degree-2 shape as a remnant of the bulge that froze in when the Moon was closer to the Earth with stronger tidal and rotational potentials. However, the dynamic feasibility of the freeze-in process has never been quantitatively examined. In this study, we explore, using numerical models of viscoelastic deformation with time-dependent rotational potential and lithospheric rheology, how the degree-2 bulge would evolve with time as the early Moon cools and migrates away from the Earth. Our model includes two competing effects: 1) a thickening lithosphere with time through cooling, which helps maintain the bulge, and 2) de-spinning through tidal locking, which tends to reduce the bulge. In our model, a strong lithosphere is represented by the topmost layer that is orders of magnitude more viscous than the mantle. The benchmark results show that our numerical model can compute the bulge size accurately. Our calculations start with a bulge size that is in hydrostatic equilibrium with the initial rotational rate. The bulge reduces with time as the Moon spins down, while the lithosphere can support certain amount of bulge as it thickens. We find that the final size of the bulge is controlled by the relative time scales of the two processes. At limiting cases, if the time scale of de-spinning were much larger than that of lithosphere thickening, the bulge size would be largely maintained. Conversely, the bulge size would be reduced significantly. We will consider more realistic time scales for these two processes, as well as effects of other subsequent processes after lunar magma ocean crystallization, such as large impacts and mare volcanism.

[Pelvic floor and pregnancy].

PubMed

Fritel, X

2010-05-01

Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders. Copyright 2010 Elsevier Masson SAS. All rights reserved.

YOUNG STARS IN AN OLD BULGE: A NATURAL OUTCOME OF INTERNAL EVOLUTION IN THE MILKY WAY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ness, M.; Debattista, Victor P.; Cole, D. R.

2014-06-01

The center of our disk galaxy, the Milky Way, is dominated by a boxy/peanut-shaped bulge. Numerous studies of the bulge based on stellar photometry have concluded that the bulge stars are exclusively old. The perceived lack of young stars in the bulge strongly constrains its likely formation scenarios, providing evidence that the bulge is a unique population that formed early and separately from the disk. However, recent studies of individual bulge stars using the microlensing technique have reported that they span a range of ages, emphasizing that the bulge may not be a monolithic structure. In this Letter we demonstratemore » that the presence of young stars that are located predominantly nearer to the plane is expected for a bulge that has formed from the disk via dynamical instabilities. Using an N-body+ smoothed particle hydrodynamics simulation of a disk galaxy forming out of gas cooling inside a dark matter halo and forming stars, we find a qualitative agreement between our model and the observations of younger metal-rich stars in the bulge. We are also able to partially resolve the apparent contradiction in the literature between results that argue for a purely old bulge population and those that show a population comprised of a range in ages; the key is where to look.« less

Hydronephrosis Presenting 6 Months After Sacral Colpopexy: Case Report and Literature Review.

PubMed

Weber LeBrun, Emily; Santamaria, Estefania; Moy, Louis

The aim of this study was to describe a case of uterovaginal prolapse managed with robotic-assisted sacral colpopexy complicated by severe right-sided hydronephrosis despite normal intraoperative cystoscopy. A 68-year-old woman presented with a worsening vaginal bulge over the past 2 years. Tricompartment stage 2 uterovaginal prolapse, with dominant cystocele and skin erosion at the posterior fourchette from prolapse friction, was identified on physical examination, and the patient underwent pelvic reconstructive surgery, including sacral colpopexy. The patient was discharged on postoperative day 4 after being treated for a urinary tract infection. At her 6-week postoperative visit, the patient demonstrated normal vaginal support. She presented 6 months postoperatively with right-sided hydronephrosis with an almost imperceptible stricture where the right iliac vessels cross the pelvic brim, demonstrating a delayed manifestation of ureteral injury. She underwent open ureteroscopy, ureteroneocystostomy with vesicopsoas hitch, and ureteral stent placement. Ureteroscopy demonstrated a very mild narrowed caliber of the ureter just above the sacroiliac joint without overt obstruction. Follow-up intravenous pyelogram demonstrated no evidence of damage or obstruction. At nearly 1-year follow-up, the patient remained asymptomatic and had normal renal function. This case demonstrates the challenges of an uncommon, but highly morbid, complication of pelvic reconstructive surgery. Even when adequate visualization of the ureters and delicate ureteral dissection is achieved throughout surgery, occult injuries can still occur. Surgeons should maintain a high index of suspicion of ureteral injury when evaluating patients for late presentations of postoperative complications.

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.

Vaginal douching and associated factors among married women attending a family planning clinic or a gynecology clinic.

PubMed

Caliskan, Deniz; Subasi, Nuket; Sarisen, Ozlem

2006-08-01

The aim of this study was to determine the vaginal douching habits and associated factors of women attending two different healthcare clinics. This cross-sectional study was conducted between 1 and 31 May 2004. All participants were women (n=635) who attended either a university hospital gynecology clinic or a primary health care center family planning unit. One-way ANOVA, chi-squared test, and binary and multiple logistic regression analyses were used for the statistical evaluation of data. The mean age of the participants was 36.90+/-10.72 years (range: 18-75). Half of the participants believed vaginal douching had a positive effect on health. They believed vaginal douching demonstrates cleanliness, prevents infections and pregnancy, removes sperm following intercourse, a necessity of Islamic doctrine, and reduces symptoms like discharge, unpleasant odor, etc. Of the women, 50.2% performed vaginal douching. Vaginal douching was associated with age, education level, type of dwelling, working outside of the home, age at marriage, age at birth of first child, parity, spontaneous abortion, history of pelvic inflammatory disease, use of contraceptives, and attending a healthcare clinic. Douching is a common habit among Turkish women. Many women are not aware of the harmful effects of douching. Public health and health professionals should monitor more closely this traditional habit in Turkey.

Why are classical bulges more common in S0 galaxies than in spiral galaxies?

NASA Astrophysics Data System (ADS)

Mishra, Preetish K.; Wadadekar, Yogesh; Barway, Sudhanshu

2018-05-01

In this paper, we try to understand why the classical bulge fraction observed in S0 galaxies is significantly higher than that in spiral galaxies. We carry out a comparative study of the bulge and global properties of a sample of spiral and S0 galaxies in a fixed environment. Our sample is flux limited and contains 262 spiral and 155 S0 galaxies drawn from the Sloan Digital Sky Survey. We have classified bulges into classical and pseudobulge categories based on their position on the Kormendy diagram. Dividing our sample into bins of galaxy stellar mass, we find that the fraction of S0 galaxies hosting a classical bulge is significantly higher than the classical bulge fraction seen in spirals even at fixed stellar mass. We have compared the bulge and the global properties of spirals and S0 galaxies in our sample and find indications that spiral galaxies which host a classical bulge, preferentially get converted into S0 population as compared to pseudobulge hosting spirals. By studying the star formation properties of our galaxies in the NUV - r color-mass diagram, we find that the pseudobulge hosting spirals are mostly star forming while the majority of classical bulge host spirals are in the green valley or in the passive sequence. We suggest that some internal process, such as AGN feedback or morphological quenching due to the massive bulge, quenches these classical bulge hosting spirals and transforms them into S0 galaxies, thus resulting in the observed predominance of the classical bulge in S0 galaxies.

Bright Compact Bulges (BCBs) at intermediate redshifts

NASA Astrophysics Data System (ADS)

Sachdeva, Sonali; Saha, Kanak

2018-04-01

Studying bright (MB < -20), intermediate-redshift (0.4 < z < 1.0), disc dominated (nB < 2.5) galaxies from HST/ACS and WFC3 in Chandra Deep Field South, in rest-frame B and I-band, we found a new class of bulges which is brighter and more compact than ellipticals. We refer to them as "Bright, Compact Bulges" (BCBs) - they resemble neither classical nor pseudo-bulges and constitute ˜12% of the total bulge population at these redshifts. Examining free-bulge + disc decomposition sample and elliptical galaxy sample from Simard et al. (2011), we find that only ˜0.2% of the bulges can be classified as BCBs in the local Universe. Bulge to total ratio (B/T) of disc galaxies with BCBs is (at ˜0.4) a factor of ˜2 and ˜4 larger than for those with classical and pseudo bulges. BCBs are ˜2.5 and ˜6 times more massive than classical and pseudo bulges. Although disc galaxies with BCBs host the most massive and dominant bulge type, their specific star formation rate is 1.5-2 times higher than other disc galaxies. This is contrary to the expectations that a massive compact bulge would lead to lower star formation rates. We speculate that our BCB host disc galaxies are descendant of massive, compact and passive elliptical galaxies observed at higher redshifts. Those high redshift ellipticals lack local counterparts and possibly evolved by acquiring a compact disc around them. The overall properties of BCBs supports a picture of galaxy assembly in which younger discs are being accreted around massive pre-existing spheroids.

A study of the effect of bulges on bar formation in disc galaxies

NASA Astrophysics Data System (ADS)

Kataria, Sandeep Kumar; Das, Mousumi

2018-04-01

We use N-body simulations of bar formation in isolated galaxies to study the effect of bulge mass and bulge concentration on bar formation. Bars are global disc instabilities that evolve by transferring angular momentum from the inner to outer discs and to the dark matter halo. It is well known that a massive spherical component such as halo in a disc galaxy can make it bar stable. In this study, we explore the effect of another spherical component, the bulge, on bar formation in disc galaxies. In our models, we vary both the bulge mass and concentration. We have used two sets of models: one that has a dense bulge and high surface density disc, and the other model has a less concentrated bulge and a lighter disc. In both models, we vary the bulge to disc mass fraction from 0 to 0.7. Simulations of both the models show that there is an upper cut-off in bulge-to-disc mass ratio Mb/Md above which bars cannot form; the cut-off is smaller for denser bulges (Mb/Md = 0.2) compared to less denser ones (Mb/Md = 0.5). We define a new criterion for bar formation in terms of the ratio of bulge to total radial force (Fb/Ftot) at the disc scale lengths above which bars cannot form. We find that if Fb/Ftot > 0.35, a disc is stable and a bar cannot form. Our results indicate that early-type disc galaxies can still form strong bars in spite of having massive bulges.

What Are the Symptoms of Primary Ovarian Insufficiency (POI)?

MedlinePlus

... NICHD Research Information Find a Study More Information Cerebral Palsy Condition Information NICHD Research Information Find a Study ... Hot flashes Night sweats Irritability Poor concentration Decreased sex drive Pain during sex Vaginal dryness 2 , 3 ...

What Are the Symptoms of Vaginitis?

MedlinePlus

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Reduced vaginal elasticity, reduced lubrication, and deep and superficial dyspareunia in irradiated gynecological cancer survivors.

PubMed

Stinesen Kollberg, Karin; Waldenström, Ann-Charlotte; Bergmark, Karin; Dunberger, Gail; Rossander, Anna; Wilderäng, Ulrica; Åvall-Lundqvist, Elisabeth; Steineck, Gunnar

2015-05-01

The purpose of this study was to examine whether or not vaginal elasticity or lack of lubrication is associated with deep or superficial dyspareunia. We investigated gynecological cancer survivors treated with radiation therapy. In a population-based study with 616 women answering a questionnaire (participation rate 78%) and who were treated with radiotherapy for gynecological cancer, we analyzed information from 243 women (39%) who reported that they had had intercourse during the previous six months. Analyses included log-binomial regression (relative risks) and multiple imputations by chained equations in combination with Bayesian Model Averaging, yielding a posterior probability value. Age range of this cancer recurrent-free group of women was 29-80. Dyspareunia affected 164 of 243 of the women (67%). One hundred thirty-four women (55%) reported superficial pain, 97 women (40%) reported deep pain, and 87 women (36%) reported both types of dyspareunia. The relative risk (RR) of deep dyspareunia was 1.87 (CI 1.41-2.49) with impaired vaginal elasticity compared to normal vaginal elasticity. Age and lower abdominal swelling were separate risk factors for deep dyspareunia. However, effects remain after adjusting for these factors. The relative risk of deep dyspareunia was almost twice as high with impaired vaginal elasticity compared to normal vaginal elasticity. If we wish to treat or even prevent deep dyspareunia in women with gynecological cancer, we may use our knowledge of the pathophysiology of deep dyspareunia and increasingly provide dilators together with instructions on how to use them for stretching exercises in order to retain vaginal elasticity. Results highlight the need for studies with more precise questions distinguishing superficial from deep dyspareunia so that in the future we may be able to primarily try to avoid reduced vaginal elasticity and secondarily reduce the symptoms.

The short-term variability of bacterial vaginosis diagnosed by Nugent Gram stain criteria among sexually active women in Rakai, Uganda.

PubMed

Thoma, Marie E; Gray, Ronald H; Kiwanuka, Noah; Aluma, Simon; Wang, Mei-Cheng; Sewankambo, Nelson; Wawer, Maria J

2011-02-01

Studies evaluating clinical and behavioral factors related to short-term fluctuations in vaginal microbiota are limited. We sought to describe changes in vaginal microbiota evaluated by Gram stain and assess factors associated with progression to and resolution of bacterial vaginosis (BV) at weekly intervals. A cohort of 255 sexually experienced, postmenarcheal women provided self-collected vaginal swabs to assess vaginal microbiota by Nugent score criteria at weekly visits for up to 2 years contributing 16,757 sequential observations. Absolute differences in Nugent scores (0-10) and transition probabilities of vaginal microbiota states classified by Nugent score into normal (0-3), intermediate (4-6), and BV (7-10) between visits were estimated. Allowing each woman to serve as her own control, weekly time-varying factors associated with progression from normal microbiota to BV and resolution of BV to normal microbiota were estimated using conditional logistic regression. The distribution of absolute difference in Nugent scores was fairly symmetric with a mode of 0 (no change) and a standard deviation of 2.64. Transition probabilities showed weekly persistence, was highest for normal (76.1%) and BV (73.6%) states; whereas, intermediate states had similar probabilities of progression (36.6%), resolution (36.0%), and persistence (27.4%). Weekly fluctuation between normal and BV states was associated with menstrual cycle phase, recency of sex, treatment for vaginal symptoms, pregnancy, and prior Nugent score. Weekly changes in vaginal microbiota were common in this population. Clinical and behavioral characteristics were associated with vaginal microbiota transitioning, which may be used to inform future studies and clinical management of BV.

Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community.

PubMed

Patel, Vikram; Pednekar, Sulochana; Weiss, Helen; Rodrigues, Merlyn; Barros, Preetam; Nayak, Bernice; Tanksale, Vandana; West, Beryl; Nevrekar, Prasad; Kirkwood, Betty R; Mabey, David

2005-08-01

Vaginal discharge is a common complaint, particularly among women in Asia. Although presumed to be caused by reproductive tract infections (RTIs), the association between the complaint and the presence of RTIs is weak. This study aimed to investigate the risk factors of the complaint of vaginal discharge. We conducted a community-based survey of 3000 women aged 18-50 years, randomly sampled from a population in Goa, India. Women who gave informed consent were invited to participate in a structured interview, which elicited data on the primary outcome (the experience of current abnormal vaginal discharge) and psychosocial exposures: gender adversity; symptoms of somatoform disorders; and common mental disorders (CMD). All women were required to provide vaginal and/or urine samples for diagnosis of RTIs using gold standard laboratory tests. Risk factors were analysed using logistic regression with the binary outcome of the complaint of vaginal discharge. Of the 2494 women (83%) who agreed to participate, 14.5% complained of having an abnormal vaginal discharge. Stress was the most common causal attribution for the complaint. The final multivariate model found that high scores for CMD (OR 2.16, 1.4-3.2) and somatoform disorders (6.23, 4.0-9.7) and the use of an intrauterine contraceptive device (1.86, 1.0-3.4) were independently associated with the complaint. Low literacy (0.54, 0.4-0.8) and age >40 years (0.29, 0.2-0.4) were associated with a reduced risk. RTI were not associated with the complaint (1.24, 0.9-1.6). Psychosocial factors have the strongest association with the complaint of vaginal discharge. Syndromic management algorithms need refinement so that women with complaints that are non-infectious in aetiology are offered psychosocial interventions.

Treatment seeking, vaginal discharge and psychosocial distress among women in urban Mumbai.

PubMed

Kostick, Kristin M; Schensul, Stephen L; Jadhav, Kalpita; Singh, Rajendra; Bavadekar, Amruta; Saggurti, Niranjan

2010-09-01

Vaginal discharge (safed pani in Hindi, meaning "white water") is one of the leading symptoms for which women in India seek care. Treatment-seeking for safed pani is disproportionately high among poor women, representing a physical, emotional and financial burden for low-income families. Safed pani is only rarely indicative of a reproductive tract or sexually transmitted infection. The discrepancy between symptom reports and observed pathology has led some researchers to characterize safed pani as a culturally based expression of more generalized negative life situation. Data are drawn from two prevention intervention studies (2002-2006 and 2007-2012) conducted in economically marginal communities in Mumbai. Results show that husbands as problem generators and spousal abusers and women's greater perceived empowerment and reported tension are significantly associated with safed pani. These results provide the basis for identifying women at greater risk for psychosocial distress and providing supports at the locations at which they seek treatment.

Bulge Region as a Putative Hair Follicle Stem Cells Niche: A Brief Review

PubMed Central

JOULAI VEIJOUYE, Sanaz; YARI, Abazar; HEIDARI, Fatemeh; SAJEDI, Nayereh; GHOROGHI MOGHANI, Fatemeh; NOBAKHT, Maliheh

2017-01-01

Background: Hair follicle stem cells exist in different sites. Most of the hair follicle stem cells are reside in niche called bulge. Bulge region is located between the opening of sebaceous gland and the attachment site of the arrector pili muscle. Methods: Data were collected using databases and resources of PubMed, Web of Science, Science Direct, Scopus, MEDLINE and their references from the earliest available published to identify English observational studies on hair follicle bulge region. Results: Bulge stem cells are pluripotent with high proliferative capacity. Specific markers allow the bulge cells to be isolated from mouse or human hair follicle. Stem cells isolated from bulge region are label retaining and slow cycling hence these cells are defined as label-retaining cells. Bulge cell populations, due to their plasticity nature are able to differentiate into distinct linage and could contribute in tissue regeneration. Conclusion: The current review discuss about bulge stem cells characteristics and biology including their cycle, location, plasticity, specific markers and regenerative nature. Also the differences between mouse and human hair follicles are investigated. PMID:29026781

Methodology for a vaginal and urinary microbiome study in women with mixed urinary incontinence.

PubMed

Komesu, Yuko M; Richter, Holly E; Dinwiddie, Darrell L; Siddiqui, Nazema Y; Sung, Vivian W; Lukacz, Emily S; Ridgeway, Beri; Arya, Lily A; Zyczynski, Halina M; Rogers, Rebecca G; Gantz, Marie

2017-05-01

We describe the rationale and methods of a study designed to compare vaginal and urinary microbiomes in women with mixed urinary incontinence (MUI) and similarly aged, asymptomatic controls. This paper delineates the methodology of a supplementary microbiome study nested in an ongoing randomized controlled trial comparing a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone for MUI. Women in the parent study had at least "moderate bother" from urgency and stress urinary incontinence symptoms (SUI) on validated questionnaire and confirmed MUI on bladder diary. Controls had no incontinence symptoms. All participants underwent vaginal and urine collection for DNA analysis and conventional urine culture. Standardized protocols were designed, and a central lab received samples for subsequent polymerase chain reaction (PCR) amplification and sequencing of the bacterial16S ribosomal RNA (rRNA) gene. The composition of bacterial communities will be determined by dual amplicon sequencing of variable regions 1-3 and 4-6 from vaginal and urine specimens to compare the microbiome of patients with controls. Sample-size estimates determined that 126 MUI and 84 control participants were sufficient to detect a 20 % difference in predominant urinary genera, with 80 % power and 0.05 significance level. Specimen collection commenced January 2015 and finished April 2016. DNA was extracted and stored for subsequent evaluation. Methods papers sharing information regarding development of genitourinary microbiome studies, particularly with control populations, are few. We describe the rigorous methodology developed for a novel urogenital microbiome study in women with MUI.

A comparison of yield from cervix versus vagina for culturing Candida albicans and Trichomonas vaginalis.

PubMed Central

Boeke, A J; Dekker, J H; Peerbooms, P G

1993-01-01

OBJECTIVE--To determine the agreement of culture results of Candida albicans and Trichomonas vaginalis from the cervix versus posterior fornix in women with vaginal symptoms. DESIGN--Same patient comparison of culture results from two sample sites. SETTING--Twenty one general practices in Amsterdam and the east of the Netherlands. SUBJECTS--Six hundred and eighty two women aged 15 to 55 years with vaginal symptoms, seen between 1 October 1987 and 31 May 1990. MAIN OUTCOME MEASURES--For each site (cervix and posterior fornix) the proportion of detected C albicans and T vaginalis. The sensitivity of the cervical swab related to the vaginal one. The percentage of concordance for both microorganisms. RESULTS--In 248 (34%) women C albicans was diagnosed and in 38 (6%) T vaginalis. In 99% of the proven C albicans cases, the yeast was found in the vagina. In 94% C albicans was isolated from the cervix. Sensitivity of the cervical swab was 94%. In 98% of the patients a concordant observation was made regarding detection of yeast. In 97% of the proven T vaginalis cases the protozoon was found in the vagina. In 91% T vaginalis was detected from the cervical swab. Sensitivity of the cervical swab was 92%. The culture results were concordant in 99%. CONCLUSION--The yield from the vaginal source was slightly better than that from the cervix for culture of both microorganisms. For screening purposes, specimen-collection for culture of N gonorrhoeae, C albicans and T vaginalis can be combined in one swab taken from the cervix. PMID:8444481

Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture.

PubMed

Persson, Lisa K G; Sakse, Abelone; Langhoff-Roos, Jens; Jangö, Hanna

2017-06-01

To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life. This is a nation-wide cross-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry. The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses. Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.

Quality of Life Assessment Using EuroQOL EQ-5D Questionnaire in Patients with Deep Infiltrating Endometriosis: The Relation with Symptoms and Locations

PubMed Central

Touboul, C.; Amate, P.; Ballester, M.; Bazot, M.; Fauconnier, A.; Daraï, E.

2013-01-01

The objective of this study was to evaluate the quality of life (QOL) of patients with deep infiltrating endometriosis (DIE) using EuroQOL (EQ-5D) and its correlation with symptoms and locations of endometriotic lesions. One hundred and fifty-nine patients referred for DIE from January 2011 to April 2011 were prospectively invited to complete questionnaires evaluating symptoms associated with endometriosis as well as the EQ-5D questionnaire and health state. Patients also had locations of DIE evaluated by clinical examination and magnetic resonance imaging (MRI). All 159 patients completed the questionnaires. Item response rate was 91.1%. The most intense symptoms were dysmenorrhea (7.1/10), painful defecation (6.3/10), and fatigue (6.0/10). Mean (SD) scores were 77 (14) for the EQ-5D questionnaire and 63.4 (21) for the health state. A relation was observed between the EQ-5D questionnaire and the presence of dysmenorrhea, dyspareunia, cyclic pelvic pain, painful defecation, and diarrhea or constipation. Vaginal and rectal infiltrations were significantly associated with altered EQ-5D and health state scores. The EQ-5D questionnaire is easy to complete and well related to symptoms of DIE. Rectal and vaginal infiltrations were found to be determinant factors of altered QOL by the EQ-5D questionnaire and health state. PMID:26464845

Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in postmenopausal women with history of breast cancer: a phase 2 pilot study.

PubMed

Hersant, Barbara; SidAhmed-Mezi, Mounia; Belkacemi, Yazid; Darmon, Franklin; Bastuji-Garin, Sylvie; Werkoff, Gabrielle; Bosc, Romain; Niddam, Jeremy; Hermeziu, Oana; La Padula, Simone; Meningaud, Jean Paul

2018-05-07

Approximately 50% to 70% of breast cancer survivors are affected by one or more symptoms of vulvovaginal atrophy (VVA). For those who cannot take hormone therapy, autologous platelet-rich plasma combined with hyaluronic acid (A-PRP-HA) may provide a new alternative therapy for the treatment of VVA in postmenopausal women with history of breast cancer. We enrolled 20 postmenopausal breast cancers survivors with VVA and a score of <15 on the Gloria Bachman Vaginal Health Index (VHI) comprised of five items including: vaginal pH, elasticity, fluid volume (secretions), epithelial integrity, and moisture.We administered intramucosal injections of A-PRP combined with HA (Regenkit) and performed clinical evaluations at 0, 1, 3, and 6 months. Primary endpoint: evaluation of vulvovaginal mucosa changes using the VHI; secondary endpoint: evaluation of dyspareunia and sexual dysfunction based on the Female Sexual Distress (FSD) score. All participants (20 women) showed improvement in the clinical symptoms of vaginal dryness and dyspareunia. The VHI score showed a significant increase at 6 months, going from a total baseline score (pretreatment) of 10.7 ± 2.12 to 20.75 ± 4.8 (P < 0.0001) at 6 months. Improvement in hydration and vaginal epithelial integrity was reported. A VHI score of > 15 showed a successful treatment outcome. The FSD score decreased significantly during the study, from a baseline score of 36.35 ± 2.53 pretreatment to 30.15 ± 2.47 6 months after treatment, representing improvement of 17% (P < 0.0001, respectively). No adverse events were reported. The injection of A-PRP-HA appeared to be a promising method to improve the trophicity and hydration of vaginal mucosa for the treatment of VVA in postmenopausal breast cancer survivors with contraindications to hormone therapy.

The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey in Europe: Country-specific comparisons of postmenopausal women's perceptions, experiences and needs.

PubMed

Nappi, Rossella E; Palacios, Santiago; Particco, Martire; Panay, Nick

2016-09-01

To achieve a better comprehension of the variability of perceptions, experiences and needs in terms of sexual and vaginal health in postmenopausal women (PMW) from four different European countries. An internet-based survey was conducted in Italy, Germany, Spain and the United Kingdom with a total surveyed population of 3768 PMW aged between 45 and 75 years. The UK sample was significantly older, with almost a quarter of participants over 65 years of age, and had the highest proportion of women experiencing recent vulvar and vaginal atrophy (52.8%). The majority of Italian and Spanish participants were receiving VVA treatment, whereas in the UK only 28% of PMW were on medication. The most common menopausal symptom was vaginal/vulvar dryness, with almost 80% of participants reporting it in all the countries except the UK (48%). On the other hand, vaginal/vulvar irritation was more frequently reported in the UK (41%). The percentage of participants with a partner was lower in the UK (71%), as was the monthly rate of sexual activity (49%). In the UK, the proportion of participants who had seen a healthcare professional for gynaecological reasons in the last year was lower than in other countries (27% vs. ≥50%), as was the proportion who has discussed their VVA symptoms with them (45% vs. ∼67%). In this sense, UK PMW waited for a longer before asking for help (especially for pain with intercourse and dryness). The main issues relating to VVA treatment difficulties expressed by participants were administration route in the UK, efficacy in Germany, and side-effects in Italy. Although all European women shared the same expectation of improving the quality of their sex lives, the opportunity for that varied among different countries in relation to the healthcare system and to the effective communication achieved with healthcare professionals when managing VVA. Copyright © 2016. Published by Elsevier Ireland Ltd.

Recurrent vulvovaginal candidiasis.

PubMed

Blostein, Freida; Levin-Sparenberg, Elizabeth; Wagner, Julian; Foxman, Betsy

2017-09-01

Recurrent vulvovaginal candidiasis (RVVC), multiple episodes of vulvovaginal candidiasis (VVC; vaginal yeast infection) within a 12-month period, adversely affects quality of life, mental health, and sexual activity. Diagnosis is not straightforward, as VVC is defined by the combination of often nonspecific vaginal symptoms and the presence of yeast-which is a common vaginal commensal. Estimating the incidence and prevalence is challenging: most VVC is diagnosed and treated empirically, the availability for purchase of effective therapies over the counter enables self-diagnosis and treatment, and the duration of the relatively benign VVC symptoms is short, introducing errors into any estimates relying on medical records or patient recall. We evaluate current estimates of VVC and RVVC and provide new prevalence estimates using data from a 2011 seven-country (n = 7345) internet panel survey on VVC conducted by Ipsos Health (https://www.ipsos.com/en). We also evaluate information on VVC-associated visits using the National Ambulatory Medical Care Survey. The estimated probability of VVC by age 50 varied widely by country (from 23% to 49%, mean 39%), as did the estimated probability of RVVC after VVC (from 14% to 28%, mean 23%). However estimated, the probability of RVVC was high suggesting RVVC is a common condition. Copyright © 2017 Elsevier Inc. All rights reserved.

Vaginal foreign body mimicking cervical cancer in postmenopausal woman - case study.

PubMed

Ciebiera, Michał; Słabuszewska-Jóźwiak, Aneta; Ledowicz, Witold; Jakiel, Grzegorz

2015-09-01

We present a case report of a 73-year-old, postmenopausal woman with detailed history of breast cancer and oncology treatment including tamoxifen therapy. She presented at the clinic of gynecology and obstetrics with recurrent inflammation of the urinary and genital tract and suspicion of a cervical mass. She also presented occasional abdominal complaints and malodorous vaginal discharge. These symptoms were observed in the patient for several years. Before hospitalization she received many kinds of empirical, antimicrobial treatment such as chlorquinaldol, metronidazole, nifuratel, and nystatin. She did not receive further guidance from doctors about the causes of ailments and further diagnostic and treatment capabilities. In our clinic a detailed diagnostic process including ultrasound transvaginal examination and a minisurgical procedure revealed the presence of a vaginal foreign body (which turned out to be a plastic, shampoo bottle cap) surrounded by a mass of inflamed tissue mimicking a cervical tumor. All symptoms and complaints subsided after surgical removal of the foreign body and antibacterial therapy with metronidazole and cefuroxime. Our study draws attention to the need of thorough gynecological care including prophylaxis, especially in the case of complaints of an intimate nature. Even trivial, frequently occurring disorders can be dangerous and require proper and responsible doctor's supervision and management through the healing process.

Vaginal foreign body mimicking cervical cancer in postmenopausal woman – case study

PubMed Central

Słabuszewska-Jóźwiak, Aneta; Ledowicz, Witold; Jakiel, Grzegorz

2015-01-01

We present a case report of a 73-year-old, postmenopausal woman with detailed history of breast cancer and oncology treatment including tamoxifen therapy. She presented at the clinic of gynecology and obstetrics with recurrent inflammation of the urinary and genital tract and suspicion of a cervical mass. She also presented occasional abdominal complaints and malodorous vaginal discharge. These symptoms were observed in the patient for several years. Before hospitalization she received many kinds of empirical, antimicrobial treatment such as chlorquinaldol, metronidazole, nifuratel, and nystatin. She did not receive further guidance from doctors about the causes of ailments and further diagnostic and treatment capabilities. In our clinic a detailed diagnostic process including ultrasound transvaginal examination and a minisurgical procedure revealed the presence of a vaginal foreign body (which turned out to be a plastic, shampoo bottle cap) surrounded by a mass of inflamed tissue mimicking a cervical tumor. All symptoms and complaints subsided after surgical removal of the foreign body and antibacterial therapy with metronidazole and cefuroxime. Our study draws attention to the need of thorough gynecological care including prophylaxis, especially in the case of complaints of an intimate nature. Even trivial, frequently occurring disorders can be dangerous and require proper and responsible doctor's supervision and management through the healing process. PMID:26528112

Fallopian tube prolapse following hysterectomy.

PubMed

Fan, Qing-bo; Liu, Zhu-feng; Lang, Jing-he; Sun, Da-wei; Leng, Jin-hua; Zhu, Lan; Ning, Liu

2006-03-01

To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy. A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period. All of them were diagnosed according to pathological results and were followed up. The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively. The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after transabdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940). There was no symptom in 3 cases. The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue. All of them were excised vaginally and cauterized. The results were proved by pathological examination. No recurrence was reported during follow-up. FTP is a rare complication after hysterectomy. The prognosis is well after proper diagnosis and treatment Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.

Undiagnosed vertebral hemangioma causing a lumbar compression fracture and epidural hematoma in a parturient undergoing vaginal delivery under epidural analgesia: a case report.

PubMed

Staikou, Chryssoula; Stamelos, Matthaios; Boutas, Ioannis; Koutoulidis, Vassileios

2015-08-01

Vertebral hemangiomas are benign vascular tumours of the bony spine which are usually asymptomatic. Pregnancy-related anatomical and hormonal changes may lead to expansion of hemangiomas and development of neurological symptoms. We present an unusual case of vertebral fracture due to an undiagnosed hemangioma presenting as postpartum back pain following epidural analgesia. A multiparous female with an unremarkable history developed intense lumbar pain after vaginal delivery under epidural analgesia. The pain was attributed to tissue trauma associated with the epidural technique. The patient had no clinical improvement with analgesics, and her symptoms deteriorated over the following days. A magnetic resonance imaging scan revealed an acute fracture of the second lumbar vertebra (L2) with epidural extension and mild compression of the dural sac, suggesting hemangioma as the underlying cause. The patient underwent successful spinal surgery with pedicle screw fixation to stabilize the fracture. Vertebral fractures secondary to acute expansion of a vertebral hemangioma rarely occur during vaginal delivery. In such cases, the labour epidural technique and analgesia may challenge the physician in making the diagnosis. Postpartum severe back pain should be thoroughly investigated even in the absence of neurological deficits, and osseous spinal pathology should be considered in the differential diagnosis.

Women's views and experiences of their vaginal bleeding patterns: an international perspective from Norplant users.

PubMed

d'Arcangues, Catherine; Jackson, Emily; Brache, Vivian; Piaggio, Gilda

2011-02-01

Contraceptive-induced vaginal bleeding changes may be an undesired side effect, or a welcome opportunity to alter menstrual patterns. In Europe and the US, such changes are increasingly accepted; this study explores the perceptions of women around the globe. Norplant users from five countries (Chile, China, the Dominican Republic, Indonesia and Tunisia; N = 486) were surveyed at entry into a contraceptive clinical trial regarding preferred frequency of menstruation, menses-associated symptoms, and activities during menses. Most women preferred once-monthly menstruation (81%); women in Chile, younger women, women neither married nor cohabitating, Christian women, and women experienced with hormonal contraception were more likely to accept alternative bleeding patterns. Women in Tunisia and Chile reported more symptoms associated with menses, while women in Beijing reported very few; decreased energy (32%), headaches (26%), abdominal pain (23%) and depression (22%) were most common. Avoidance of activities during menses such as physical work, sports, praying and entering religious sites, was closely tied to study centre. Across all sites, women (90%) avoided sexual intercourse during menses. Despite growing acceptance of altering bleeding patterns, women in this study preferred monthly vaginal bleeding. Understanding sociocultural contexts and individual preferences is important when addressing this issue with women from diverse backgrounds.

Bright compact bulges at intermediate redshifts

NASA Astrophysics Data System (ADS)

Sachdeva, Sonali; Saha, Kanak

2018-07-01

Studying bright (MB < -20), intermediate-redshift (0.4 < z< 1.0), disc-dominated (nB < 2.5) galaxies from Hubble Space Telescope/Advanced Camera for Surveys and Wide Field Camera 3 in Chandra Deep Field-South, in rest-frame B and I band, we found a new class of bulges that is brighter and more compact than ellipticals. We refer to them as `bright, compact bulges' (BCBs) - they resemble neither classical nor pseudo-bulges and constitute ˜12 per cent of the total bulge population at these redshifts. Examining free-bulge + disc decomposition sample and elliptical galaxy sample from Simard et al., we find that only ˜0.2 per cent of the bulges can be classified as BCBs in the local Universe. Bulge to total light ratio of disc galaxies with BCBs is (at ˜0.4) a factor of ˜2 and ˜4 larger than for those with classical and pseudo-bulges. BCBs are ˜2.5 and ˜6 times more massive than classical and pseudo-bulges. Although disc galaxies with BCBs host the most massive and dominant bulge type, their specific star formation rate is 1.5-2 times higher than other disc galaxies. This is contrary to the expectations that a massive compact bulge would lead to lower star formation rates. We speculate that our BCB host disc galaxies are descendant of massive, compact, and passive elliptical galaxies observed at higher redshifts. Those high-redshift ellipticals lack local counterparts and possibly evolved by acquiring a compact disc around them. The overall properties of BCBs support a picture of galaxy assembly in which younger discs are being accreted around massive pre-existing spheroids.

Determination of Prognostic Factors for Vaginal Mucosal Toxicity Associated With Intravaginal High-Dose Rate Brachytherapy in Patients With Endometrial Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bahng, Agnes Y.; Dagan, Avner; Bruner, Deborah W.

2012-02-01

Purpose: The objective of this study was to determine the patient- and treatment-related prognostic factors associated with vaginal toxicity in patients who received intravaginal high dose rate (HDR) brachytherapy alone as adjuvant treatment for endometrial cancer. Secondary goals of this study included a quantitative assessment of optimal dilator use frequency and a crude assessment of clinical predictors for compliant dilator use. Methods and Materials: We retrospectively reviewed the charts of 100 patients with histologically confirmed endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection and adjuvant intravaginal brachytherapy between 1995 and 2009 at themore » Hospital of University of Pennsylvania. The most common treatment regimen used was 21 Gy in three fractions (71 patients). Symptoms of vaginal mucosal toxicity were taken from the history and physical exams noted in the patients' charts and were graded according to the Common Toxicity Criteria for Adverse Events v. 4.02. Results: The incidence of Grade 1 or asymptomatic vaginal toxicity was 33% and Grade 2-3 or symptomatic vaginal toxicity was 14%. Multivariate analysis of age, active length, and dilator use two to three times a week revealed odds ratios of 0.93 (p = 0.013), 3.96 (p = 0.008), and 0.17 (p = 0.032) respectively. Conclusion: Increasing age, vaginal dilator use of at least two to three times a week, and shorter active length were found to be significantly associated with a decreased risk of vaginal stenosis. Future prospective studies are necessary to validate our findings.« less

Chlamydia Infections

MedlinePlus

... include Abnormal vaginal discharge, which may have a strong smell A burning sensation when urinating Pain during intercourse If the infection spreads, you might get lower abdominal pain, pain during sex, nausea, or fever. Symptoms in men include Discharge from your penis A burning sensation ...

Vaginal pH and Microbicidal Lactic Acid When Lactobacilli Dominate the Microbiota

PubMed Central

O’Hanlon, Deirdre E.; Moench, Thomas R.; Cone, Richard A.

2013-01-01

Lactic acid at sufficiently acidic pH is a potent microbicide, and lactic acid produced by vaginal lactobacilli may help protect against reproductive tract infections. However, previous observations likely underestimated healthy vaginal acidity and total lactate concentration since they failed to exclude women without a lactobacillus-dominated vaginal microbiota, and also did not account for the high carbon dioxide, low oxygen environment of the vagina. Fifty-six women with low (0-3) Nugent scores (indicating a lactobacillus-dominated vaginal microbiota) and no symptoms of reproductive tract disease or infection, provided a total of 64 cervicovaginal fluid samples using a collection method that avoided the need for sample dilution and rigorously minimized aerobic exposure. The pH of samples was measured by microelectrode immediately after collection and under a physiological vaginal concentration of CO2. Commercial enzymatic assays of total lactate and total acetate concentrations were validated for use in CVF, and compared to the more usual HPLC method. The average pH of the CVF samples was 3.5 ± 0.3 (mean ± SD), range 2.8-4.2, and the average total lactate was 1.0% ± 0.2% w/v; this is a five-fold higher average hydrogen ion concentration (lower pH) and a fivefold higher total lactate concentration than in the prior literature. The microbicidal form of lactic acid (protonated lactic acid) was therefore eleven-fold more concentrated, and a markedly more potent microbicide, than indicated by prior research. This suggests that when lactobacilli dominate the vaginal microbiota, women have significantly more lactic acid-mediated protection against infections than currently believed. Our results invite further evaluations of the prophylactic and therapeutic actions of vaginal lactic acid, whether provided in situ by endogenous lactobacilli, by probiotic lactobacilli, or by products that reinforce vaginal lactic acid. PMID:24223212

The laboratory diagnosis of bacterial vaginosis

PubMed Central

Money, Deborah

2005-01-01

Bacterial vaginosis (BV) is an extremely common health problem for women. In addition to the troublesome symptoms often associated with a disruption in the balance of vaginal flora, BV is associated with adverse gynecological and pregnancy outcomes. Although not technically a sexually transmitted infection, BV is a sexually associated condition. Diagnostic tests include real-time clinical/microbiological diagnosis, and the current gold standard, the standardized evaluation of morphotypes on Gram stain analysis. The inappropriate use of vaginal culture can be misleading. Future developments into molecular-based diagnostics will be important to further understand this complex endogenous flora disruption. PMID:18159532

A Comparison of Galaxy Bulge+Disk Decomposition Between Pan-STARRS and SDSS

NASA Astrophysics Data System (ADS)

Lokken, Martine Elena; McPartland, Conor; Sanders, David B.

2018-01-01

Measurements of the size and shape of bulges in galaxies provide key constraints for models of galaxy evolution. A comprehensive catalog of bulge measurements for Sloan Digital Sky Survey (SDSS) DR7 galaxies is currently available to the public. However, the Pan-STARRS1 (PS1) 3π survey now covers the same region with ~1-2 mag deeper photometry, a ~10-30% smaller PSF, and additional coverage in y-band. To test how much improvement in galaxy parameter measurements (e.g. bulge + disk) can be achieved using the new PS1 data, we make use of ultra-deep imaging data from the Hyper Suprime-Cam (HSC) Subaru Strategic Program (SSP). We fit bulge+disk models to images of 372 bright (mi < 18.5) galaxies detected in all three surveys. Comparison of galaxy parameters derived from SDSS and PS1 images with those measured from HSC-SSP images shows a tighter correlation between PS1 and SSP measurements for both bulge and disk parameters. Bulge parameters, such as bulge-to-total fraction and bulge radius, show the strongest improvement. However, measurements of all parameters degrade for galaxies with total r-band magnitude below the SDSS spectroscopic limit, mr = 17.7. We plan to use the PS1 3π survey data to produce an updated catalog of bulge+disk decomposition measurements for the entire SDSS DR7 spectroscopic galaxy sample.

Menarche? A Case of Abdominal Pain and Vaginal Bleeding in a Preadolescent Girl.

PubMed

Riney, Lauren C; Reed, Jennifer L; Kruger, Laura L; Brody, Alan J; Pomerantz, Wendy J

2015-11-01

Abdominal pain is one of the most common complaints in the pediatric ED. Because of the broad range of potential diagnoses, it can pose challenges in diagnosis and therapy in the preadolescent girl. An 11-year-old previously healthy girl presented to our pediatric ED with fever, decreased appetite, vaginal bleeding, and abdominal pain. Initial evaluation yielded elevated creatinine levels, leukocytosis with bandemia, elevated inflammatory markers, and urine concerning for a urinary tract infection. She began receiving antibiotics for presumed pyelonephritis and was admitted to the hospital. After worsening respiratory status and continued abdominal pain, a computed tomography scan was obtained and a pelvic foreign body and abscess were identified. Adolescent gynecology was consulted for examination under anesthesia for abscess drainage and foreign body removal. A foreign body in the vagina or uterus can present as vaginal discharge, vaginal bleeding, abdominal pain, dysuria, or hematuria. Because symptoms can be diverse, an intravaginal or uterine foreign body should be considered in the preteen female patient presenting to the ED with abdominal pain. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Surgical Treatment of Persistent Vaginal Granulation Tissue Using CO2 Laser Vaporization Under Colposcopic and Laparoscopic Guidance

PubMed Central

Mapp, Tiffany; Mama, Saifuddin; Echols, Karolynn T.

2012-01-01

Introduction: There have been many reports in the literature on vaginal mesh erosion as a complication of pelvic floor reconstructive surgery. Several reports describe successful surgical excision of the exposed mesh as a resolution. However, in rare cases of mesh erosion, poor surgical outcomes and multiple resection failures have been reported. We describe an innovative surgical approach to persistent vaginal mesh erosion using CO2 laser vaporization under colposcopic and laparoscopic guidance. Case Description: A 58-y-old postmenopausal woman first presented with a 3-y history of vaginal discharge and spotting after undergoing a Mentor ObTape transobturator sling (Mentor Corp, Santa Barbara, CA), for the treatment of stress urinary incontinence. Despite surgical removal of the mesh and multiple attempts at cauterization of persistent granulation tissue, her symptoms persisted. Discussion: Using a CO2 laser under colposcopic and laparoscopic guidance, we were able to safely expose and remove the remaining portion of retained mesh. To our knowledge, this is the first report describing CO2 laser vaporization as a surgical approach for the successful treatment of recurrent mesh erosion. PMID:23318081

Conservative Management of Placenta Accreta/Increta after Vaginal Birth

PubMed Central

Peiffer, S.; Reinhard, J.; Reitter, A.; Louwen, F.

2012-01-01

Aim: Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery. Method: A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome. Results: Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14–100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus. Conclusion: In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus. PMID:25308979

Preoperative vaginal preparation with baby shampoo compared with povidone-iodine before gynecologic procedures.

PubMed

Lewis, Linda A; Lathi, Ruth B; Crochet, Patrice; Nezhat, Camran

2007-01-01

The objective of this study was to compare the postoperative infection rates between patients receiving either povidone-iodine (PI) or baby shampoo vaginal preparations before gynecologic surgery. Cohort study (Canadian Task Force classification II-2). University referral center for gynecologic endoscopy. All patients underwent minimally invasive gynecologic surgery including hysteroscopy or laparoscopy. The agents used for vaginal preparation were either baby shampoo in a 1:1 dilution with sterile normal saline solution or PI 7.5% scrub solution. Charts were reviewed for evidence of infection within 30 days of surgery (symptoms of urinary tract infection, abdominal or vaginal wound infections, temperature > 100.4 degrees F, and fungal or bacterial vaginitis). A total of 249 cases were collected; 96 subjects underwent surgery before the change to baby shampoo and 153 subjects after. Both groups were well matched for the types of surgery performed, age, risk factors for postoperative infections, and the postoperative diagnosis. The infection rates were 14/96 (14.6%) with PI preparation versus 18/153 (11.8%) with baby shampoo (p = .52). Baby shampoo should be studied as an alternative to PI because it is a nonirritating, inexpensive mild detergent. This preliminary study suggests that baby shampoo is as effective as PI in preventing postoperative infection.

Recognition of thymine in DNA bulges by a Zn(II) macrocyclic complex.

PubMed

del Mundo, Imee Marie A; Fountain, Matthew A; Morrow, Janet R

2011-08-14

A Zn(II) macrocyclic complex with appended quinoline is a bifunctional recognition agent that uses both the Zn(II) center and the pendent aromatic group to bind to thymine in bulges with good selectivity over DNA containing G, C or A bulges. Spectroscopic studies show that the stem containing the bulge stays largely intact in a DNA hairpin with the Zn(II) complex bound to the thymine bulge. This journal is © The Royal Society of Chemistry 2011

Genital Herpes

MedlinePlus

... herpes is spread through: Vaginal, oral, or anal sex. The herpes virus is usually spread through contact with open sores. But you also can get herpes from someone without any symptoms or sores. Genital touching Childbirth from a mother to her baby Breastfeeding if a baby touches ...

Detection of the human 70-kD and 60-kD heat shock proteins in the vagina: relation to microbial flora, vaginal pH, and method of contraception.

PubMed Central

Giraldo, P; Neuer, A; Ribeiro-Filho, A; Linhares, I; Witkin, S S

1999-01-01

The expression of the 60-kD and 70-kD heat shock proteins (hsp60 and hsp70) in the vaginas of 43 asymptomatic women of reproductive age with or without a history of recurrent vulvovaginitis (RVV) were compared. Vaginal wash samples were obtained and assayed by enzyme-linked immunosorbent assay (ELISA) for human hsp60 and hsp70. Heat shock protein 70 was not detected in any of the 19 women with no history of RVV, and hsp60 was present in only one woman in this group. In contrast, in the RVV group, 11 (45.8%) were hsp60-positive and eight (33.3%) were hsp70-positive. The presence of either heat shock protein in the vagina was associated with an elevated vaginal pH (>4.5). Bacterial vaginosis or Candida was identified in some of the asymptomatic subjects; their occurrence was significantly higher in women with vaginal hsp70 than in women with no heat shock proteins. Oral contraceptives were used by 35.7% of subjects who were negative for vaginal heat shock proteins, as opposed to only 12.5% of women who were positive for hsp70 and 8.3% who were positive for hsp60. Expression of heat shock proteins in the vagina may indicate an altered vaginal environment and a susceptibility to vulvovaginal symptoms. PMID:10231004

[Itraconazole and secnidazole capsules vs. vaginal ovules of fluocinolone acetonide, nystatin and metronidazole in the symptomatic treatment of vaginitis].

PubMed

Alvarado García, A; Gaviño Ambriz, S

1998-04-01

Evaluation of oral treatment in vaginitis and vaginosis using Itraconazol and sechidazol, in comparison to topic treatment using vaginal ovules of acetonido of fluocinolona 0.50 mg, nistatina 100,000 U and metronidazol 500 mg. Longitudinal, prospective and open comparative study. Servicio de Reproducción Humana(Human Reproduction Department), Centro Médico Nacional "20 de Noviembre". Forty female patients, without any relevant differences in their general characteristics, chose diagnosis was vaginitis and vaginosis, who were medically treated through external consultation, divided in two groups of twenty each one. Group 1 oral treatment with itraconazol and secnidazol. Group 2 had topic treatment with fluocinolona, nistatina and metronidazol. All of the patients were controlled in seven and fourteen days time, in order to evaluate the intensity of their clinical symptomatology, as well as the efficacy in both ways of treatment. Leukorrhea was the most important symptom in all the cases, going from minor to serious white discharge. After the treatment, we found a relevant difference statistically significative in patients treated with intraconazol and secnidazol. We did not find any differences in relation to ardor, pruritus, dispareunia and disuria at post-treatment evaluation. However, group 1 betterment was statistically significative between the first and the seventh days of treatment. Treating vaginitis or vaginosis (or both) with itraconazol and secnidazol takes less time for betterment in addition to comfort and easiness of oral administration; therefore, we consider them proper medicines in these specific cases.

Distinct single-cell morphological dynamics under beta-lactam antibiotics

PubMed Central

Yao, Zhizhong; Kahne, Daniel; Kishony, Roy

2012-01-01

Summary The bacterial cell wall is conserved in prokaryotes, stabilizing cells against osmotic stress. Beta-lactams inhibit cell wall synthesis and induce lysis through a bulge-mediated mechanism; however, little is known about the formation dynamics and stability of these bulges. To capture processes of different timescales, we developed an imaging platform combining automated image analysis with live cell microscopy at high time resolution. Beta-lactam killing of Escherichia coli cells proceeded through four stages: elongation, bulge formation, bulge stagnation and lysis. Both the cell wall and outer membrane (OM) affect the observed dynamics; damaging the cell wall with different beta-lactams and compromising OM integrity cause different modes and rates of lysis. Our results show that the bulge formation dynamics is determined by how the cell wall is perturbed. The OM plays an independent role in stabilizing the bulge once it is formed. The stabilized bulge delays lysis, and allows recovery upon drug removal. PMID:23103254

Minimizing genital tract trauma and related pain following spontaneous vaginal birth.

PubMed

Albers, Leah L; Borders, Noelle

2007-01-01

Genital tract trauma is common following vaginal childbirth, and perineal pain is a frequent symptom reported by new mothers. The following techniques and care measures are associated with lower rates of obstetric lacerations and related pain following spontaneous vaginal birth: antenatal perineal massage for nulliparous women, upright or lateral positions for birth, avoidance of Valsalva pushing, delayed pushing with epidural analgesia, avoidance of episiotomy, controlled delivery of the baby's head, use of Dexon (U.S. Surgical; Norwalk, CT) or Vicryl (Ethicon, Inc., Somerville, NJ) suture material, the "Fleming method" for suturing lacerations, and oral or rectal ibuprofen for perineal pain relief after delivery. Further research is warranted to determine the role of prenatal pelvic floor (Kegel) exercises, general exercise, and body mass index in reducing obstetric trauma, and also the role of pelvic floor and general exercise in pelvic floor recovery after childbirth.

Eggs containing larvae of Enterobius vermicularis in vaginal smear

PubMed Central

Shetty, Jyothi B; Kulkarni, Dhanashri V; Prabhu, VL

2012-01-01

Enterobius vermicularis also known commonly as pinworm is the most common intestinal parasite. It is a nematode that inhabits the human terminal ileum, colon and appendix. The fertilized female migrates to the perianal area where eggs are deposited but occasionally introduces itself into adjacent orifices, most commonly the female genitourinary tract. Thus the eggs can be seen in the vaginal smear as a result of contamination. We report a case wherein the patient presented with signs and symptoms of vulvovaginitis. In her vaginal smear there were eggs of Enterobius vermicularis which showed a coiled larva within it. In the background there were plenty of acute inflammatory cells. This patient responded favorably to antihelminthics. We report this case to highlight the morphology of the parasite and also to emphasize that such findings should not be neglected. Timely reporting and appropriate treatment of such cases will prevent further complications of this parasite including endometritis, salphingitis and peritonitis. PMID:22438633

Eggs containing larvae of Enterobius vermicularis in vaginal smear.

PubMed

Shetty, Jyothi B; Kulkarni, Dhanashri V; Prabhu, Vl

2012-01-01

Enterobius vermicularis also known commonly as pinworm is the most common intestinal parasite. It is a nematode that inhabits the human terminal ileum, colon and appendix. The fertilized female migrates to the perianal area where eggs are deposited but occasionally introduces itself into adjacent orifices, most commonly the female genitourinary tract. Thus the eggs can be seen in the vaginal smear as a result of contamination. We report a case wherein the patient presented with signs and symptoms of vulvovaginitis. In her vaginal smear there were eggs of Enterobius vermicularis which showed a coiled larva within it. In the background there were plenty of acute inflammatory cells. This patient responded favorably to antihelminthics. We report this case to highlight the morphology of the parasite and also to emphasize that such findings should not be neglected. Timely reporting and appropriate treatment of such cases will prevent further complications of this parasite including endometritis, salphingitis and peritonitis.

Vaginal Enterobius vermicularis diagnosed on liquid-based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature.

PubMed

Tsai, Chun-Yi; Junod, Rachel; Jacot-Guillarmod, Martine; Beniere, Charles; Ziadi, Sonia; Bongiovanni, Massimo

2018-02-01

Enterobiasis is one of the most common human parasitic infections. It is considered an intestinal parasite, but cases of extra-intestinal affections exist, notably infections of the female genital tract. Enterobius vermicularis (EV) eggs (or ova) have been found in the cervical smears of two patients in our institute during the last 16 years. No gynaecological or gastrointestinal symptoms were reported, and there was no known intestinal infection in these two cases. A review of the available literature revealed rare cases of vaginal enterobiasis, with a wide range of clinical presentations, many patients being asymptomatic. The diagnosis may sometimes be difficult, mainly because of the lack of clinical suspicion. However, cytological identification of EV in cervico-vaginal smears is important, especially when considering the risk of ascending infections of the genital tract associated with severe complications. © 2017 Wiley Periodicals, Inc.

Aerobic vaginal pathogens and their sensitivity pattern.

PubMed

Mumtaz, Shamim; Ahmad, Mumtaz; Aftab, Irum; Akhtar, Naeem; ul Hassan, Masood; Hamid, Abdul

2008-01-01

The vaginal flora is a complicated environment, containing dozens of microbiological species in variable quantities and relative proportions. The frequent cause of vaginal discharge is an infection or colonization with different microorganisms. Some pathologic conditions causing vaginitis are well defined yet, 7-72% of women with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora neither considered as normal, nor can be called bacterial vaginosis have been termed as 'intermediate flora' and its management probably differ from that of bacterial vaginosis. It is of crucial importance in pregnant females at risk of preterm delivery. The present study has been conducted especially to elucidate this type of aerobic vaginal isolates and their culture and sensitivity towards currently used antibiotics. This study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years (April 2004-March 2006). One thousand, nine hundred and twenty three high vaginal swabs, both from indoor and outdoor patients were collected, cultured and their susceptibility to various antibiotics was determined. Significant growth was obtained in 731 samples. The highest frequency of infection (39.5%) was observed at 31-40 years followed by 41-50 years (35.8%). About 76% were from outdoor and 24% were from indoor patients. Staphylococcus aureus was the most prevalent vaginal pathogen at 11-60 yrs & with highest prevalence at 31-40 years followed by 41-50 years. It was a predominant pathogen in both indoor (35%) as well as outdoor (41.6%) patients, followed by enteric gram-negative bacilli and other gram-positive cocci. There were very few antibiotics among the conventionally available aminoglycosides, third generation cephalosporins, penicillin, quinolones, sulfonamides and tetracyclines possessing good sensitivity (> 80%) against any one the common aerobic vaginal pathogens. The effective chemotherapeutics agents belong to the groups of carbapenems and beta-lactams beta-lactamase inhibitor combinations. The high prevalence of gynaecological infections demands that the patients with gynaecological symptoms be investigated thoroughly. Culture must invariably be done. Currently the antibiotics showing good sensitivity are very expensive. So there is a need for an effective antimicrobial policy. Effective drug should be reserved for the treatment of serious life threatening situations only.

Direct questioning is more effective than patient-initiated report for the detection of sexually transmitted infections in a primary care HIV clinic in Western Kenya.

PubMed

Woo, Victoria Gah Hay; Cohen, Craig R; Bukusi, Elizabeth A; Huchko, Megan J

2013-02-01

In resource-limited settings, detection of sexually transmitted infections (STIs) often relies on self-reported symptoms to initiate management. We found self-report demonstrated poor sensitivity for STI detection. Adding clinician-initiated questions about symptoms improved detection rates. Vaginal examination further increased sensitivity. Including clinician-initiated screening in resource-limited settings would improve management of treatable STIs.

THE MOLECULAR GAS DENSITY IN GALAXY CENTERS AND HOW IT CONNECTS TO BULGES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisher, David B.; Bolatto, Alberto; Drory, Niv

2013-02-20

In this paper we present gas density, star formation rate (SFR), stellar masses, and bulge-disk decompositions for a sample of 60 galaxies. Our sample is the combined sample of the BIMA SONG, CARMA STING, and PdBI NUGA surveys. We study the effect of using CO-to-H{sub 2} conversion factors that depend on the CO surface brightness, and also that of correcting SFRs for diffuse emission from old stellar populations. We estimate that SFRs in bulges are typically lower by 20% when correcting for diffuse emission. Using the surface brightness dependent conversion factor, we find that over half of the galaxies inmore » our sample have {Sigma}{sub mol} > 100 M {sub Sun} pc{sup -2}. Though our sample is not complete in any sense, our results are enough to rule out the assumption that bulges are uniformly gas-poor systems. We find a trend between gas density of bulges and bulge Sersic index; bulges with lower Sersic index have higher gas density. Those bulges with low Sersic index (pseudobulges) have gas fractions that are similar to that of disks. Conversely, the typical molecular gas fraction in classical bulges is more similar to that of an elliptical galaxy. We also find that there is a strong correlation between bulges with the highest gas surface density and the galaxy being barred. However, we also find that classical bulges with low gas surface density can be barred as well. Our results suggest that understanding the connection between the central surface density of gas in disk galaxies and the presence of bars should also take into account the total gas content of the galaxy. Finally, we show that when using the corrected SFRs and gas densities, the correlation between SFR surface density and gas surface density of bulges is similar to that of disks. This implies that at the scale of the bulges the timescale for converting gas into stars is comparable to those results found in disks.« less

Was the Milky Way Bulge Formed from the Buckling Disk Instability, Hierarchical Collapse, Accretion of Clumps, or All of the Above?

NASA Astrophysics Data System (ADS)

Nataf, David M.

2017-09-01

The assembly of the Milky Way bulge is an old topic in astronomy, one now in a period of renewed and rapid development. That is due to tremendous advances in observations of bulge stars, motivating observations of both local and high-redshift galaxies, and increasingly sophisticated simulations. The dominant scenario for bulge formation is that of the Milky Way as a nearly pure disk galaxy, with the inner disk having formed a bar and buckled. This can potentially explain virtually all bulge stars with [Fe/H] ≳ -1.0, which comprise 95% of the stellar population. The evidence is the incredible success in N-body models of this type in making non-trivial, non-generic predictions, such as the rotation curve and velocity dispersion measured from radial velocities, and the spatial morphologies of the peanut/X-shape and the long bar. The classical bulge scenario, whereby the bulge formed from early dissipative collapse and mergers, remains viable for stars with [Fe/H] ≲ -1.0 and potentially a minority of the other stars. A classical bulge is expected from Λ-CDM cosmological simulations, can accentuate the properties of an existing bar in a hybrid system, and is most consistent with the bulge abundance trends such as [Mg/Fe], which are elevated relative to both the thin and thick disks. Finally, the clumpy-galaxy scenario is considered, as it is the correct description of most Milky Way precursors given observations of high-redshift galaxies. Simulations predict that these star-forming clumps will sometimes migrate to the centres of galaxies where they may form a bulge, and galaxies often include a bulge clump as well. They will possibly form a bar with properties consistent with those of the Milky Way, such as the exponential profile and metallicity gradient. Given the relative successes of these scenarios, the Milky Way bulge is plausibly of composite origin, with a classical bulge and/or inner halo numerically dominant for stars with [Fe/H] ≲ -1.0, a buckling thick disk for stars with - 1.0 ≲ [Fe/H

Frequency of vagınal candida colonization and relationship between metabolic parameters in children with type 1 diabetes mellitus.

PubMed

Atabek, Mehmet Emre; Akyürek, Nesibe; Eklioglu, Beray Selver

2013-10-01

Patients with diabetes mellitus (DM) are at risk for vulvovaginal candidasis. The aim of this study was to determine the species-specific prevalence rate and risk of candidiasis in patients with type 1 DM. Children aged between 8-16 years were included in the study. Clinical and laboratory features of diabetes and evidence of genital symptoms were recorded. Vaginal swabs were taken from patients and placed on Sabouraud's dextrose agar and incubated. Following fasting overnight for 12 hours venous blood samples were taken simultaneously for analyses of blood glucose, HbA1c, and lipid profile. A simple 1-time fluconazole treatment regimen was used to treat patients with vulvo-vaginal candidiasis. Candida species were isolated in 30 of 76 (39%) swabs of patients with type 1 DM. Subjects who had candida colonization and candidiasis were all acute. The predominant candida species isolated from patients with type 1 DM were C.albicans 50%, C. glabrata 36.6%, C.crusei 3.3%, C.spesies 6.6%, and C.dubliniensis 3.3%. 42 patients had symptoms.The prevalence of candidiasis in symptomatic patients was 59.2%. Subjects with vulvo-vaginal candidiasis had higher mean HbA1c when compared to those who had no such infection (P = .047). There seems to be a significant link between hyperglycemia and vulvo-vaginal candidiasis in patients with type 1 DM. Improving glucose control may reduce the risk of candidiasis and potentially symptomatic infection among children with diabetes. Because of high rate of colonization with candida species in diabetes, patients should undergo periodic screening for genital candidiasis. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Higher than expected estradiol levels in aromatase inhibitor-treated, postmenopausal breast cancer patients.

PubMed

Kunovac Kallak, T; Baumgart, J; Stavreus Evers, A; Sundström Poromaa, I; Moby, L; Kask, K; Norjavaara, E; Kushnir, M M; Bergquist, J; Nilsson, K

2012-10-01

Vaginal estradiol is considered contraindicated in aromatase inhibitor (AI)-treated patients because of the risk of elevated estrogen levels. This leaves limited treatment options for patients experiencing gynecological symptoms. However, in clinical practice, no precise estimation has been performed of circulating estrogens and aromatase index in postmenopausal breast cancer patients on long-lasting AI or tamoxifen treatment. Steroid hormones were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) and extraction radioimmunoassay (RIA). Postmenopausal AI-treated patients (n =33) were compared with tamoxifen-treated patients (n =34) and controls without vaginal treatment (n =56), with vaginal estradiol (n =25), or with estriol (n =11) treatment. By use of LC-MS/MS, median (range) estradiol plasma concentrations were 16.7 (2.4-162.6), 31.0 (13.4-77.1), 27.2 (7.8-115.8) and 33.3 (20.3-340.1) pmol/l in AI-treated breast cancer patients, tamoxifen-treated breast cancer patients, postmenopausal controls and postmenopausal controls on vaginal estradiol, respectively. The AI-treated group and subgroups had significantly lower estradiol and estrone concentrations than all other groups (p <0.05). There was extensive interindividual variation in estradiol concentration within the AI-treated group, measured using both LC-MS/MS (2.3-182.0 pmol/l) and extraction RIA (2.4-162.6 pmol/l). The AI-treated group had lower aromatase index compared to all other groups (p <0.05-0.001). Circulating estrogen levels may have been underestimated in previous longitudinal studies of AI-treated breast cancer patients. Additional studies are required to further evaluate the role of circulating estrogens in breast cancer patients suffering from gynecological symptoms.

The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review.

PubMed

Olieman, Renske M; Siemonsma, Femke; Bartens, Margaux A; Garthus-Niegel, Susan; Scheele, Fedde; Honig, Adriaan

2017-06-19

Obstetricians are often reluctant to grant requests for an elective cesarean section (ECS) due to childbirth fear. To date, it is unknown if an ECS on request improves mental well-being in the mother in the peripartum period and if possible beneficial effects on anxiety and depression could outweigh the increased risk of complications associated with a surgical delivery. A systematic review was conducted to explore the effect of ECS on request on peripartum anxiety and depression. We searched on PubMed, PsychoInfo and Embase. Studies were included with primary data on anxiety and/or depression postpartum in women with childbirth fear who had requested an ECS. After full-text evaluation of 65 papers and quality analysis of four papers, three papers were included. Of one paper additional and yet unpublished data were provided. Studies varied in outcome measures, hence no meta-analysis was performed. Women who requested an ECS had higher antepartum depression and anxiety levels but no different postpartum depression levels than women who delivered vaginally. One study of good quality examined the effect of vaginal delivery in women preferring ECS: These women had significantly higher symptom levels of post-traumatic stress disorder (PTSD) and depression than women with normal vaginal delivery. The prospect of an ECS does not lower antepartum anxiety and/or depression levels in women requesting an ECS. If women resolutely persist in wishing an ECS despite adequate counselling and/or psychiatric treatment, the risk of developing depressive and PTSD symptoms in case of vaginal delivery should be taken into account, and an ECS may be considered as a valid alternative.

Health-related quality of life and outcomes after surgical treatment of complications from vaginally placed mesh.

PubMed

Hokenstad, Erik D; El-Nashar, Sherif A; Blandon, Roberta E; Occhino, John A; Trabuco, Emanuel C; Gebhart, John B; Klingele, Christopher J

2015-01-01

We aimed to report on health-related quality of life after surgical excision of vaginally placed mesh for treatment of pelvic organ prolapse and to identify predictors of successful surgical management. We identified patients who underwent surgery for treatment of complications from vaginally placed mesh from January 1, 2003, through December 31, 2011, and conducted a follow-up survey. Logistic regression models were used to identify predictors of successful treatment. We identified 114 patients who underwent surgery for mesh-related complications and 68 underwent mesh excision. Of the 68 patients, 44 (64.7%) completed the survey. Of the 44 responders, 41 returned their consent form and were included in the analysis. Only 22 (54%) patients reported a successful outcome after mesh excision. Of 29 (71%) sexually active patients, 23 had dyspareunia before mesh excision and only 3 patients reported resolution of dyspareunia after excision. We reported a multivariable model for predicting successful surgical outcome with an area under the curve for the receiver operator characteristic of 0.781. In this model, complete excision of mesh, new overactive bladder symptoms after mesh placement, and a body mass index higher than 30 kg/m were associated with successful patient-reported outcomes; adjusted odds ratios (95% confidence intervals) were 5.46 (1.10-41.59), 7.76 (1.18-89.55), and 8.41 (1.35-92.41), respectively. Only half of the patients who had surgery for vaginally placed mesh complications reported improvement after surgery, with modest improvement in dyspareunia. Patients who had complete mesh excision, new overactive bladder symptoms, and obesity were more likely to report improvement.

Defecatory dysfunction and fecal incontinence in women with or without posterior vaginal wall prolapse as measured by pelvic organ prolapse quantification (POP-Q).

PubMed

Augusto, Kathiane Lustosa; Bezerra, Leonardo Robson Pinheiro Sobreira; Murad-Regadas, Sthela Maria; Vasconcelos Neto, José Ananias; Vasconcelos, Camila Teixeira Moreira; Karbage, Sara Arcanjo Lino; Bilhar, Andreisa Paiva Monteiro; Regadas, Francisco Sérgio Pinheiro

2017-07-01

Pelvic Floor Dysfunction is a complex condition that may be asymptomatic or may involve a loto f symptoms. This study evaluates defecatory dysfunction, fecal incontinence, and quality of life in relation to presence of posterior vaginal prolapse. 265 patients were divided into two groups according to posterior POP-Q stage: posterior POP-Q stage ≥2 and posterior POP-Q stage <2. The two groups were compared regarding demographic and clinical data; overall POP-Q stage, percentage of patients with defecatory dysfunction, percentage of patients with fecal incontinence, pelvic floor muscle strength, and quality of life scores. The correlation between severity of the prolapse and severity of constipation was calculated using ρ de Spearman (rho). Women with Bp stage ≥2 were significantly older and had significantly higher BMI, numbers of pregnancies and births, and overall POP-Q stage than women with stage <2. No significant differences between the groups were observed regarding proportion of patients with defecatory dysfunction or incontinence, pelvic floor muscle strength, quality of life (ICIQ-SF), or sexual impact (PISQ-12). POP-Q stage did not correlate with severity of constipation and incontinence. General quality of life perception on the SF-36 was significantly worse in patients with POP-Q stage ≥2 than in those with POP-Q stage <2. The lack of a clinically important association between the presence of posterior vaginal prolapse and symptoms of constipation or anal incontinence leads us to agree with the conclusion that posterior vaginal prolapse probably is not an independent cause defecatory dysfunction or fecal incontinence. Copyright © 2017 Elsevier B.V. All rights reserved.

Electrodynamic parameters in the nighttime sector during auroral substorms

NASA Technical Reports Server (NTRS)

Fujii, R.; Hoffman, R. A.; Anderson, P. C.; Craven, J. D.; Sugiura, M.; Frank, L. A.; Maynard, N. C.

1994-01-01

The characteristics of the large-scale electrodynamic parameters, field-aligned currents (FACs), electric fields, and electron precipitation, which are associated with auroral substorm events in the nighttime sector, have been obtained through a unique analysis which places the ionospheric measurements of these parameters into the context of a generic substorm determined from global auroral images. A generic bulge-type auroral emission region has been deduced from auroral images taken by the Dynamics Explorer 1 (DE 1) satellite during a number of isolated substorms, and the form has been divided into six sectors, based on the peculiar emission characteristics in each sector: west of bulge, surge horn, surge, middle surge, eastern bulge, and east of bulge. By comparing the location of passes of the Dynamics Explorer 2 (DE 2) satellite to the simultaneously obtained auroral images, each pass is placed onto the generic aurora. The organization of DE 2 data in this way has systematically clarified peculiar characteristics in the electrodynamic parameters. An upward net current mainly appears in the surge, with little net current in the surge horn and the west of bulge. The downward net current is distributed over wide longitudinal regions from the eastern bulge to the east of bulge. Near the poleward boundary of the expanding auroral bulge, a pair of oppositely directed FAC sheets is observed, with the downward FAC on the poleward side. This downward FAC and most of the upward FAC in the surge and the middle surge are assoc iated with narrow, intense antisunwqard convection, corresponding to an equatorward directed spikelike electric field. This pair of currents decreases in amplitude and latitudinal width toward dusk in the surge and the west of bulge, and the region 1 and 2 FACs become embedded in the sunward convection region. The upward FAC region associated with the spikelike field on the poleward edge of the bulge coincides well with intense electron precipitation and aurora appearing in this western and poleward protion of the bulge. The convection reversal is sharp in the west of bulge and surge horn sectors, and near the high-latitude boundary of the upward region 1, with a near stagnation region often extending over a large interval of latitude. In the eastern bulge and east of bulge sectors, the region 1 and 2 FACs are located in the sunward convection region, while a spikelike electric field occasionally appears poleward of the aurora but usually not associated with a pair of FAC sheets. In the eastern bulge, magnetic field data show complicated FAC distributions which correspond to current segments and filamentary currents.

Postmenopausal vaginal atrophy: evaluation of treatment with local estrogen therapy

PubMed Central

Minkin, Mary Jane; Maamari, Ricardo; Reiter, Suzanne

2014-01-01

Postmenopausal vaginal atrophy, resulting from decreased estrogen production, frequently requires treatment. Estrogen preparations provide the most effective treatment; local application is preferred to systemic drugs when treating only vaginal symptoms. As local estrogen therapies have comparable efficacy, this study aimed to understand treatment practices, assess experiences with different forms of local estrogen-delivering applicators, and evaluate satisfaction. Women who were US residents aged ≥18 years, menopausal (no spontaneous menstrual period for ≥1 year or with a double oophorectomy), and receiving local estrogen therapy for 1–6 months (vaginal cream [supplied with a reusable applicator] or vaginal tablets [supplied with a single-use/disposable applicator]), completed an online questionnaire. Data from 200 women (100 cream users and 100 tablet users; mean therapy duration 3.48 months) showed that most stored medication in the room in which it was applied (88%) and applied it at bedtime (71%), a procedure for which cream users required, on average, more than twice the time of tablet users (5.08 minutes versus 2.48 minutes). Many cream users applied larger-than-prescribed amounts of cream, attempting to achieve greater efficacy (42%), or lower-than-recommended doses (45%), most frequently to avoid messiness (33%) or leakage (30%). More tablet users (69%) than cream users (14%) were “extremely satisfied” with their applicator. Postmenopausal women using local estrogen therapy were generally more satisfied with the application of vaginal tablets than cream. Patient satisfaction may help to facilitate accurate dosing. Positive perceptions of medication will help to optimize treatment, which, although not assessed in this study, is likely, in turn, to improve vaginal health. PMID:24648772

Literature Review of Benign Müllerian Papilloma Contrasted With Vaginal Rhabdomyosarcoma.

PubMed

McQuillan, Sarah K; Grover, Sonia R; Pyman, Jan; Jayasinghe, Yasmin L

2016-08-01

Benign müllerian papillomas of the genital tract are rare and, hence, can be mistaken for vaginal rhabdomyosarcoma on initial clinical review. This review of the literature will consolidate the previous cases of müllerian papilloma reported and looks for clues to differentiate the 2 entities. We provide a case report and literature review, with patients from a pediatric adolescent gynecology clinic in a tertiary center. We conducted a search of English-language publications from 1951 (the first case report) until January 2014 by using the search words "Müllerian papilloma" and "prepubertal bleeding." References from previous published reports were also obtained for completeness. Literature review of benign müllerian papilloma. Since 1951, 56 cases of müllerian papilloma were reported, including 4 cases at our institution. Comorbid conditions were found in 31.5% of cases (with 3 cases associated with mesenchymal tumors). The average length of time from onset of symptoms (primarily vaginal bleeding) to diagnosis was 6.7 months (range, 1 day to 3 years), with only 1 case diagnosed incidentally. Median age of presentation was 5 years (range, 1 day to 52 years). Most cases were localized and resected with ease. Histology reveals complex papillary lesions without cytologic atypia. Benign müllerian papilloma is distinguished from the more significant diagnosis of vaginal rhabdomyosarcoma by initial length of vaginal bleeding at presentation, lack of vaginal wall extension, ease of resection, and histopathology. This is compared with vaginal rhabdomyosarcoma which commonly exhibits both localized and distant spread. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Velocity Dispersions Across Bulge Types

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fabricius, Maximilian; Bender, Ralf; Hopp, Ulrich

2010-06-08

We present first results from a long-slit spectroscopic survey of bulge kinematics in local spiral galaxies. Our optical spectra were obtained at the Hobby-Eberly Telescope with the LRS spectrograph and have a velocity resolution of 45 km/s (sigma*), which allows us to resolve the velocity dispersions in the bulge regions of most objects in our sample. We find that the velocity dispersion profiles in morphological classical bulge galaxies are always centrally peaked while the velocity dispersion of morphologically disk-like bulges stays relatively flat towards the center--once strongly barred galaxies are discarded.

Fear of childbirth and depressive symptoms among postnatal women: A cross-sectional survey from Chhattisgarh, India.

PubMed

Jha, Paridhi; Larsson, Margareta; Christensson, Kyllike; Svanberg, Agneta Skoog

2018-04-01

Prevalence rates of Fear of Birth and postnatal depressive symptoms have not been explored in Chhattisgarh, India. To validate Hindi Wijma Delivery Experience Questionnaire and to study the prevalence of Fear of Birth and depressive symptoms among postnatal women. A cross-sectional survey at seventeen public health facilities in two districts of Chhattisgarh, India among postnatal women who gave birth vaginally or through C-section to a live neonate. Participants were recruited through consecutive sampling based on health facility records of daily births. Data were collected through one-to-one interviews using the Wijma Delivery Experience Questionnaire Version B and the Edinburgh Postnatal Depression Scale. Non-parametric associations and linear regression data analyses were performed. The Hindi Wijma Delivery Experience Questionnaire Version B had reliable psychometric properties. The prevalence of Fear of Birth and depressive symptoms among postnatal women were 13.1% and 17.1%, respectively, and their presence had a strong association (p<0.001). Regression analyses revealed that, among women having vaginal births: coming for institutional births due to health professionals' advice, giving birth in a district hospital and having postnatal depressive symptoms were associated with presence of FoB; while depressive symptoms were associated with having FoB, perineal suturing without pain relief, and giving birth to a low birth-weight neonate in a district hospital. The prevalence of Fear of Birth and depressive symptoms is influenced by pain management during childbirth and care processes between women and providers. These care practices should be improved for better mental health outcomes among postnatal women. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

In first-time mothers, post-partum depressive symptom prospectively predict symptoms of post-traumatic stress.

PubMed

Shahar, Golan; Herishanu-Gilutz, Shirley; Holcberg, Gershon; Kofman, Ora

2015-11-01

Symptoms of both depression and Post-Traumatic Stress Disorder (PTSD) are prevalent among first-time mothers following birth. However, the direction of the association between the two types of symptoms is unclear. Ninety six first-time mothers giving birth via vaginal delivery (N=38), emergency C-Section (N=27) and planned C-Section (N=21) were assessed for depression and PTSD twice: Six weeks post-partum and six-weeks later. Cross-lagged Structural Equation Modeling (SEM) analyses revealed a prospective effect of depressive symptoms on PTSD symptoms. No moderating factors were identified. A relatively modest sample size and only two assessment waves. An early detection and intervention with symptoms of post-partum depression might also prevent the development of PTSD symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.

The Galactic Bulge Radial Velocity/Abundance Assay

NASA Astrophysics Data System (ADS)

Rich, R. M.

2012-08-01

The Bulge Radial Velocity Assay (BRAVA) measured radial velocities for ˜ 9500 late-type giants in the Galactic bulge, predominantly from -10° < l < +10° and -2° < b < -10°. The project has discovered that the bulge exhibits cylindrical rotation characteristic of bars, and two studies of dynamics (Shen et al. 2010; Wang et al. 2012 MNRAS sub.) find that bar models- either N-body formed from an instability in a preexisting disk, or a self-consistent model- can account for the observed kinematics. Studies of the Plaut field at (l,b) = 0°, -8° show that alpha enhancement is found in bulge giants even 1 kpc from the nucleus. New infrared studies extending to within 0.25° = 35 pc of the Galactic Center find no iron or alpha gradient from Baade's Window (l,b) = 0.9°, -3.9° to our innermost field, in contrast to the marked gradient observed in the outer bulge. We consider the case of the remarkable globular cluster Terzan 5, which has a strongly bimodal iron and rm [α/Fe] within its members, and we consider evidence pro and con that the bulge was assembled from dissolved clusters. The Subaru telescope has the potential to contribute to study of the Galactic bulge, especially using the Hyper Superime-Cam and planned spectroscopic modes, as well as the high resolution spectrograph. The planned Jasmine satellite series may deliver a comprehensive survey of distances and proper motions of bulge stars, and insight into the origin and importance of the X-shaped bulge.

The Heavy Ion Afternoon Bulge: Structure and Formation Mechanisms

NASA Astrophysics Data System (ADS)

Fernandes, P. A.; Larsen, B.; Skoug, R. M.; Reeves, G. D.; Denton, M.; Engel, M.; Ferradas, C.; Funsten, H. O.; Henderson, M. G.; Jahn, J. M.; Morley, S.; Thomsen, M. F.

2017-12-01

Recent observations of near-equatorial inner magnetosphere plasma composition indicate the presence of an "afternoon bulge" plasma population at low L-shell. A detailed statistical survey using HOPE data characterized this afternoon bulge as an enhancement in 10 keV O+ and He+ ions extending from 1100-2200 MLT and 2 ≤ L ≤ 4 during quiet/moderate geomagnetic activity (Kp < 5). This statistical HOPE study postulated that formation of the bulge is caused by variations in Kp: 10 keV particles have access to low L-shells during geomagnetically active times and become trapped during the transition to quiet times. In this study, we expand on previous observations of the afternoon bulge by examining individual transits of this feature by the Van Allen Probes. We analyze periods with optimal spacecraft transits of the afternoon bulge region, including: May - Oct. 2013, Feb. - June 2014, and Apr. - Aug. 2015. We determine the presence and duration of the bulge during case studies representing three categories of geomagnetic activity: 1) extended quiet geomagnetic conditions; 2) sharp transitions of Kp from active to quiet conditions; and 3) rises and falls in Kp on the time scales of spacecraft orbits to days. We thoroughly characterize the energy structure of the bulge as a function of Kp. We also analyze these transits of the bulge in the context of plasma access using both drift path modeling and UBK-derived energy access maps.

KINEMATIC SIGNATURES OF BULGES CORRELATE WITH BULGE MORPHOLOGIES AND SERSIC INDEX

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fabricius, Maximilian H.; Saglia, Roberto P.; Bender, Ralf

2012-07-20

We use the Marcario Low Resolution Spectrograph at the Hobby-Eberly Telescope to study the kinematics of pseudobulges and classical bulges in the nearby universe. We present major axis rotational velocities, velocity dispersions, and h{sub 3} and h{sub 4} moments derived from high-resolution ({sigma}{sub inst} Almost-Equal-To 39 km s{sup -1}) spectra for 45 S0 to Sc galaxies; for 27 of the galaxies we also present minor axis data. We combine our kinematics with bulge-to-disk decompositions. We demonstrate for the first time that purely kinematic diagnostics of the bulge dichotomy agree systematically with those based on Sersic index. Low Sersic index bulgesmore » have both increased rotational support (higher v/{sigma} values) and on average lower central velocity dispersions. Furthermore, we confirm that the same correlation also holds when visual morphologies are used to diagnose bulge type. The previously noted trend of photometrically flattened bulges to have shallower velocity dispersion profiles turns out to be significant and systematic if the Sersic index is used to distinguish between pseudobulges and classical bulges. The anti-correlation between h{sub 3} and v/{sigma} observed in elliptical galaxies is also observed in intermediate-type galaxies, irrespective of bulge type. Finally, we present evidence for formerly undetected counter-rotation in the two systems NGC 3945 and NGC 4736.« less

METALLICITY GRADIENTS THROUGH DISK INSTABILITY: A SIMPLE MODEL FOR THE MILKY WAY'S BOXY BULGE

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martinez-Valpuesta, Inma; Gerhard, Ortwin, E-mail: imv@mpe.mpg.de, E-mail: gerhard@mpe.mpg.de

2013-03-20

Observations show a clear vertical metallicity gradient in the Galactic bulge, which is often taken as a signature of dissipative processes in the formation of a classical bulge. Various evidence shows, however, that the Milky Way is a barred galaxy with a boxy bulge representing the inner three-dimensional part of the bar. Here we show with a secular evolution N-body model that a boxy bulge formed through bar and buckling instabilities can show vertical metallicity gradients similar to the observed gradient if the initial axisymmetric disk had a comparable radial metallicity gradient. In this framework, the range of metallicities inmore » bulge fields constrains the chemical structure of the Galactic disk at early times before bar formation. Our secular evolution model was previously shown to reproduce inner Galaxy star counts and we show here that it also has cylindrical rotation. We use it to predict a full mean metallicity map across the Galactic bulge from a simple metallicity model for the initial disk. This map shows a general outward gradient on the sky as well as longitudinal perspective asymmetries. We also briefly comment on interpreting metallicity gradient observations in external boxy bulges.« less

Tube Bulge Process : Theoretical Analysis and Finite Element Simulations

NASA Astrophysics Data System (ADS)

Velasco, Raphael; Boudeau, Nathalie

2007-05-01

This paper is focused on the determination of mechanics characteristics for tubular materials, using tube bulge process. A comparative study is made between two different models: theoretical model and finite element analysis. The theoretical model is completely developed, based first on a geometrical analysis of the tube profile during bulging, which is assumed to strain in arc of circles. Strain and stress analysis complete the theoretical model, which allows to evaluate tube thickness and state of stress, at any point of the free bulge region. Free bulging of a 304L stainless steel is simulated using Ls-Dyna 970. To validate FE simulations approach, a comparison between theoretical and finite elements models is led on several parameters such as: thickness variation at the free bulge region pole with bulge height, tube thickness variation with z axial coordinate, and von Mises stress variation with plastic strain. Finally, the influence of geometrical parameters deviations on flow stress curve is observed using analytical model: deviations of the tube outer diameter, its initial thickness and the bulge height measurement are taken into account to obtain a resulting error on plastic strain and von Mises stress.

The continuous rise of bulges out of galactic disks

NASA Astrophysics Data System (ADS)

Breda, Iris; Papaderos, Polychronis

2018-06-01

Context. A key subject in extragalactic astronomy concerns the chronology and driving mechanisms of bulge formation in late-type galaxies (LTGs). The standard scenario distinguishes between classical bulges and pseudo-bulges (CBs and PBs, respectively), the first thought to form monolithically prior to disks and the second gradually out of disks. These two bulge formation routes obviously yield antipodal predictions on the bulge age and bulge-to-disk age contrast, both expected to be high (low) in CBs (PBs). Aims: Our main goal is to explore whether bulges in present-day LTGs segregate into two evolutionary distinct classes, as expected from the standard scenario. Other questions motivating this study center on evolutionary relations between LTG bulges and their hosting disks, and the occurrence of accretion-powered nuclear activity as a function of bulge stellar mass ℳ⋆ and stellar surface density Σ⋆. Methods: In this study, we have combined three techniques - surface photometry, spectral modeling of integral field spectroscopy data and suppression of stellar populations younger than an adjustable age cutoff with the code REMOVEYOUNG (ℛ𝒴) - toward a systematic analysis of the physical and evolutionary properties (e.g., ℳ⋆, Σ⋆ and mass-weighted stellar age ℳ and metallicity ℳ, respectively) of a representative sample of 135 nearby (≤ 130 Mpc) LTGs from the CALIFA survey that cover a range between 108.9 M⊙ and 1011.5 M⊙ in total stellar mass ℳ⋆,T. In particular, the analysis here revolves around ⟨δμ9G⟩, a new distance- and formally extinction-independent measure of the contribution by stellar populations of age ≥ 9 Gyr to the mean r-band surface brightness of the bulge. We argue that ⟨δμ9G⟩ offers a handy semi-empirical tracer of the physical and evolutionary properties of LTG bulges and a promising means for their characterization. Results: The essential insight from this study is that LTG bulges form over 3 dex in ℳ⋆ and more than 1 dex in Σ⋆ a tight continuous sequence of increasing ⟨δμ9G⟩ with increasing ℳ⋆, Σ⋆, ℳ and ℳ. Along this continuum of physical and evolutionary properties, our sample spans a range of 4 mag in ⟨δμ9G⟩: high-⟨δμ9G⟩ bulges are the oldest, densest and most massive ones (ℳ 11.7 Gyr, Σ⋆ > 109 M⊙ kpc-2, ℳ⋆ ≥ 1010 M⊙), whereas the opposite is the case for low-⟨δμ9G⟩ bulges (ℳ 7 Gyr) that generally reside in low-mass LTGs. Furthermore, we find that the bulge-to-disk age and metallicity contrast, as well as the bulge-to-disk mass ratio, show a positive trend with ℳ⋆,T, raising from, respectively, 0 Gyr, 0 dex and 0.25 to 3 Gyr, 0.3 dex and 0.67 across the mass range covered by our sample. Whereas gas excitation in lower-mass (≲ 109.7 M⊙) bulges is invariably dominated by star formation (SF), LINER- and Seyfert-specific emission-line ratios were exclusively documented in high-mass (≳ 1010 M⊙), high-Σ⋆ (≳ 109 M⊙ kpc-2) bulges. This is in agreement with previous work and consistent with the notion that the Eddington ratio or the black hole-to-bulge mass ratio scale with ℳ⋆. The coexistence of Seyfert and SF activity in 20% of higher-ℳ⋆, high-Σ⋆ bulges being spectroscopically classified as Composites suggests that the onset of AGN-driven feedback does not necessarily lead to an abrupt termination of SF in LTG nuclei. Conclusions: The continuity both in the properties of LTG bulges themselves and in their age and metallicity contrast to their parent diskssuggests that these components evolve alongside in a concurrent process that leads to a continuum of physical and evolutionary characteristics. Our results are consistent with a picture where bulge growth in LTGs is driven by a superposition of quick-early and slow-secular processes, the relative importance of which increases with ℳ⋆,T. These processes, which presumably combine in situ SF in the bulge and inward migration of material from the disk, are expected to lead to a non-homologous radial growth of Σ⋆ and a trend for an increasing Sérsic index with increasing galaxy mass. Table C.1 is only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/614/A48

Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract

PubMed Central

Jaquiery, A; Stylianopoulos, A; Hogg, G; Grover, S

1999-01-01

AIM—To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause.
DESIGN—It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery.
RESULTS—Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases.
CONCLUSIONS— The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation.

 PMID:10373139

Comparison of clinical diagnosis and microbiological test results in vaginal infections.

PubMed

Karaca, M; Bayram, A; Kocoglu, M E; Gocmen, A; Eksi, F

2005-01-01

Lower genital tract infections continue to be a problem due to the fact that the clinical diagnosis is usually inadequate, and subsequent care is suboptimal. This study aimed at evaluating the accuracy of clinical diagnosis by comparing it with microbiologic test results, and to determine the causative agents of vaginal infections. Sixty-seven nonpregnant women (18-45 years of age) with the clinical diagnosis of lower genital tract infection were enrolled in the study. Patients were not included if they had a history of vaginal infection during the previous three-month period or intrauterine device. The clinical diagnosis was based on the combinations of symptoms, direct observation of wet mount, homogeneous discharge, vaginal pH > 4.5, and detection of the amine odor after exposure of vaginal secretions to 10% KOH. Vaginal samples were taken with two cotton swabs, one was used for pH determination, and the second was utilized for microbiological tests. Gram staining and cultures with Sabouraud agar and chocolate agar were performed for microbiological diagnosis, and the results were compared. The clinical diagnoses included 26 (38.8%) candidiasis, 18 (26.8%) bacterial vaginosis, three (4.5%) trichomoniasis, and 20 (29.9%) mixed vaginal infections. Of the 26 patients with clinical diagnoses of candidiasis, 12 (46.1%) revealed Candiada albicans, nine (34.6) patients revealed microorganisms other than candida species, and five (19.2%) patients had no growth. Five (27.8%) bacterial vaginosis patients revealed Gardnarella vaginalis and 12 patients (66.6%) did not grow any microorganism. The overall rate of accurate clinical diagnoses confirmed by microbiological test results was 43.2%. Seventeen (43.6) of the 39 microbiological test results correlated with clinical diagnosis, and no growth was observed in 28 (41.8%) cultures. We conclude that the clinical diagnosis of vaginal infection is inadequate and should be confirmed with microbiological testing if the resources are avaliable.

Foreign body in the vagina of a four-year-old-girl: a childish prank or sexual abuse.

PubMed

Sakhavar, Nahid; Teimoori, Batool; Ghasemi, Marzie

2014-06-01

Foreign body in the vagina is a common cause of vaginal discharge, which may be either purulent or hemorrhagic. This problem may produce symptoms or be asymptomatic for long periods of time and may result from ignorance, accident, malice, psychotic tendencies, attempts at sexual stimulation or sexual abuse. The current report presents the case of a girl that had inserted a foreign body in her vagina probably due to childish prank. The clinicians should always think of foreign bodies in the vagina in cases of chronic, antibiotic resistant vaginal discharge and lower abdominal pain especially in young girls.

Is candidiasis the true cause of vulvovaginal irritation in women with diabetes mellitus?

PubMed Central

Rowe, B R; Logan, M N; Farrell, I; Barnett, A H

1990-01-01

Vulvovaginitis is common in diabetic women and is often treated with antifungal agents on the assumption that the causative organism is Candida albicans. In a survey of 100 consecutive diabetic women attending a diabetes clinic 36 had complained to their general practitioner about vulvovaginal irritation during the past three years and 26 were treated with antifungal agents without a vaginal examination or swabs being taken. In a separate study 27 post-menopausal women with non-insulin dependent diabetes and symptoms of vulvovaginitis were investigated. The organisms cultured were: Candida albicans (n = 6), beta haemolytic streptococci (n = 14), Gardnerella vaginalis (n = 2), Staphylococcus aureus (n = 2), Streptococcus milleri (n = 1), Streptococcus faecalis (n = 1), Klebsiella oxytoca (n = 1), no organisms (n = 3). Where a bacterial organism was isolated symptoms resolved in all but one case with appropriate antibiotic treatment. It is recommended that the practice of initiating antifungal treatment without taking high vaginal swabs should be reviewed and treatment should be given specifically rather than empirically. PMID:2131794

Management of surgically hypogonadal patients unable to take sex hormone replacement therapy.

PubMed

Nieman, Lynnette K

2003-06-01

Lifestyle changes in diet, exercise and the environment may help to prevent or ameliorate hot flashes and low bone density in men and women after surgical castration. Conventional medications, including megestrol acetate, SSRIs or clonidine, may improve hot flashes but may have limiting side effects. Some complementary and alternative approaches, including black cohosh, vitamin E, and soy products, work as well as placebo to decrease hot flashes and may be helpful, because they have low toxicity. Acupuncture and neurontin are promising but must be studied further. With regards to the prevention of osteoporosis and fractures in men and women, bisphosphonates are the most potent of the currently available agents; calcitonin is less effective. PTH has a large beneficial effect but is not yet available and is less well studied. In women, continued sexual intercourse and use of vaginal lubricants and moisturizers help to minimize symptoms of vaginal atrophy but do not ameliorate urinary symptoms. Low dose local estrogen treatment is a promising approach for the latter complaints.

Obstetrical anal sphincter laceration and anal incontinence 5-10 years after childbirth

PubMed Central

EVERS, Emily C.; BLOMQUIST, Joan L.; MCDERMOTT, Kelly C.; HANDA, Victoria L.

2012-01-01

Objective To investigate the long-term impact of anal sphincter laceration on anal incontinence. Study Design Five to ten years after first delivery, anal incontinence and other bowel symptoms were measured using the Epidemiology of Prolapse and Incontinence Questionnaire and the short form of the Colorectal-Anal Impact Questionnaire. Obstetrical exposures were assessed with review of hospital records. Symptoms and quality of life impact were compared between 90 women with at least one anal sphincter laceration, 320 who delivered vaginally without sphincter laceration and 527 who delivered by cesarean. Results Women who sustained an anal sphincter laceration were most likely to report anal incontinence (odds ratio 2.32; 95% confidence interval 1.27, 4.26) and reported the greatest negative impact on quality of life. Anal incontinence and quality of life scores were similar between women who delivered by cesarean and those who delivered vaginally without sphincter laceration. Conclusion(s) Anal sphincter laceration is associated with anal incontinence 5-10 years after delivery. PMID:22831810

Is candidiasis the true cause of vulvovaginal irritation in women with diabetes mellitus?

PubMed

Rowe, B R; Logan, M N; Farrell, I; Barnett, A H

1990-08-01

Vulvovaginitis is common in diabetic women and is often treated with antifungal agents on the assumption that the causative organism is Candida albicans. In a survey of 100 consecutive diabetic women attending a diabetes clinic 36 had complained to their general practitioner about vulvovaginal irritation during the past three years and 26 were treated with antifungal agents without a vaginal examination or swabs being taken. In a separate study 27 post-menopausal women with non-insulin dependent diabetes and symptoms of vulvovaginitis were investigated. The organisms cultured were: Candida albicans (n = 6), beta haemolytic streptococci (n = 14), Gardnerella vaginalis (n = 2), Staphylococcus aureus (n = 2), Streptococcus milleri (n = 1), Streptococcus faecalis (n = 1), Klebsiella oxytoca (n = 1), no organisms (n = 3). Where a bacterial organism was isolated symptoms resolved in all but one case with appropriate antibiotic treatment. It is recommended that the practice of initiating antifungal treatment without taking high vaginal swabs should be reviewed and treatment should be given specifically rather than empirically.

Obstructing urethral calculus in a woman revealed to be the cause of chronic pelvic pain.

PubMed

Thomas, J S; Crew, J

2012-10-01

Urethral calculi are extremely rarely reported in Caucasian females and are usually associated with an anatomical abnormality such as a diverticulum or a stricture. Ureteric calculi can move to become lodged in the urethra, although this is rare in women because of their short urethral length. We present a case of a 55-year-old woman presenting with urinary retention secondary to an obstructing upper tract calculus that had moved into the urethra. Four years previously, the patient had been diagnosed with chronic pelvic pain following a primary posterior vaginal wall repair. Following treatment of the obstructing calculus, her symptoms of pelvic pain completely resolved. We report a very unusual case that highlights the importance of investigating chronic pelvic pain. This patient's symptom of vaginal pain, though highly localized, was caused by pathology elsewhere in the pelvis. Alternative diagnoses should be sought for such patients and investigation performed to detect any nonvisible hematuria.

The Moderating Effects of Cannabis Use and Decision Making on the Relationship between Conduct Disorder and Risky Sexual Behavior

PubMed Central

Ross, J. Megan; Coxe, Stefany; Schuster, Randi M.; Rojas, Angelica; Gonzalez, Raul

2015-01-01

Risky sexual behavior (RSB) is a current public health concern affecting adolescents and young adults. Conduct disorder, cannabis use and decision making (DM) ability are interrelated constructs that are relevant to RSB; however, there is little research on the association of DM and RSB. Participants were 79 cannabis users assessed through self-report measures of RSB and mental health, and a timeline follow-back procedure for substance use. DM ability was assessed via the Iowa Gambling Task. We found that more conduct disorder symptoms accounted for unique variance in measures of overall RSB and an earlier initiation of oral sex, even when taking into account DM and cannabis use. Amount of cannabis use and DM ability moderated the relationships between number of conduct disorder symptoms and number of oral sex partners and age of initiation for vaginal sex. An increase in conduct disorder symptoms was associated with more oral sex partners when DM was poor and fewer partners when DM was better, however this relationship was only present at higher levels of cannabis use. Furthermore, when DM was poor, more conduct disorder symptoms predicted a younger age of initiation of vaginal sex, with the age decreasing as amount of cannabis use increased. Determining how DM influences RSB may assist in the identification of novel treatment approaches to reduce engagement in RSB. PMID:25832553

Macro-regional variation in attitudes toward and experiences of vulvar and vaginal atrophy among Italian post-menopausal women: a post hoc analysis of REVIVE survey data.

PubMed

Nappi, Rossella E; Particco, Martire; Biglia, Nicoletta; Cagnacci, Angelo; Di Carlo, Costantino; Luisi, Stefano; Paoletti, Anna Maria

2017-05-01

Italian participants in the European REVIVE survey reported that vaginal and vulvar atrophy (VVA) impaired various aspects of their lives, notably the ability to enjoy sex. The aim of the present study was to explore regional differences in knowledge, experiences, and treatment of VVA in the Italian REVIVE sample (n = 1000), which was analyzed according to region of residence. While many respondents were unfamiliar with the VVA condition, most could relate their VVA symptoms to the menopause. The rate of diagnosis of VVA was twice as high in Central Italy as in the North-East. For individual VVA symptoms, 25.4-41.6% of respondents judged that the symptom had worsened over time. There were no significant regional differences for symptoms in terms of reported rate, change in severity, impact on sexual activity, or health-care visits. Testosterone cream and OTC medication based on hyaluronic acid showed significant regional differences in lifetime rates of use. In Italy, there are modest regional differences in knowledge, diagnosis, and treatment of VVA, some of which may be explained by inter-regional differences in health care. Further efforts are needed to ensure that Italian women are properly informed about VVA and have access to appropriate health care and treatments.

The American-European difference in vulvar and vaginal atrophy views: a lesson from the REVIVE Survey.

PubMed

Nappi, R E; Krychman, M L

2016-06-01

Vulvar and vaginal atrophy (VVA) is a common complaint in postmenopausal women and consists of a variety of symptoms and strong repercussions that negatively affect comfort during sexual activity and ultimately impact quality of life. The EU and US REVIVE surveys have detected significant barriers in health-care professional management and educational programs that prevent correct diagnosis and effective treatment. This was common in both Europe and the US, but differential behaviors and patterns could be detected after reviewing the published results. The frequency of reporting VVA symptoms was lower in European participants. However, a better knowledge that VVA is a consequence of menopause was evident in Europe, probably in relation to more frequent gynecological visits and more frequent specialist visits as a referral health-care professional. Moreover, a trend towards an improved satisfaction with management by the health-care professional was observed in Europe. European participants acknowledged a significantly higher impact of VVA symptoms on sexual intercourse and partner interaction than North American (US) participants, and both cohorts were observed to have differences between their respective VVA symptom profiles. These observations have implications in the overall concerns that participants stated with long-term VVA medication and for the optimal therapeutic approach, providing evidence to support the concept that unexplored methods to improve management of patients with VVA remain.

Determinants of Patient Delay in Seeking Diagnosis and Treatment among Moroccan Women with Cervical Cancer

PubMed Central

Hanchi, Zaki; Bekkali, Rachid; Ahid, Samir; Mesfioui, Abdelhalem

2016-01-01

Introduction. This study sought to investigate potential determinants of patient delay among Moroccan women with cervical cancer. Methods. A cross-sectional study was conducted from June 2014 to June 2015 at the National Institute of Oncology in Rabat. Data were collected using questionnaire among patients with cervical cancer locally advanced or metastatic (stages IIA–IVB). Medical records were abstracted to complete clinical information. An interval longer than 90 days between discovery of initial symptoms and presentation to a provider was defined as a patient delay. Results. Four hundred and one patients with cervical cancer enrolled in this study. The mean age was 52.4 years (SD = 11.5). 53.6% were illiterate. Abnormal vaginal bleeding was identified for 65.8% of patients. 60.1% were diagnosed at stages IIA-IIB. 55.4% were found having patient delay. The regression analyses showed the association between literacy (p < 0.001), distance of the place of the first consultation (p = 0.031), abnormal vaginal bleeding as an earlier symptom (p < 0.001), stage at diagnosis (p < 0.03), knowledge of symptoms (p < 0.001), knowledge of causes (p = 0.008), and practice of gynecological exam during the last three years (p = 0.018) and the patient delay. Conclusion. Educational messages should aim at increasing awareness of cervical cancer, assisting women in symptom recognition, and encouraging earlier presentation. PMID:27882055

Mapping a stellar disk into a boxy bulge: The outside-in part of the Milky Way bulge formation

NASA Astrophysics Data System (ADS)

Di Matteo, P.; Haywood, M.; Gómez, A.; van Damme, L.; Combes, F.; Hallé, A.; Semelin, B.; Lehnert, M. D.; Katz, D.

2014-07-01

By means of idealized, dissipationless N-body simulations that follow the formation and subsequent buckling of a stellar bar, we study the characteristics of boxy/peanut-shaped bulges and compare them with the properties of the stellar populations in the Milky Way (MW) bulge. The main results of our modeling, valid for the general family of boxy/peanut shaped bulges, are the following: (i) Because of the spatial redistribution in the disk initiated at the epoch of bar formation, stars from the innermost regions to the outer Lindblad resonance (OLR) of the stellar bar are mapped into a boxy bulge. (ii) The contribution of stars to the local bulge density depends on their birth radius: stars born in the innermost disk tend to dominate the innermost regions of the boxy bulge, while stars originating closer to the OLR are preferably found in the outer regions of the boxy/peanut structure. (iii) Stellar birth radii are imprinted in the bulge kinematics: the larger the birth radii of stars ending up in the bulge, the greater their rotational support and the higher their line-of-sight velocity dispersions (but note that this last trend depends on the bar viewing angle). (iv) The higher the classical bulge-over-disk ratio, the larger its fractional contribution of stars at large vertical distance from the galaxy midplane. Comparing these results with the properties of the stellar populations of the MW bulge recently revealed by the ARGOS survey, we conclude that (I) the two most metal-rich populations of the MW bulge, labeled A and B in the ARGOS survey, originate in the disk, with the population of A having formed on average closer to the Galaxy center than the population of component B; (II) a massive (B/D ~ 0.25) classical spheroid can be excluded for the MW, thus confirming previous findings that the MW bulge is composed of populations that mostly have a disk origin. On the basis of their chemical and kinematic characteristics, the results of our modeling suggest that the populations A, B, and C, as defined by the ARGOS survey, can be associated, respectively, with the inner thin disk, to the young thick and to the old thick disk, following the nomenclature that we recently suggested for stars in the solar neighborhood. Appendix A is available in electronic form at http://www.aanda.org

Recurrent paediatric pinworm infection of the vagina as a potential reservoir for Enterobius vermicularis.

PubMed

Kashyap, B; Samantray, J C; Kumar, S; Jhamb, R; Singh, A K; Kaur, I R

2014-09-01

Enterobius vermicularis infection remains one of the most common parasitic infections, particularly prevalent in children. Enterobiasis, although not usually dangerous, may cause significant morbidity. Elimination of the parasite from a family or an institution often poses problems, either because of an incomplete cure or re-infection. While there have been limited reports of ectopic enterobiasis throughout the world, ours is probably one of the rarest reports of recurrent vaginal E. vermicularis infection in the absence of any gastrointestinal symptoms despite complete treatment. A 4-year-old girl presented with recurrent episodes of vulval itching on 3-4 occasions over 2 years. There was no pruritis ani nor urinary/gastrointestinal complaints. The vulva was inflamed with 4-5 living worms, 6-7 mm in length, emerging from the anterior vaginal fornix, but with no vaginal discharge. Direct microscopic examination of vaginal swabs revealed adult worms of Enterobius but no eggs. Repeated stool samples from the patient, parents and a sibling were negative. The patient was treated orally with 100 mg of mebendazole for 3 days followed by two more courses at 3-week intervals over a period of 3 months. Recurrent vaginal enterobiasis despite complete treatment and in the absence of any gastrointestinal involvement suggests that the vagina is a potential reservoir for E. vermicularis, which supports the theory of rare ectopic enterobiasis through the ascending pathway of the female genital tract.

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

PubMed Central

2011-01-01

Background Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial. Methods/Design This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid. The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference. Discussion Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient. PMID:21281464

Morpho-kinematic properties of field S0 bulges in the CALIFA survey

NASA Astrophysics Data System (ADS)

Méndez-Abreu, J.; Aguerri, J. A. L.; Falcón-Barroso, J.; Ruiz-Lara, T.; Sánchez-Menguiano, L.; de Lorenzo-Cáceres, A.; Costantin, L.; Catalán-Torrecilla, C.; Zhu, L.; Sánchez-Blazquez, P.; Florido, E.; Corsini, E. M.; Wild, V.; Lyubenova, M.; van de Ven, G.; Sánchez, S. F.; Bland-Hawthorn, J.; Galbany, L.; García-Benito, R.; García-Lorenzo, B.; González Delgado, R. M.; López-Sánchez, A. R.; Marino, R. A.; Márquez, I.; Ziegler, B.; Califa Collaboration

2018-02-01

We study a sample of 28 S0 galaxies extracted from the integral field spectroscopic (IFS) survey Calar Alto Legacy Integral Field Area. We combine an accurate two-dimensional (2D) multicomponent photometric decomposition with the IFS kinematic properties of their bulges to understand their formation scenario. Our final sample is representative of S0s with high stellar masses (M⋆/M⊙ > 1010). They lay mainly on the red sequence and live in relatively isolated environments similar to that of the field and loose groups. We use our 2D photometric decomposition to define the size and photometric properties of the bulges, as well as their location within the galaxies. We perform mock spectroscopic simulations mimicking our observed galaxies to quantify the impact of the underlying disc on our bulge kinematic measurements (λ and v/σ). We compare our bulge corrected kinematic measurements with the results from Schwarzschild dynamical modelling. The good agreement confirms the robustness of our results and allows us to use bulge deprojected values of λ and v/σ. We find that the photometric (n and B/T) and kinematic (v/σ and λ) properties of our field S0 bulges are not correlated. We demonstrate that this morpho-kinematic decoupling is intrinsic to the bulges and it is not due to projection effects. We conclude that photometric diagnostics to separate different types of bulges (disc-like versus classical) might not be useful for S0 galaxies. The morpho-kinematics properties of S0 bulges derived in this paper suggest that they are mainly formed by dissipational processes happening at high redshift, but dedicated high-resolution simulations are necessary to better identify their origin.

Stellar populations of bulges in galaxies with a low surface-brightness disc

NASA Astrophysics Data System (ADS)

Morelli, L.; Corsini, E. M.; Pizzella, A.; Dalla Bontà, E.; Coccato, L.; Méndez-Abreu, J.

2015-03-01

The radial profiles of the Hβ, Mg, and Fe line-strength indices are presented for a sample of eight spiral galaxies with a low surface-brightness stellar disc and a bulge. The correlations between the central values of the line-strength indices and velocity dispersion are consistent to those known for early-type galaxies and bulges of high surface-brightness galaxies. The age, metallicity, and α/Fe enhancement of the stellar populations in the bulge-dominated region are obtained using stellar population models with variable element abundance ratios. Almost all the sample bulges are characterized by a young stellar population, on-going star formation, and a solar α/Fe enhancement. Their metallicity spans from high to sub-solar values. No significant gradient in age and α/Fe enhancement is measured, whereas only in a few cases a negative metallicity gradient is found. These properties suggest that a pure dissipative collapse is not able to explain formation of all the sample bulges and that other phenomena, like mergers or acquisition events, need to be invoked. Such a picture is also supported by the lack of a correlation between the central value and gradient of the metallicity in bulges with very low metallicity. The stellar populations of the bulges hosted by low surface-brightness discs share many properties with those of high surface-brightness galaxies. Therefore, they are likely to have common formation scenarios and evolution histories. A strong interplay between bulges and discs is ruled out by the fact that in spite of being hosted by discs with extremely different properties, the bulges of low and high surface-brightness discs are remarkably similar.

Chronic vulvovaginitis in women older than 50 years: analysis of a prospective database.

PubMed

Nyirjesy, Paul; Leigh, Randi D; Mathew, Leny; Lev-Sagie, Ahinoam; Culhane, Jennifer F

2012-01-01

This study aimed to examine differences in symptoms and diagnoses between women 50 years and younger and women older than 50 years who have chronic vulvovaginal complaints. New patients of the Drexel University Vaginitis Center with chronic vulvovaginal complaints were eligible. Participants underwent a standardized medical evaluation and completed detailed questionnaires. Data were analyzed using the t test, χ test, and the Fisher exact test. Subjects were 469 women aged 18 to 79 years. Subjects 50 years and younger (group A) were more likely to complain of vaginal itching and were less likely to complain of burning, irritation, or soreness (p ≤ .05 for all). Subjects older than 50 years (group B) were more likely to be diagnosed with atrophic vaginitis (p = .000), desquamative inflammatory vaginitis (DIV; p = .001), lichen planus (LP; p = .000), and lichen sclerosus (p = .000). Diagnosis of LS, LP, or DIV was associated with increased likelihood of multiparity and decreased likelihood of a history of systemic estrogen use. Postmenopausal women are more likely than premenopausal women to be diagnosed with DIV, LP, or LS. Both childbirth and estrogen nonuse were associated with the occurrence of these latter 3 conditions.

Management of vaginal atrophy: a real mess. Results from the AGATA study.

PubMed

Palma, Federica; Xholli, Anjeza; Cagnacci, Angelo

2017-09-01

To investigate the management of vaginal atrophy (VA) in a population-based study. A sub-study of a cross-sectional multicenter study on 913 postmenopausal women. Management of VA was investigated on the 274 women referring having received a previous diagnosis of VA. Women had received, no therapy (9.8%), systemic hormones (9.2%), intra-vaginal estrogens (44.5%) or local non-hormonal (36.5%) therapy. There was heterogeneity of treatments. Local therapies were given in cycles, and used for a length of time ranging from 1 to 12 months. At the time of the investigation 59.5% of these women were not on treatment, either because following the physician's indication (31.1%) or because spontaneously withdrawing from treatment (68.9%). Reasons for withdrawing from therapy were insufficient symptom relief (46.6%), messiness (24.3%), difficulty in application (7.8%) and vaginal discharge (1.9%). At the time of investigation only 2.9% of treated women did not suffer from VA. This study underlines the presence of a great confusion about the therapy used for VA, along with patients' dissatisfaction with actual treatments. The emerging evidence is that in real world VA remains untreated.

A 34-Week Size Uterus with a Complete Hydatidiform Mole: Hook Effect and Severe Anemia with No Vaginal Bleeding.

PubMed

McLaren, Rodney; Bayya, Vijaya; Irani, Mohamad

2018-01-01

Complete hydatidiform mole is an abnormal pregnancy that usually presents with vaginal bleeding and markedly elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 16-year-old nulligravid who presented with a 34-week size uterus and a relatively low serum ß-hCG level (722 IU/L)-likely related to the "hook effect"-and severe anemia (hemoglobin: 6.1 g/dL) despite the absence of vaginal bleeding. She also reported right flank pain and was diagnosed with moderate right hydronephrosis owing to the compression exerted by the enlarged uterus on the right ureter. The patient received a total of 6 units of packed red blood cells and was managed by dilation and evacuation followed by serial monitoring of serum ß-hCG levels. Therefore, complete mole can present with symptoms related to an enlarged uterus and severe anemia before the occurrence of vaginal bleeding. It is also important to note that a negative urine pregnancy test or relatively low serum ß-hCG level should prompt repeating the measurement on diluted sample to prevent the "hook effect."

Anterior vaginal wall tenderness (AVWT) as a physical symptom in chronic pelvic pain.

PubMed

Paulson, John D; Paulson, Joseph N

2011-01-01

Chronic pelvic pain is often difficult to diagnose and treat properly. Physicians called on to treat this problem may not be able to give a specific diagnosis. The aim of this study was to see whether the physical presence of anterior vaginal wall tenderness could help narrow down and elucidate diagnoses in a practice focusing on diagnosis and treatment of chronic pelvic pain. The study cohort comprised 284 patients with chronic pelvic pain limited to gynecologic and lower urinary problems. Histories, physical examinations, and endoscopic procedures were performed on each patient. An analysis of this information was conducted. Of the chronic pelvic pain patients, 78% had endometriosis, 81% had interstitial cystitis, and 61% had both concurrently. The sensitivity of anterior vaginal wall tenderness (AVWT) in patients with interstitial cystitis was 95%, and in those with only endometriosis and no interstitial cystitis, the sensitivity was 17%. The positive predictive value for interstitial cystitis was 85%, and for endometriosis it was 67%. Examination of the anterior vaginal wall with an empty bladder at the initial examination can lead one to suspect interstitial cystitis and possibly either concomitant or singular endometriosis and allow the physician to approach the workup accordingly.

Numerical Simulation of Bulging Deformation for Wide-Thick Slab Under Uneven Cooling Conditions

NASA Astrophysics Data System (ADS)

Wu, Chenhui; Ji, Cheng; Zhu, Miaoyong

2018-06-01

In the present work, the bulging deformation of a wide-thick slab under uneven cooling conditions was studied using finite element method. The non-uniform solidification was first calculated using a 2D heat transfer model. The thermal material properties were derived based on a microsegregation model, and the water flux distribution was measured and applied to calculate the cooling boundary conditions. Based on the solidification results, a 3D bulging model was established. The 2D heat transfer model was verified by the measured shell thickness and the slab surface temperature, and the 3D bulging model was verified by the calculated maximum bulging deflections using formulas. The bulging deformation behavior of the wide-thick slab under uneven cooling condition was then determined, and the effect of uneven solidification, casting speed, and roll misalignment were investigated.

Numerical Simulation of Bulging Deformation for Wide-Thick Slab Under Uneven Cooling Conditions

NASA Astrophysics Data System (ADS)

Wu, Chenhui; Ji, Cheng; Zhu, Miaoyong

2018-02-01

In the present work, the bulging deformation of a wide-thick slab under uneven cooling conditions was studied using finite element method. The non-uniform solidification was first calculated using a 2D heat transfer model. The thermal material properties were derived based on a microsegregation model, and the water flux distribution was measured and applied to calculate the cooling boundary conditions. Based on the solidification results, a 3D bulging model was established. The 2D heat transfer model was verified by the measured shell thickness and the slab surface temperature, and the 3D bulging model was verified by the calculated maximum bulging deflections using formulas. The bulging deformation behavior of the wide-thick slab under uneven cooling condition was then determined, and the effect of uneven solidification, casting speed, and roll misalignment were investigated.

Tracing the evolution of the Galactic bulge with chemodynamical modelling of alpha-elements

NASA Astrophysics Data System (ADS)

Friaça, A. C. S.; Barbuy, B.

2017-02-01

Context. Galactic bulge abundances can be best understood as indicators of bulge formation and nucleosynthesis processes by comparing them with chemo-dynamical evolution models. Aims: The aim of this work is to study the abundances of alpha-elements in the Galactic bulge, including a revision of the oxygen abundance in a sample of 56 bulge red giants. Methods: Literature abundances for O, Mg, Si, Ca and Ti in Galactic bulge stars are compared with chemical evolution models. For oxygen in particular, we reanalysed high-resolution spectra obtained using FLAMES+UVES on the Very Large Telescope, now taking each star's carbon abundances, derived from CI and C2 lines, into account simultaneously. Results: We present a chemical evolution model of alpha-element enrichment in a massive spheroid that represents a typical classical bulge evolution. The code includes multi-zone chemical evolution coupled with hydrodynamics of the gas. Comparisons between the model predictions and the abundance data suggest a typical bulge formation timescale of 1-2 Gyr. The main constraint on the bulge evolution is provided by the O data from analyses that have taken the C abundance and dissociative equilibrium into account. Mg, Si, Ca and Ti trends are well reproduced, whereas the level of overabundance critically depends on the adopted nucleosynthesis prescriptions. Observations collected both at the European Southern Observatory, Paranal, Chile (ESO programmes 71.B-0617A, 73.B0074A, and GTO 71.B-0196)

Hair Follicle Bulge Stem Cells Appear Dispensable for the Acute Phase of Wound Re‐epithelialization

PubMed Central

Garcin, Clare L.; Ansell, David M.; Headon, Denis J.; Paus, Ralf

2016-01-01

Abstract The cutaneous healing response has evolved to occur rapidly, in order to minimize infection and to re‐establish epithelial homeostasis. Rapid healing is achieved through complex coordination of multiple cell types, which importantly includes specific cell populations within the hair follicle (HF). Under physiological conditions, the epithelial compartments of HF and interfollicular epidermis remain discrete, with K15+ve bulge stem cells contributing progeny for HF reconstruction during the hair cycle and as a basis for hair shaft production during anagen. Only upon wounding do HF cells migrate from the follicle to contribute to the neo‐epidermis. However, the identity of the first‐responding cells, and in particular whether this process involves a direct contribution of K15+ve bulge cells to the early stage of epidermal wound repair remains unclear. Here we demonstrate that epidermal injury in murine skin does not induce bulge activation during early epidermal wound repair. Specifically, bulge cells of uninjured HFs neither proliferate nor appear to migrate out of the bulge niche upon epidermal wounding. In support of these observations, Diphtheria toxin‐mediated partial ablation of K15+ve bulge cells fails to delay wound healing. Our data suggest that bulge cells only respond to epidermal wounding during later stages of repair. We discuss that this response may have evolved as a protective safeguarding mechanism against bulge stem cell exhaust and tumorigenesis. Stem Cells 2016;34:1377–1385 PMID:26756547

Galaxies Grow Their Bulges and Black Holes in Diverse Ways

NASA Astrophysics Data System (ADS)

Bell, Eric F.; Monachesi, Antonela; Harmsen, Benjamin; de Jong, Roelof S.; Bailin, Jeremy; Radburn-Smith, David J.; D'Souza, Richard; Holwerda, Benne W.

2017-03-01

Galaxies with Milky Way-like stellar masses have a wide range of bulge and black hole masses; in turn, these correlate with other properties such as star formation history. While many processes may drive bulge formation, major and minor mergers are expected to play a crucial role. Stellar halos offer a novel and robust measurement of galactic merger history; cosmologically motivated models predict that mergers with larger satellites produce more massive, higher-metallicity stellar halos, reproducing the recently observed stellar halo metallicity-mass relation. We quantify the relationship between stellar halo mass and bulge or black hole prominence using a sample of 18 Milky Way-mass galaxies with newly available measurements of (or limits on) stellar halo properties. There is an order of magnitude range in bulge mass, and two orders of magnitude in black hole mass, at a given stellar halo mass (or, equivalently, merger history). Galaxies with low-mass bulges show a wide range of quiet merger histories, implying formation mechanisms that do not require intense merging activity. Galaxies with massive “classical” bulges and central black holes also show a wide range of merger histories. While three of these galaxies have massive stellar halos consistent with a merger origin, two do not—merging appears to have had little impact on making these two massive “classical” bulges. Such galaxies may be ideal laboratories to study massive bulge formation through pathways such as early gas-rich accretion, violent disk instabilities, or misaligned infall of gas throughout cosmic time.

Use of a novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes.

PubMed

Sokol, Eric R; Karram, Mickey M

2017-07-01

To assess safety and efficacy of a fractional CO2 laser therapy for the treatment of genitourinary syndrome of menopause (GSM) with follow-up to 1 year posttreatment. Women presenting with GSM and meeting inclusion criterion were enrolled. Visual Analog Scales were used to grade vaginal pain, burning, itching, dryness, dyspareunia, and dysuria. Dilators were used to rate vaginal elasticity at baseline and at each follow-up visit. Before each treatment and at follow-up, Vaginal Health Index scoring and Female Sexual Function Index questionnaires were completed. Women received three vaginal laser treatments spaced 6 weeks apart. Participant satisfaction was measured on 5-point Likert scales (1 = very dissatisfied, 5 = very satisfied). Of 30 women (mean age 58.6 ± 8.8 years), three were lost to follow-up at 3 months and six at 1 year. None were discontinued or withdrew due to an adverse event. Average improvement in Visual Analog Scale scores for all symptom categories was statistically significant at 3 months and remained so through 1 year, except dysuria. Differences between data at 3 months and 1 year were not statistically significant, indicating persistence of positive outcomes. Average overall improvement in pain was 1.9 (±3.4), burning 1.9 (±3.1), itching 1.4 (±1.9), dryness 5.9 (±2.8), dyspareunia 4.9 (±3.3), and dysuria 0.9 (±3.1). Improvement in average Vaginal Health Index and Female Sexual Function Index scores was also statistically significant (P < 0.0001). Of 19 women undergoing dilator examination at 1 year, 18 (94.8%) were comfortable with the same or larger dilator size. Twenty-two of 24 women (92%) were satisfied or extremely satisfied with the treatment at 1 year. Based on study data up to 1 year, the fractional CO2 laser may be an effective and safe treatment for women suffering from symptoms of GSM, although additional studies with larger populations and placebo control is needed to confirm these results.

Estrous Cyclicity of Mice During Simulated Weightlessness

NASA Technical Reports Server (NTRS)

Moyer, Eric; Talyansky, Yuli; Scott, Ryan; Tash, Joseph; Christenson, Lane; Alwood, Joshua; Ronca, April

2017-01-01

Hindlimb unloading (HU) is a rodent model system used to simulate weightlessness experienced in space. However, some effects of this approach on rodent physiology are under-studied, specifically the effects on ovarian estrogen production which drives the estrous cycle. To resolve this deficiency, we conducted a ground-based validation study using the HU model, while monitoring estrous cycles in 16-weeks-old female C57BL6 mice. Animals were exposed to HU for 12 days following a 3 day HU cage acclimation period, and estrous cycling was analyzed in HU animals (n22), normally loaded HU Cage Pair-Fed controls (CPF; n22), and Vivarium controls fed ad libitum (VIV; n10). Pair feeding was used to control for potential nutritional deficits on ovarian function. Vaginal cells were sampled daily in all mice via saline lavage. Cells were dried and stained with crystal violet, and the smears evaluated using established vaginal cytology techniques by two individuals blinded to the animal treatment group. Estrous cyclicity was disrupted in nearly all HU and CPF mice, while those maintained in VIV had an average normal cycle length of 4.8 0.5 days, with all stages in the cycle visibly observed. CPF and HU animals arrested in the diestrous phase, which precedes the pre-ovulatory estrogen surge. Additionally, infection-like symptoms characterized by vaginal discharge and swelling arose in several HU animals, which we suspect was due to an inability of these mice to properly groom themselves, andor due to the change in the gravity vector relative to the vaginal opening, which prevented drainage of the lavage solution. Pair-feeding resulted in similar weight gains of HU and CPF (1.5 vs 3.0, respectively). The current results indicate that pair-feeding controlled weight gain and that the HU cage alone influenced estrous cyclicity. Thus, longer acclimation needs to be tested to determine if and when normal estrous cycling resumes in non-loaded mice in HU cages prior to HU testing. Future studies might also examine whether modifications to the vaginal lavage procedure might prevent the onset of the infection-like symptoms, and allow estrous cyclicity to be measured in this model system.

Spanish version of Pregnancy Symptoms Inventory: transcultural adaptation and reliability.

PubMed

Oviedo-Caro, Miguel A; Bueno-Antequera, Javier; Munguía-Izquierdo, Diego

2017-09-01

To transcultural adapt and analyze the reliability of Spanish version of Pregnancy Symptoms Inventory (PSI) and assess the prevalence of pregnancy symptoms in Spanish pregnant women. A subsample of 120 healthy pregnant women answered the PSI twice and a sample of 280 report the prevalence and limitation of pregnancy symptoms. The reliability was examined by means of percent agreement and weighted Kappa coefficients. The prevalence of pregnancy symptoms was evaluated by the frequency of answers. Perfect and perfect-acceptable agreement was observed in 82% and 96% of the pregnant women, respectively. Weighted Kappa coefficients ranged from 0.589 to 0.889, indicating a good reliability. The most frequent symptoms perceived by Spanish pregnant women were urinary frequency, poor sleep, increased vaginal discharge and tiredness. Spanish Pregnancy Symptoms Inventory is a brief, conceptually equivalent and satisfactory reliable tool that allows an early assessment of the wide range of pregnancy symptoms in the health care practices.

Relations among Menopausal Symptoms, Sleep Disturbance and Depressive Symptoms in Midlife

PubMed Central

Brown, Jessica P.; Gallicchio, Lisa; Flaws, Jodi F.; Tracy, J. Kathleen

2009-01-01

Objectives To investigate the relations among hot flashes, other menopausal symptoms, sleep quality and depressive symptoms in midlife women Methods A large population-based cross-sectional study of 639 women (ages 45 to 54 years) consisting of a questionnaire including the Center for Epidemiologic Studies-Depression Scale (CES-D), demographics, health behaviors, menstrual history, and menopausal symptoms Results After controlling for menopausal status, physical activity level, smoking status and current self-reported health status elevated CES-D score is associated with frequent nocturnal hot flashes, frequent trouble sleeping, experiencing hot flashes, nausea, headaches, weakness, visual problems, vaginal discharge, irritability, muscle stiffness, and incontinence. Conclusions The present study found significant links between depressive symptoms and several menopausal symptoms including hot flashes, sleep disturbance, irritability, muscle stiffness, and incontinence after controlling for covariates. These findings suggest that a potential mechanism in which bothersome menopausal symptoms may influence depressed mood during the midlife is through sleep disturbance. PMID:19128903

Structure/cleavage-based insights into helical perturbations at bulge sites within T. thermophilus Argonaute silencing complexes

PubMed Central

Sheng, Gang; Gogakos, Tasos; Wang, Jiuyu; Zhao, Hongtu; Serganov, Artem; Juranek, Stefan

2017-01-01

Abstract We have undertaken a systematic structural study of Thermus thermophilus Argonaute (TtAgo) ternary complexes containing single-base bulges positioned either within the seed segment of the guide or target strands and at the cleavage site. Our studies establish that single-base bulges 7T8, 5A6 and 4A5 on the guide strand are stacked-into the duplex, with conformational changes localized to the bulge site, thereby having minimal impact on the cleavage site. By contrast, single-base bulges 6’U7’ and 6’A7’ on the target strand are looped-out of the duplex, with the resulting conformational transitions shifting the cleavable phosphate by one step. We observe a stable alignment for the looped-out 6’N7’ bulge base, which stacks on the unpaired first base of the guide strand, with the looped-out alignment facilitated by weakened Watson–Crick and reversed non-canonical flanking pairs. These structural studies are complemented by cleavage assays that independently monitor the impact of bulges on TtAgo-mediated cleavage reaction. PMID:28911094

Supermassive black holes do not correlate with dark matter haloes of galaxies.

PubMed

Kormendy, John; Bender, Ralf

2011-01-20

Supermassive black holes have been detected in all galaxies that contain bulge components when the galaxies observed were close enough that the searches were feasible. Together with the observation that bigger black holes live in bigger bulges, this has led to the belief that black-hole growth and bulge formation regulate each other. That is, black holes and bulges coevolve. Therefore, reports of a similar correlation between black holes and the dark matter haloes in which visible galaxies are embedded have profound implications. Dark matter is likely to be non-baryonic, so these reports suggest that unknown, exotic physics controls black-hole growth. Here we show, in part on the basis of recent measurements of bulgeless galaxies, that there is almost no correlation between dark matter and parameters that measure black holes unless the galaxy also contains a bulge. We conclude that black holes do not correlate directly with dark matter. They do not correlate with galaxy disks, either. Therefore, black holes coevolve only with bulges. This simplifies the puzzle of their coevolution by focusing attention on purely baryonic processes in the galaxy mergers that make bulges.

Vaginal Heparan Sulfate Linked to Neutrophil Dysfunction in the Acute Inflammatory Response Associated with Experimental Vulvovaginal Candidiasis.

PubMed

Yano, Junko; Noverr, Mairi C; Fidel, Paul L

2017-03-14

Despite acute inflammation by polymorphonuclear neutrophils (PMNs) during vulvovaginal candidiasis (VVC), clearance of Candida fails to occur. The purpose of this study was to uncover the mechanism of vaginal PMN dysfunction. Designs included assessing PMN migration, proinflammatory mediators, and tissue damage (by analysis of the activity of lactate dehydrogenase [LDH]) in mice susceptible (C3H/HeN-C57BL/6) or resistant (CD-1) to chronic VVC (CVVC-S or CVVC-R) and testing morphology-specific Candida albicans strains under conditions of preinduced PMN migration (CVVC-S mice) or PMN depletion (CVVC-R mice). In vitro designs included evaluation of C. albicans killing by elicited vaginal or peritoneal PMNs in standard or vaginal conditioned medium (VCM). Results showed that despite significant migration of PMNs and high levels of vaginal beta interleukin-1 (IL-1β) and alarmin S100A8, CVVC-S mice failed to reduce vaginal fungal burden irrespective of morphology or whether PMNs were present pre- or postinoculation, and had high LDH levels. In contrast, CVVC-R mice had reduced fungal burden and low LDH levels following PMN recruitment and IL-1β/S100A8 production, but maintained colonization in the absence of PMNs. Elicited vaginal and peritoneal PMNs showed substantial killing activity in standard media or VCM from CVVC-R mice but not in VCM from CVVC-S mice. The inhibitory effect of VCM from CVVC-S mice was unaffected by endogenous or exogenous estrogen and was ablated following depletion/neutralization of Mac-1 ligands using Mac-1 +/+ PMNs or recombinant Mac-1. Heparan sulfate (HS) was identified as the putative inhibitor as evidenced by the rescue of PMN killing following heparanase treatment of VCM, as well as by inhibition of killing by purified HS. These results suggest that vaginal HS is linked to PMN dysfunction in CVVC-S mice as a competitive ligand for Mac-1. IMPORTANCE Vaginal candidiasis, caused by Candida albicans , affects a significant number of women worldwide. Despite an acute inflammatory response by neutrophils during infection, the response fails to reduce the organism. Instead, the response is considered a key process underlying the symptoms of vaginitis. Therefore, it is important to determine the mechanism(s) associated with the lack of vaginal neutrophil antifungal activity. The established mouse model of Candida vaginitis was used to uncover the mechanism of neutrophil dysfunction. Results revealed that heparan sulfate present in the vagina of mice susceptible to chronic vaginitis served as a competitive ligand for the receptor (Mac-1) necessary for fungal recognition and neutrophil-mediated killing. This inhibitory function of heparan sulfate, confirmed through several approaches, provides the first evidence to explain the lack of antifungal immune reactivity during vaginal candidiasis. This finding paves the way for design of therapeutic strategies to reduce/eliminate symptomatic vaginal candidiasis and restore quality of life to those affected. Copyright © 2017 Yano et al.

Quantitative analysis of the extensional tectonics of Tharsis bulge, Mars - Geodynamic implications

NASA Astrophysics Data System (ADS)

Thomas, P. G.; Allemand, P.

1993-07-01

The amount of horizontal strain on the Martian Tharsis bulge is quantified in order to provide further information on the tectonic evolution of this province. About 10 percent of the Tharsis surface bulge exhibits elliptical impact craters, which are the largest strain markers in the solar system. It is shown that these strain ellipses indicate more strain than could be due to the bulge building alone. The existence of such intensely deformed areas, the direction of the extensive strain, the localization of these areas on the bulge crest or on the top of topographic slopes, and the evidence of nonthinned crust under these areas may all be explained by gravitational slidings of the bulge surface over the topographic slope. This sliding would be possible because of the presence of a decollement level two kilometers below the surface, and because of the prefracturation which have made the detachment possible.

River bulge evolution and dynamics in a non-tidal sea - Daugava River plume in the Gulf of Riga, Baltic Sea

NASA Astrophysics Data System (ADS)

Soosaar, Edith; Maljutenko, Ilja; Uiboupin, Rivo; Skudra, Maris; Raudsepp, Urmas

2016-03-01

Satellite remote sensing imagery and numerical modelling were used for the study of river bulge evolution and dynamics in a non-tidal sea, the Gulf of Riga (GoR) in the Baltic Sea. Total suspended matter (TSM) images showed a clearly formed anti-cyclonically rotating river bulge from Daugava River discharge during the studied low wind period. In about 7-8 days the bulge grew up to 20 km in diameter, before being diluted. A high-resolution (horizontal grid step of 125 m) General Estuarine Transport Model (GETM) was used for detailed description of the development of the river plume in the southern GoR over the period when satellite images were acquired. In the model simulation, the bulge growth rate was estimated as rb ˜ t0.5 ± 0.04 (R2 = 0.90). Both the model simulation and the satellite images showed that river water was mainly contained in the bulge and there were numerous intrusions at the outer perimeter of the bulge. We performed numerical sensitivity tests with actual bathymetry and measured river runoff without wind forcing (1) having an initial three-dimensional density distribution, and (2) using initially a homogeneous ambient density field. In the first case, the anti-cyclonic bulge did not develop within the course of the model simulation and the coastal current was kept offshore due to ambient density-driven circulation. In the second case, the river plume developed steadily into an anti-cyclonically recirculating bulge, with rb ˜ t0.28 ± 0.01 (R2 = 0.98), and a coastal current. Additional simulations with constant cross-shore and alongshore winds showed a significant effect of the wind in the evolution of the river bulge, even if the wind speed was moderate (3-4 m s-1). While previous studies conclude that the mid-field bulge region is governed by a balance between centrifugal, Coriolis and pressure gradient terms, our study showed that geostrophic balance is valid for the entire mid-field of the bulge, except during the 1-1.5 rotation period at the beginning of the bulge formation. In addition, while there is discharge into the homogenous GoR in the case of a high inflow Rossby number, the river inflow might split into two jets, with strong mixing zone in-between, in the plume near-field region.

The role of periodically varying discharge on river plume structure and transport

NASA Astrophysics Data System (ADS)

Yuan, Yeping; Horner-Devine, Alexander R.; Avener, Margaret; Bevan, Shaun

2018-04-01

We present results from laboratory experiments that simulate the effects of periodically varying discharge on buoyant coastal plumes. Freshwater is discharged into a two meter diameter tank filled with saltwater on a rotating table. The mean inflow rate, tank rotation period and density of the ambient salt water are varied to simulate a range of inflow Froude and Rossby numbers. The amplitude and the period of the inflow modulation are varied across a range that simulates variability due to tides and storms. Using the optical thickness method, we measure the width and depth of the plume, plume volume and freshwater retention rate in the plume. With constant discharge, freshwater is retained in a growing anticyclonic bulge circulation near the river mouth, as observed in previous studies. When the discharge is varied, the bulge geometry oscillates between a circular plume structure that extends mainly in the offshore direction, and a compressed plume structure that extends mainly in the alongshore direction. The oscillations result in periodic variations in the width and depth of the bulge and the incidence angle formed where the bulge flow re-attaches with the coastal wall. The oscillations are more pronounced for longer modulation periods, but are relatively insensitive to the modulation amplitude. A phase difference between the time varying transport within the bulge and bulge geometry determines the fraction of the bulge flow discharged into the coastal current. As a result, the modulation period determines the variations in amount of freshwater that returns to the bulge. Freshwater retention in the bulge is increased in longer modulation periods and more pronounced for larger modulation amplitudes.

Hair Follicle Bulge Stem Cells Appear Dispensable for the Acute Phase of Wound Re-epithelialization.

PubMed

Garcin, Clare L; Ansell, David M; Headon, Denis J; Paus, Ralf; Hardman, Matthew J

2016-05-01

The cutaneous healing response has evolved to occur rapidly, in order to minimize infection and to re-establish epithelial homeostasis. Rapid healing is achieved through complex coordination of multiple cell types, which importantly includes specific cell populations within the hair follicle (HF). Under physiological conditions, the epithelial compartments of HF and interfollicular epidermis remain discrete, with K15(+ve) bulge stem cells contributing progeny for HF reconstruction during the hair cycle and as a basis for hair shaft production during anagen. Only upon wounding do HF cells migrate from the follicle to contribute to the neo-epidermis. However, the identity of the first-responding cells, and in particular whether this process involves a direct contribution of K15(+ve) bulge cells to the early stage of epidermal wound repair remains unclear. Here we demonstrate that epidermal injury in murine skin does not induce bulge activation during early epidermal wound repair. Specifically, bulge cells of uninjured HFs neither proliferate nor appear to migrate out of the bulge niche upon epidermal wounding. In support of these observations, Diphtheria toxin-mediated partial ablation of K15(+ve) bulge cells fails to delay wound healing. Our data suggest that bulge cells only respond to epidermal wounding during later stages of repair. We discuss that this response may have evolved as a protective safeguarding mechanism against bulge stem cell exhaust and tumorigenesis. Stem Cells 2016;34:1377-1385. © 2016 The Authors. Stem Cells published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

Technique and outcomes of laparoscopic bulge repair after abdominal free flap reconstruction.

PubMed

Lee, Johnson C; Whipple, Lauren A; Binetti, Brian; Singh, T Paul; Agag, Richard

2016-01-21

Bulges and hernias after abdominal free flap surgery are uncommon with rates ranging from as low as 0-36%. In the free flap breast reconstruction population, there are no clear guidelines or optimal strategies to treating postoperative bulges. We describe our minimally invasive technique and outcomes in managing bulge complications in abdominal free flap breast reconstruction patients. A retrospective review was performed on all abdominal free flap breast reconstruction patients at Albany Medical Center from 2011 to 2014. All patients with bulges on clinical exam underwent abdominal CT imaging prior to consultation with a minimally invasive surgeon. Confirmed symptomatic bulges were repaired laparoscopically and patients were monitored regularly in the outpatient setting. Sixty-two patients received a total of 80 abdominal free flap breast reconstructions. Flap types included 41 deep inferior epigastric perforator (DIEP), 36 muscle-sparing transverse rectus abdominus myocutaneous (msTRAM), 2 superficial inferior epigastric artery, and 1 transverse rectus abdominus myocutaneous flap. There were a total of 9 (14.5%) bulge complications, with the majority of patients having undergone msTRAM or DIEP reconstruction. There were no complications, revisions, or recurrences from laparoscopic bulge repair after an average follow-up of 181 days. Although uncommon, bulge formation after abdominal free flap reconstruction can create significant morbidity to patients. Laproscopic hernia repair using composite mesh underlay offers an alternative to traditional open hernia repair and can be successfully used to minimize scarring, infection, and pain to free flap patients who have already undergone significant reconstructive procedures. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2016 Wiley Periodicals, Inc.

Galaxies Grow Their Bulges and Black Holes in Diverse Ways

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bell, Eric F.; Harmsen, Benjamin; D’Souza, Richard

Galaxies with Milky Way–like stellar masses have a wide range of bulge and black hole masses; in turn, these correlate with other properties such as star formation history. While many processes may drive bulge formation, major and minor mergers are expected to play a crucial role. Stellar halos offer a novel and robust measurement of galactic merger history; cosmologically motivated models predict that mergers with larger satellites produce more massive, higher-metallicity stellar halos, reproducing the recently observed stellar halo metallicity–mass relation. We quantify the relationship between stellar halo mass and bulge or black hole prominence using a sample of 18more » Milky Way-mass galaxies with newly available measurements of (or limits on) stellar halo properties. There is an order of magnitude range in bulge mass, and two orders of magnitude in black hole mass, at a given stellar halo mass (or, equivalently, merger history). Galaxies with low-mass bulges show a wide range of quiet merger histories, implying formation mechanisms that do not require intense merging activity. Galaxies with massive “classical” bulges and central black holes also show a wide range of merger histories. While three of these galaxies have massive stellar halos consistent with a merger origin, two do not—merging appears to have had little impact on making these two massive “classical” bulges. Such galaxies may be ideal laboratories to study massive bulge formation through pathways such as early gas-rich accretion, violent disk instabilities, or misaligned infall of gas throughout cosmic time.« less

Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis

PubMed Central

2011-01-01

Background Clinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women. Methods We conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms. Results Of the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI. Conclusions Clinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI. PMID:21985418

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ryde, N.; Schultheis, M.; Grieco, V.

The structure, formation, and evolution of the Milky Way bulge is a matter of debate. Important diagnostics for discriminating between models of bulge formation and evolution include α-abundance trends with metallicity, and spatial abundance and metallicity gradients. Due to the severe optical extinction in the inner Bulge region, only a few detailed investigations of this region have been performed. Here we aim at investigating the inner 2 degrees of the Bulge (projected galactocentric distance of approximately 300 pc), rarely investigated before, by observing the [α/Fe] element trends versus metallicity, and by trying to derive the metallicity gradient in the bmore » < 2° region. [α/Fe] and metallicities have been determined by spectral synthesis of 2 μm spectra of 28 M-giants in the Bulge, lying along the southern minor axis at (l, b) = (0, 0), (0, −1°), and (0, −2°). These were observed with the CRIRES spectrometer at the Very Large Telescope, (VLT) at high spectral resolution. Low-resolution K-band spectra, observed with the ISAAC spectrometer at the VLT, are used to determine the effective temperature of the stars. We present the first connection between the Galactic center (GC) and the Bulge using similar stars, high spectral resolution, and analysis techniques. The [α/Fe] trends in all our three fields show a large similarity among each other and with trends further out in the Bulge. All point to a rapid star formation episode in the Bulge. We find that there is a lack of an [α/Fe] gradient in the Bulge all the way into the center, suggesting a homogeneous Bulge when it comes to the enrichment process and star formation history. We find a large range of metallicities from −1.2 < [Fe/H] < +0.3, with a lower dispersion in the GC: −0.2 < [Fe/H] < +0.3. The derived metallicities of the stars in the three fields get, in the mean, progressively higher the closer to the Galactic plane they lie. We could interpret this as a continuation of the metallicity gradient established further out in the Bulge, but due to the low number of stars and possible selection effects, more data of the same sort as presented here is necessary to conclude on the inner metallicity gradient from our data alone. Our results firmly argue for the center being in the context of the Bulge rather than very distinct.« less

River bulge evolution and dynamics in a non-tidal sea - Daugava River plume in the Gulf of Riga, Baltic Sea

NASA Astrophysics Data System (ADS)

Soosaar, E.; Maljutenko, I.; Uiboupin, R.; Skudra, M.; Raudsepp, U.

2015-10-01

Satellite remote sensing imagery and numerical modelling were used for the study of river bulge evolution and dynamics in a non-tidal sea, the Gulf of Riga (GoR) in the Baltic Sea. Total suspended matter (TSM) images showed a clearly formed anti-cyclonically rotating river bulge from Daugava River discharge during the studied low wind period. In about 7-8 days the bulge grew up to 20 km in diameter, before being diluted. Bulge growth rate was estimated as rb ~ t 0.31± 0.23 (R2 = 0.87). A high resolution (horizontal grid step of 125 m) General Estuarine Transport Model (GETM) was used for detailed description of the development of the river plume in the southern GoR over the period when satellite images were acquired. In the model simulation, the rb ~ t 0.5± 0.04 (R2 = 0.90). Both the model simulation and the satellite images showed that river water was mainly contained in the bulge and there were numerous intrusions at the outer perimeter of the bulge. We made numerical sensitivity tests with actual bathymetry and measured river runoff without wind forcing: (1) having initial 3-dimensional density distribution, (2) using initially a homogeneous ambient density field. In the first case, the anti-cyclonic bulge did not develop within the course of the model simulation and coastal current was kept offshore due to ambient density-driven circulation. In the second case, the river plume developed steadily into an anti-cyclonically recirculating bulge and a coastal current. This showed a significant effect of the wind in the evolution of the river bulge, even if the wind speed was moderate (3-4 m s-1). In the second case, rb ~ t 0.28± 0.01 (R2 = 0.98). While previous studies conclude that mid-field bulge region is governed by balance between centrifugal, Coriolis and pressure gradient terms, our study showed that geostrophic balance is valid for the entire mid-field of the bulge. In addition, while there is discharge into the homogenous GoR in case of high inflow Rossby number, the river inflow might split into two jets, with strong mixing zone in-between, in the plume near field region.

A New Population of Galactic Bulge Planetary Nebulas

NASA Astrophysics Data System (ADS)

Stenborg, T. N.

A new population of Galactic bulge planetary nebulas is presented. Nebula candidates were discovered by systematically reviewing archival [OIII] on/off band survey imaging of the central -5° ≤ l ≤ 5°, -5° ≤ b ≤ 5° region around the Galactic centre. An image segmentation and interleaving scheme was developed to facilitate this review. The resultant candidates (> 200) were then double checked against complementary archival Hα sky survey data to screen for obvious planetary nebula (PN) mimics or spurious image artefacts. Confirmatory spectroscopy of the PN candidates was pursued with thin slit, fibre multiobject and wide field spectrographs. Custom software was built to streamline interfacing with third-party spectroscopic management tools and a parallel greedy set cover algorithm implemented for efficient field selection in constrained multi-object observations. The combined imaging and spectroscopic evidence yielded true (4), probable (31) and possible (83) PNs toward the bulge. Secondary discoveries such as new PN mimics and late type stars were by-products of the confirmatory spectroscopy. Instances of literature PN duplication encountered during the investigation were noticed and documented. Spectral analysis of new PNs, including those obtained with a new optimised sky subtraction technique devised and demonstrated here, provided diagnostic data allowing radial velocity and Balmer decrement determination. Using a combined diameter and radial velocity criterion, bona fide bulge PNs were distinguished from new foreground PNs. Where Balmer decrements were available for new bulge PNs, differential aperture photometry was used to provide a modest data increment to Galactic bulge planetary nebula luminosity function (PNLF). The PNLF was revised with data from some new bulge PNs, but more significantly, by a series of corrections to the data derived from previously known bulge PNs (~225), such as improved filter transmission effects, statistically justified binning and application of a uniform bulge-relevant extinction law. The result was the most rigorous bulge PNLF to date. An improvement on the legacy PNLF, the revised PNLF exhibited a form inconsistent with typical extragalactic examples, an expected result of the unusual extinction correction method used to address bulge-specific observational limitations. Issues restricting the accuracy of the bulge PNLF were identified. Until those restrictions are ameliorated, the utility of the PNLF in aiding physical understanding of its constituent members or their progenitors cannot be realised.

The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe.

PubMed

DiBonaventura, Marco; Luo, Xuemei; Moffatt, Margaret; Bushmakin, Andrew G; Kumar, Maya; Bobula, Joel

2015-09-01

Vulvovaginal atrophy (VVA) is a condition associated with decreased estrogenization of the vaginal tissue, which can result in vaginal dryness, irritation, and dyspareunia. This study quantified the burden associated with VVA symptoms across the United States and Europe and compared this burden with other chronic conditions. Data were analyzed from the International Women's Health Study, a cross-sectional Internet survey of women aged 40-75 years in the United States and Europe. All postmenopausal women aged 40-75 years were included in the analyses (Germany n=970, Spain n=294, France n=1054, Italy n=387, United Kingdom n=1096, United States n=3267). VVA symptom severity (none, mild, moderate, severe) was assessed using the Menopause Rating Scale and included in general linear models to predict EuroQol-5D (EQ-5D) quality of life scores. The prevalence of VVA symptoms varied between 40.00% (Germany) and 54.42% (Spain), with half of women reporting their symptoms as either moderate or severe. Pooling data from all countries together, each incremental level of severity (none through severe) was associated with a significant decrement in EQ-5D scores (none=0.84 vs. mild=0.81 vs. moderate=0.79 vs. severe=0.74; p<0.05). The decrements in EQ-5D scores associated with moderate to severe VVA symptoms were comparable to those observed in other serious conditions including arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. VVA symptoms are associated with clinically meaningful decrements in quality of life that may be comparable to serious conditions such as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Improved management of VVA symptoms may be required to alleviate the impact of VVA on the quality of life of affected women.

Metallicity-dependent kinematics and morphology of the Milky Way bulge

NASA Astrophysics Data System (ADS)

Athanassoula, E.; Rodionov, S. A.; Prantzos, N.

2017-05-01

We use N-body chemo-dynamic simulations to study the coupling between morphology, kinematics and metallicity of the bar/bulge region of our Galaxy. We make qualitative comparisons of our results with available observations and find very good agreement. We conclude that this region is complex, since it comprises several stellar components with different properties - I.e. a boxy/peanut bulge, thin and thick disc components, and, to lesser extents, a disky pseudo-bulge, a stellar halo and a small classical bulge - all cohabiting in dynamical equilibrium. Our models show strong links between kinematics and metallicity, or morphology and metallicity, as already suggested by a number of recent observations. We discuss and explain these links.

The influence of childbirth experiences on women׳s postpartum traumatic stress symptoms: A comparison between Israeli Jewish and Arab women.

PubMed

Halperin, Ofra; Sarid, Orly; Cwikel, Julie

2015-06-01

childbirth is a positive experience for most women yet some women express distress after birth. Traumatic experience can sometimes cause post-traumatic stress disorder (PTSD) in relation to childbirth. Prevalence of traumatic birth experience and PTSD after childbirth differs between cultures. to examine the subjective recall of childbirth experiences and PTSD symptoms of Israeli Jewish and Arab women; to examine comparatively the prevalence of PTSD symptoms six to eight weeks after childbirth and to establish the factors that predict PTSD symptoms. a prospective study was conducted in a region characterised by wide variations in ethnocultural groups. The study was comprised of two time points: Time 1 (T1) interviews were conducted at the bedside of the women in the maternity ward of each hospital 24-48 hours after childbirth. Time 2 (T2), all 171 women participating in T1 were interviewed by phone six to eight weeks after childbirth. 34 women (19.9%) reported their labour as traumatic 24-48 hours after birth (T1), and six to eight weeks later (T2) 67 women (39.2%) assessed their experience as traumatic. More Arab women (69.6%) than Jewish women (56.5%) had a positive memory of childbirth, but this difference only approached statistical significance (p=.09). Results showed rather low frequencies of PTSD symptoms, and no ethnic difference. PTSD symptoms were significantly and positively predicted by subjective recollection of childbirth experience (Time 2). PTSD symptoms were higher for women who did not have a vaginal birth, and more women with PTSD symptoms were not breast feeding. we found more similarities than differences between Arab and Jewish women׳s experience of their births and no differences between them on the prevalence of PTSD symptoms after birth. The results suggest that non-vaginal birth (instrumental or caesarean section) and negative recollection of the childbirth experience are important factors related to the development of PTSD symptoms after birth, and that women with PTSD symptoms are less likely to breast feed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Post-traumatic female urethral reconstruction.

PubMed

Blaivas, Jerry G; Purohit, Rajveer S

2008-09-01

Post-traumatic urethral damage resulting in urethrovaginal fistulas or strictures, though rare, should be suspected in patients who have unexpected urinary incontinence or lower urinary tract symptoms after pelvic surgery, pelvic fracture, a long-term indwelling urethral catheter, or pelvic radiation. Careful physical examination and cystourethroscopy are critical to diagnose and assess the extent of the fistula. A concomitant vesicovaginal or ureterovaginal fistula should also be ruled out. The two main indications for reconstruction are sphincteric incontinence and urethral obstruction. Surgical correction intends to create a continent urethra that permits volitional, painless, and unobstructed passage of urine. An autologous pubovaginal sling, with or without a Martius flap at time of reconstruction, should be considered. The three approaches to urethral reconstruction are anterior bladder flaps, posterior bladder flaps, and vaginal wall flaps. We believe vaginal flaps are usually the best option. Options for vaginal repair of fistula include primary closure, peninsula flaps, bilateral labial pedicle flaps, and labial island flaps. Outcomes are optimized by using exacting surgical principles during repair and careful postoperative management by an experienced reconstructive surgeon.

[Use of probiotics in bacterial vaginosis].

PubMed

Mur Pérez, A M; Mateo Segura, Z; Ramírez Domínguez, N; Vela Condón, P

Bacterial vaginosis (BV) is a change in the vaginal microbiota due to bacterial overgrowth of normal microorganisms, which produces symptoms of vaginal discomfort, increased malodorous vaginal discharge, etc. Although they been seen to improve recurrence rates in clinical practice, the role of probiotics is questioned in these situations. A literature review on BV is presented in order to evaluate the effectiveness of using probiotics as adjuvant therapy in BV. PubMed, Cochrane and SCOPUS review of the last 5 years publications using probiotics to treat women diagnosed with BV. An analysis was performed on the 10 items that refer to the use of probiotics in addition to antibiotic treatments. All items conclude that the use of probiotics is beneficial in cases of BV in addition to conventional treatments. However, the conclusions are not categorical due to there being a wide variety of studies and probiotics used. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Abdominopelvic kinesiotherapy for pelvic floor muscle training: a tested proposal in different groups.

PubMed

Botelho, Simone; Martinho, Natalia Miguel; Silva, Valéria Regina; Marques, Joseane; Alves, Fabiola Kenia; Riccetto, Cássio

2015-12-01

This video's proposal was to present one of the pelvic floor muscle (PFM) training programs used in our research, and to study the effects of abdominopelvic kinesiotherapy on female PFM function. A total of 82 women participated in this study, 11 nulliparous, 13 primiparous pregnant, 20 primiparous postpartum and 38 postmenopausal women, who were evaluated first by digital palpation, then by either electromyography or vaginal dynamometry to investigate their PFM strength, followed by ICIQ UI-SF and ICIQ-OAB to evaluate urinary symptoms. This intervention protocol lasted for 60 min, three times a week, with a total of 10 sessions, and was supervised by a physiotherapist, using a gym ball, according to Marques and collaborators. A significant increase in PFM strength was observed by digital palpation in all groups. This finding was confirmed by electromyography in both pregnant (p = 0.0001) and postpartum (p = 0.0001) groups, as well as in 20 of the 38 women from the postmenopausal group (p = 0.003) then by vaginal dynamometry (p = 0.02) in the rest of the women (18) from the same group, with a concomitant decrease in urinary symptoms (p < 0.05). The abdominopelvic kinesiotherapy program promotes an increase in pelvic floor muscle strength and a decrease in urinary symptoms.

Foreign Body in the Vagina of A Four-Year-Old-Girl: A Childish Prank or Sexual Abuse

PubMed Central

Sakhavar, Nahid; Teimoori, Batool; Ghasemi, Marzie

2014-01-01

Introduction: Foreign body in the vagina is a common cause of vaginal discharge, which may be either purulent or hemorrhagic. Case Presentation: This problem may produce symptoms or be asymptomatic for long periods of time and may result from ignorance, accident, malice, psychotic tendencies, attempts at sexual stimulation or sexual abuse. The current report presents the case of a girl that had inserted a foreign body in her vagina probably due to childish prank. Conclusions: The clinicians should always think of foreign bodies in the vagina in cases of chronic, antibiotic resistant vaginal discharge and lower abdominal pain especially in young girls. PMID:25032156

Wilms Tumor With Metastasis to the Vagina: A Case Report.

PubMed

Howe, Adam S; Morganstern, Bradley A; Appelbaum, Heather; Mehta, Sandeep; Palmer, Lane S

2017-03-01

A 12-year-old female presented with abdominal pain, night sweats, weight loss, constipation, dysmenorrhea, menorrhagia, and vaginal discharge. Examination revealed a palpable flank mass and a large tumor adherent to the anterior vaginal wall. Computed tomography scan demonstrated a 23 cm mass in the left kidney, a separate 10.8 cm pelvic mass, and metastatic disease. Biopsies were consistent with Wilms tumor. Neoadjuvant chemotherapy and a left radical nephrectomy were performed for her stage IV disease as the kidney was amiable to complete resection. The patient received radiation and resumed chemotherapy. She was doing well with improved symptoms at follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.

Human platelet lysate versus minoxidil stimulates hair growth by activating anagen promoting signaling pathways.

PubMed

Dastan, Maryam; Najafzadeh, Nowruz; Abedelahi, Ali; Sarvi, Mohammadreza; Niapour, Ali

2016-12-01

Minoxidil and human platelet lysate (HPL) are commonly used to treat patients with hair loss. However, the roles of HPL versus minoxidil in hair follicle biology largely remain unknown. Here, we hypothesized that bulge and dermal papilla (DP) cells may express specific genes, including Kras, Erk, Akt, Shh and β-catenin after exposure to minoxidil or HPL. The mouse hair follicles were isolated on day 10 after depilation and bulge or DP regions were dissected. The bulge and DP cells were cultured for 14days in DMEM/F12 medium. Then, the cells were treated with 100μM minoxidil and 10% HPL for 10 days. Nuclear morphology was identified using DAPi staining. Reverse transcriptase and real-time polymerase chain reaction (PCR) analysis were also performed to examine the expression of Kras, Erk, Akt, Shh and β-catenin mRNA levels in the treated bulge and DP regions after organ culture. Here, we found that minoxidil influences bulge and DP cell survival (P<0.05). Apoptosis in DP cells was also meaningfully decreased by HPL treatment (P=0.014). In addition, Kras, Akt, Erk, Shh and β-catenin mRNA levels were changed in response to minoxidil treatment in both bulge and DP cells. HPL mediated Erk upregulation in both bulge and DP cells (P<0.05), but Kras and Akt mRNA levels were not considerably different in the HPL-treated cells. β-catenin mRNA level was also significantly increased in the bulge region by HPL. We also found that Shh mRNA level was considerably higher in HPL-treated bulge cells than in minoxidil-treated bulge cells. In contrast, the expression of β-cateinin and Shh in the DP cells was not meaningfully increased after treatment with HPL. Our results suggest that minoxidil and HPL can promote hair growth by activating the main anagen inducing signaling pathways. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Abundances of disk and bulge giants from high-resolution optical spectra. II. O, Mg, Ca, and Ti in the bulge sample

NASA Astrophysics Data System (ADS)

Jönsson, H.; Ryde, N.; Schultheis, M.; Zoccali, M.

2017-02-01

Context. Determining elemental abundances of bulge stars can, via chemical evolution modeling, help to understand the formation and evolution of the bulge. Recently there have been claims both for and against the bulge having a different [α/Fe] versus [Fe/H] trend as compared to the local thick disk. This could possibly indicate a faster, or at least different, formation timescale of the bulge as compared to the local thick disk. Aims: We aim to determine the abundances of oxygen, magnesium, calcium, and titanium in a sample of 46 bulge K giants, 35 of which have been analyzed for oxygen and magnesium in previous works, and compare this sample to homogeneously determined elemental abundances of a local disk sample of 291 K giants. Methods: We used spectral synthesis to determine both the stellar parameters and elemental abundances of the bulge stars analyzed here. We used the exact same method that we used to analyze the comparison sample of 291 local K giants in Paper I of this series. Results: Compared to the previous analysis of the 35 stars in our sample, we find lower [Mg/Fe] for [Fe/H] >-0.5, and therefore contradict the conclusion about a declining [O/Mg] for increasing [Fe/H]. We instead see a constant [O/Mg] over all the observed [Fe/H] in the bulge. Furthermore, we find no evidence for a different behavior of the alpha-iron trends in the bulge as compared to the local thick disk from our two samples. Note to the reader: following the publication of the corrigendum, the subtitle of the article was corrected on April 6, 2017. "O, Mg, Co, and Ti" has been replaced by "O, Mg, Ca, and Ti".Based on observations collected at the European Southern Observatory, Chile (ESO programs 71.B-0617(A), 073.B-0074(A), and 085.B-0552(A)).

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vaghmare, Kaustubh; Kembhavi, Ajit; Barway, Sudhanshu, E-mail: kaustubh@iucaa.ernet.in, E-mail: akk@iucaa.ernet.in, E-mail: barway@saao.ac.za

In this Letter, we present a systematic study of lenticular (S0) galaxies based on mid-infrared imaging data on 185 objects taken using the Spitzer Infrared Array Camera. We identify the S0s hosting pseudobulges based on the position of the bulge on the Kormendy diagram and the Sersic index of the bulge. We find that pseudobulges preferentially occur in the fainter luminosity class (defined as having total K-band absolute magnitude M{sub K} fainter than -22.66 in the AB system). We present relations between bulge and disk parameters obtained as a function of the bulge type. The disks in the pseudobulge hostingmore » galaxies are found to have distinct trends on the r{sub e}-r{sub d} and {mu}{sub d}(0)-r{sub d} correlations compared to those in galaxies with classical bulges. We show that the disks of pseudobulge hosts possess on average a smaller scale length and have a fainter central surface brightness than their counterparts occurring in classical bulge hosting galaxies. The differences found for discs in pseudobulge and classical bulge hosting galaxies may be a consequence of the different processes creating the central mass concentrations.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oohama, N.; Okamura, S.; Fukugita, M.

A bulge-disk decomposition is made for 737 spiral and lenticular galaxies drawn from a Sloan Digital Sky Survey galaxy sample for which morphological types are estimated. We carry out the bulge-disk decomposition using the growth curve fitting method. It is found that bulge properties, effective radius, effective surface brightness, and also absolute magnitude, change systematically with the morphological sequence; from early to late types, the size becomes somewhat larger, and surface brightness and luminosity fainter. In contrast, disks are nearly universal, their properties remaining similar among disk galaxies irrespective of detailed morphologies from S0 to Sc. While these tendencies weremore » often discussed in previous studies, the present study confirms them based on a large homogeneous magnitude-limited field galaxy sample with morphological types estimated. The systematic change of bulge-to-total luminosity ratio, B/T, along the morphological sequence is therefore not caused by disks but mostly by bulges. It is also shown that elliptical galaxies and bulges of spiral galaxies are unlikely to be in a single sequence. We infer the stellar mass density (in units of the critical mass density) to be OMEGA = 0.0021 for spheroids, i.e., elliptical galaxies plus bulges of spiral galaxies, and OMEGA = 0.00081 for disks.« less

Gauging the Helium Abundance of the Galactic Bulge RR Lyrae Stars

NASA Astrophysics Data System (ADS)

Marconi, Marcella; Minniti, Dante

2018-02-01

We report the first estimate of the He abundance of the population of RR Lyrae stars in the Galactic bulge. This is done by comparing the recent observational data with the latest models. We use the large samples of ab-type RR Lyrae stars found by OGLE IV in the inner bulge and by the VVV survey in the outer bulge. We present the result from the new models computed by Marconi et al., showing that the minimum period for fundamental RR Lyrae pulsators depends on the He content. By comparing these models with the observations in a period versus effective temperature plane, we find that the bulk of the bulge ab-type RR Lyrae are consistent with primordial He abundance Y = 0.245, ruling out a significant He-enriched population. This work demonstrates that the He content of the bulge RR Lyrae is different from that of the bulk of the bulge population as traced by the red clump giants that appear to be significantly more He-rich. Based on observations collected at the European Organisation for Astronomical Research in the Southern Hemisphere under ESO programmes 179.B-2002 and 298.D-5048.

Teetering near the edge; women's experiences of anal incontinence following obstetric anal sphincter injury: an interpretive phenomenological research study.

PubMed

Tucker, Julie; Clifton, Vicki; Wilson, Anne

2014-08-01

Obstetric anal sphincter injury (OASIS) following vaginal delivery increases the risk of anal incontinence (AI). Subsequent vaginal delivery and ageing increase the risk of worsening symptoms. Very little literature describes any in-depth understanding of what it is like to live with AI following a history of known OASIS. To describe and interpret women's experience of AI following OASIS and its impact on quality of life. An interpretive phenomenological study was conducted in a level 2 tertiary hospital in South Australia. Women with a history of OASIS and AI were purposefully recruited. The St Marks Vaizey score was utilised to identify symptom severity. Semi-structured open-ended interviews were conducted, and data were analysed utilising Van Manen thematic analysis. Participants (n = 10) aged 26-56 years. All women were symptomatic of AI following OASIS, and 80% had received a primary OASIS at their first vaginal delivery. The St Marks Vaizey score mean was 9.1 (range within 4-22). Three essential themes grieving for loss, silence, striving for normality with eight subthemes identified a significant sense of loss and psychological impact of AI for this group of women. Health professionals require a greater understanding of the negative impact of OASIS and AI on women's quality of life. This may improve the management, education and clinical care of this condition which may result as a consequence of OASIS. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial

PubMed Central

Pirotta, Marie; Gunn, Jane; Chondros, Patty; Grover, Sonia; O'Malley, Paula; Hurley, Susan; Garland, Suzanne

2004-01-01

Objective To test whether oral or vaginal lactobacillus can prevent vulvovaginitis after antibiotic treatment. Design Randomised, placebo controlled, double blind, factorial 2×2 trial. Setting Fifty general practices and 16 pharmacies in Melbourne, Australia. Participants Non-pregnant women aged 18-50 years who required a short course of oral antibiotics for a non-gynaecological infection: 278 were enrolled in the study, and results were available for 235. Interventions Lactobacillus preparations taken orally or vaginally, or both, from enrolment until four days after completion of their antibiotic course. Main outcome measures Participants' reports of symptoms of post-antibiotic vulvovaginitis, with microbiological evidence of candidiasis provided by a self obtained vaginal swab. Results Overall, 55/235 (23% (95% confidence interval 18% to 29%)) women developed post-antibiotic vulvovaginitis. Compared with placebo, the odds ratio for developing post-antibiotic vulvovaginitis with oral lactobacillus was 1.06 (95% confidence interval 0.58 to 1.94) and with vaginal lactobacillus 1.38 (0.75 to 2.54). Compliance with antibiotics and interventions was high. The trial was terminated after the second interim analysis because of lack of effect of the interventions. Given the data at this time, the chances of detecting a significant reduction in vulvovaginitis with oral or vaginal lactobacillus treatment were less than 0.032 and 0.0006 respectively if the trial proceeded to full enrolment. Conclusions The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results. Further research on this subject is unlikely to be fruitful, unless new understandings about the pathogenesis of post-antibiotic vulvovaginitis indicate a possible role for lactobacillus. PMID:15333452

Effect of fennel vaginal cream on sexual function in postmenopausal women: A double blind randomized controlled trial

PubMed Central

Abedi, Parvin; Najafian, Mahin; Yaralizadeh, Masumeh; Namjoyan, Foroogh

2018-01-01

Objective: The aim of this study was to assess the effect of fennel on sexual function in postmenopausal women. It was a randomized controlled trial in 60 postmenopausal women with sexual dysfunction who were randomly assigned to two groups receiving either fennel vaginal cream (n=30) or placebo (n=30). Vaginal atrophy in the women was assessed using symptoms such as pallor, dryness, dyspareunia, itching and burning. The pH of the vagina and cytology of the vaginal mucosa were also measured at baseline and 8 weeks after the intervention. All participants were requested to fill out the Female Sexual Function Index (FSFI) at baseline and after 8 weeks. The intervention group was requested to use fennel vaginal cream (5 grams) every night, while the control group used placebo each night for 8 weeks. The data were analyzed using the independent t-test and Chi-square, Mann-Whitney and Wilcoxon tests. All areas of sexual function including arousal, lubrication, orgasm, sexual satisfaction and pain improved in both fennel and placebo groups after 8 weeks; however, the differences in the fennel group were more evident (p<0.05). The total FSFI score was significantly higher in the fennel group compared to the control group (8.2 ±9.4 and 8.03±10.36 before the intervention and changing to 33.79±0.7 and 18.99±1.09 after the intervention in the fennel and placebo groups, respectively; p<0.001). Discussion: According to our results, fennel vaginal cream is an effective means of improving sexual activity in postmenopausal women. The use of this product in women who have sexual dysfunction and contraindications for hormone therapy is recommended. PMID:29696061

Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study.

PubMed

de Tayrac, Renaud; Devoldere, Guy; Renaudie, Joël; Villard, Pierre; Guilbaud, Olivier; Eglin, Georges

2007-03-01

The aim of this study was to evaluate the anatomical and functional results of a low-weight polypropylene mesh coated with an absorbable film in prolapse surgery by vaginal route. We have conducted a prospective multicentre study in 13 gynaecological and urological units. There were 230 patients requiring repair for anterior or posterior vaginal prolapse included. The present report is based on the analysis of the first 143 patients evaluated after at least 10 months follow-up. All patients were operated by the vaginal route using a specially designed mesh (Ugytex, Sofradim, France). Prolapse severity were evaluated using the Pelvic Organ Prolapse staging system. Symptoms and quality of life were evaluated preoperatively and during follow-up using the validated Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) self-questionnaires. Mean age was 63 years (37-91). Anterior, posterior and anterior-posterior repair with the mesh were performed in 67 (46.9%), 11 (7.7%) and 65 (45.4%) patients, respectively. With a mean follow-up of 13 months (10-19), 132 patients were considered anatomically cured (92.3%) with a recurrence rate of 9 of 132 for cystocele (6.8%) and 2 of 76 for rectocele (2.6%). Nine vaginal erosions occurred (6.3%), six of them necessitated another procedure by simple excision. The rate of de novo dyspareunia was 12.8%. At follow-up, improvement of PFDI and PFIQ scores were highly significant (p<0.0001). The use of low-weight polypropylene mesh coated with a hydrophilic absorbable film for vaginal repair of genital prolapse seems to decrease local morbidity while maintaining low recurrence rates.

Frequency of anal sphincter rupture at delivery in Sweden and Finland--result of difference in manual help to the baby's head.

PubMed

Pirhonen, J P; Grenman, S E; Haadem, K; Gudmundsson, S; Lindqvist, P; Siihola, S; Erkkola, R U; Marsal, K

1998-11-01

Anal sphincter rupture is a serious complication of vaginal delivery and almost half the affected women have persistent defecatory symptoms despite adequate primary repair. During the past decade, the incidence of anal sphincter ruptures has been increasing in Sweden and is currently estimated to occur in 2.5% of vaginal deliveries. The aim of the study was to report the frequency of anal sphincter ruptures in two university hospitals in two Scandinavian countries, Malmö in Sweden and Turku in Finland, and analyze the potential determinants. Retrospective analysis of a population of 30,933 deliveries (26,541 vaginal) during the years 1990 to 1994. The incidence of anal sphincter ruptures in Malmö, Sweden was 2.69%, and in Turku, Finland 0.36%. There were no significant population differences for the known risk factors (fetal weight, nulliparity or fetal head circumference). However, there is a difference in manual support given to the perineum and to the baby's head when crowning through the vaginal introitus between Malmö and Turku. The proportion of operative vaginal deliveries and abnormal presentations was significantly higher in Turku reflected in the lower Apgar score at 5 minutes and longer duration of second phase of labor. When high risk deliveries (operative vaginal delivery, abnormal presentation and newborns over 4,000 g) were excluded, the risk for anal sphincter ruptures was estimated to be 13 times higher in Malmö than in Turku. The difference in the incidence of anal sphincter rupture between Malmö, Sweden and Turku, Finland may be due to the difference in manual control of the baby's head when crowning.

Clinical Characteristics of Patients Who Underwent Surgery for Genital Tract Malformations at Peking Union Medical College Hospital across 31 Years.

PubMed

Wang, Guang-Han; Zhu, Lan; Liu, Ai-Ming; Xu, Tao; Lang, Jing-He

2016-10-20

Female genital malformations represent miscellaneous deviations from normal anatomy. This study aimed to explore the clinical characteristics of patients who underwent surgery for genital tract malformations at Peking Union Medical College Hospital (PUMCH) during a 31-year period. We retrospectively reviewed surgical cases of congenital malformation of the female genital tract at PUMCH for a 31-year period, analyzed the clinical characteristics of 1634 hospitalized patients, and investigated their general condition, diagnosis, and treatment process. The average patient age was 27.6 ± 9.9 years. The average ages of patients who underwent surgery for uterine malformation and vaginal malformation were 31.9 ± 8.8 years and 24.7 ± 9.0 years, respectively; these ages differed significantly (P < 0.01). Among patients with genital tract malformation, the percentages of vaginal malformation, uterine malformation, vulva malformation, cervical malformation, and other malformations were 43.9%, 43.5%, 7.4%, 2.3%, and 2.8%, respectively. Among patients with uterine malformation, 34.5% underwent surgery for the genital tract malformation, whereas in patients with vaginal malformation, the proportion is 70.6%; the difference between the two groups was statistically significant (P < 0.01). The percentage of complications of the urinary system in patients with vaginal malformations was 10.2%, which was statistically significantly higher than that (5.3%) in patients with uterine malformations (P < 0.01). Compared to patients with uterine malformations, patients with vaginal malformations displayed more severe clinical symptoms, a younger surgical age, and a greater need for attention, early diagnosis, and treatment. Patients with genital tract malformations, particularly vaginal malformations, tend to have more complications of the urinary system and other malformations than patients with uterine malformations.

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. PMID:18297379

Effect of norfloxacin therapy for acute, uncomplicated lower urinary tract infection on vaginal Candida prevalence.

PubMed

Rocha, Rodrigo M; Zanni, Pâmela C M Delvas; de Souza Bonfim-Mendonça, Patrícia; Gimenes, Fabrícia; Alczuk, Silvia S Dantas; Svidzinski, Terezinha I Estivalet; Consolaro, Márcia E Lopes

2016-05-01

Acute uncomplicated lower urinary tract infections (UTI) and vulvovaginal candidiasis (VVC) both occur frequently in women. Although VVC is believed to commonly occur after antibiotic therapy, few studies have demonstrated this association. Thus, the aim of the study was to estimate the prevalence of colonization by Candida spp. and VVC after norfloxacin (NOR) use for UTI and the effects on the vaginal microbiota and inflammatory process. This was a prospective cohort study of women with culture-proven UTI who were treated with NOR (antibiotic group). The control group consisted of women with noninfectious diseases or in preventive care. Candida vaginal infections were monitored both clinically and mycologically at baseline and at the follow-up evaluation. All women showed UTI remission after NOR treatment, and no woman in either group, antibiotic and control, showed symptoms of VVC. Both groups showed similar ratios of a positive Candida culture at baseline (6.7 % and 12.8 %, respectively) and at follow-up (3.3 % and 8.5 %, respectively) (p = 0.2768 and p = 0.5035, respectively). The antibiotic group showed no increased risk of Candida colonization or VVC after NOR treatment compared with the control group [odds ratio (OR) 0.556, 95 % confidence interval (CI) 0.2407-10.05]. NOR was effective for UTI treatment, did not increase the risk of vaginal colonization by Candida or VVC, and did not lead to major disturbances of the vaginal microbiota.

Which Factors Contribute to False-Positive, False-Negative, and Invalid Results in Fetal Fibronectin Testing in Women with Symptoms of Preterm Labor?

PubMed

Bruijn, Merel M C; Hermans, Frederik J R; Vis, Jolande Y; Wilms, Femke F; Oudijk, Martijn A; Kwee, Anneke; Porath, Martina M; Oei, Guid; Scheepers, Hubertina C J; Spaanderman, Marc E A; Bloemenkamp, Kitty W M; Haak, Monique C; Bolte, Antoinette C; Vandenbussche, Frank P H A; Woiski, Mallory D; Bax, Caroline J; Cornette, Jérôme M J; Duvekot, Johannes J; Bijvank, Bas W A N I J; van Eyck, Jim; Franssen, Maureen T M; Sollie, Krystyna M; van der Post, Joris A M; Bossuyt, Patrick M M; Kok, Marjolein; Mol, Ben W J; van Baaren, Gert-Jan

2017-02-01

Objective  We assessed the influence of external factors on false-positive, false-negative, and invalid fibronectin results in the prediction of spontaneous delivery within 7 days. Methods  We studied symptomatic women between 24 and 34 weeks' gestational age. We performed uni- and multivariable logistic regression to estimate the effect of external factors (vaginal soap, digital examination, transvaginal sonography, sexual intercourse, vaginal bleeding) on the risk of false-positive, false-negative, and invalid results, using spontaneous delivery within 7 days as the outcome. Results  Out of 708 women, 237 (33%) had a false-positive result; none of the factors showed a significant association. Vaginal bleeding increased the proportion of positive fetal fibronectin (fFN) results, but was significantly associated with a lower risk of false-positive test results (odds ratio [OR], 0.22; 95% confidence intervals [CI], 0.12-0.39). Ten women (1%) had a false-negative result. None of the investigated factors was significantly associated with a significantly higher risk of false-negative results. Twenty-one tests (3%) were invalid; only vaginal bleeding showed a significant association (OR, 4.5; 95% CI, 1.7-12). Conclusion  The effect of external factors on the performance of qualitative fFN testing is limited, with vaginal bleeding as the only factor that reduces its validity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maximum density echogram analysis : a novel approach to study the characteristics of oblique echoes observed by MARSIS/Mars Express

NASA Astrophysics Data System (ADS)

P, M.; Narukull, V. R.; Rao, S. V. B.

2017-12-01

The ionograms of the Mars Advance Radar for Subsurface and Ionospheric Sounding (MARSIS) instrument aboard Mars Express spacecraft show vertical and oblique echoes from the Martian ionosphere. The vertical echoes are from the normal ionosphere while the oblique echoes are believed to be from ionization bulges that occur in regions of strong vertical magnetic fields. These oblique echoes appear as downward facing hyperbolas when plotted as radargram (at 1.9 MHz), which is a color coded plot of apparent altitude as a function of time at a single frequency. In order to extract further information from these ionization bulges, we considered the peak density of the oblique echoes and plotted them in a format similar to a radargram and called it as a 'maximum density radargram' (MDR). Thus, an MDR shows the peak densities in entire ionization bulge. This analysis revealed several new aspects of the ionization bulges. We found that there is an asymmetry in the ionization bulge so that the density on one side of the hyperbola is different than the other side. In some cases, the density on the same side of the hyperbola, between the edge and apex, changes. Occasionally, the radargrams show only one side of the hyperbola, while the MDRs show a full hyperbola. When the density structures are repeatedly observed over the same location with a few days interval, the MDR analysis shows that the density inside the bulge varies from one pass to another. Finally, the ionization bulges in the MDR displays are clearly observed on several nights. Several of these nighttime bulges were not apparent in radargram analysis. These observations are discussed in the light of current understanding on the ionization bulges.

VERY METAL-POOR STARS IN THE OUTER GALACTIC BULGE FOUND BY THE APOGEE SURVEY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Garcia Perez, Ana E.; Majewski, Steven R.; Hearty, Fred R.

2013-04-10

Despite its importance for understanding the nature of early stellar generations and for constraining Galactic bulge formation models, at present little is known about the metal-poor stellar content of the central Milky Way. This is a consequence of the great distances involved and intervening dust obscuration, which challenge optical studies. However, the Apache Point Observatory Galactic Evolution Experiment (APOGEE), a wide-area, multifiber, high-resolution spectroscopic survey within Sloan Digital Sky Survey III, is exploring the chemistry of all Galactic stellar populations at infrared wavelengths, with particular emphasis on the disk and the bulge. An automated spectral analysis of data on 2403more » giant stars in 12 fields in the bulge obtained during APOGEE commissioning yielded five stars with low metallicity ([Fe/H] {<=} -1.7), including two that are very metal-poor [Fe/H] {approx} -2.1 by bulge standards. Luminosity-based distance estimates place the 5 stars within the outer bulge, where 1246 of the other analyzed stars may reside. A manual reanalysis of the spectra verifies the low metallicities, and finds these stars to be enhanced in the {alpha}-elements O, Mg, and Si without significant {alpha}-pattern differences with other local halo or metal-weak thick-disk stars of similar metallicity, or even with other more metal-rich bulge stars. While neither the kinematics nor chemistry of these stars can yet definitively determine which, if any, are truly bulge members, rather than denizens of other populations co-located with the bulge, the newly identified stars reveal that the chemistry of metal-poor stars in the central Galaxy resembles that of metal-weak thick-disk stars at similar metallicity.« less

Bulge Growth and Quenching since z = 2.5 in CANDELS/3D-HST

NASA Astrophysics Data System (ADS)

Lang, Philipp; Wuyts, Stijn; Somerville, Rachel S.; Förster Schreiber, Natascha M.; Genzel, Reinhard; Bell, Eric F.; Brammer, Gabe; Dekel, Avishai; Faber, Sandra M.; Ferguson, Henry C.; Grogin, Norman A.; Kocevski, Dale D.; Koekemoer, Anton M.; Lutz, Dieter; McGrath, Elizabeth J.; Momcheva, Ivelina; Nelson, Erica J.; Primack, Joel R.; Rosario, David J.; Skelton, Rosalind E.; Tacconi, Linda J.; van Dokkum, Pieter G.; Whitaker, Katherine E.

2014-06-01

Exploiting the deep high-resolution imaging of all five CANDELS fields, and accurate redshift information provided by 3D-HST, we investigate the relation between structure and stellar populations for a mass-selected sample of 6764 galaxies above 1010 M ⊙, spanning the redshift range 0.5 < z < 2.5. For the first time, we fit two-dimensional models comprising a single Sérsic fit and two-component (i.e., bulge + disk) decompositions not only to the H-band light distributions, but also to the stellar mass maps reconstructed from resolved stellar population modeling. We confirm that the increased bulge prominence among quiescent galaxies, as reported previously based on rest-optical observations, remains in place when considering the distributions of stellar mass. Moreover, we observe an increase of the typical Sérsic index and bulge-to-total ratio (with median B/T reaching 40%-50%) among star-forming galaxies above 1011 M ⊙. Given that quenching for these most massive systems is likely to be imminent, our findings suggest that significant bulge growth precedes a departure from the star-forming main sequence. We demonstrate that the bulge mass (and ideally knowledge of the bulge and total mass) is a more reliable predictor of the star-forming versus quiescent state of a galaxy than the total stellar mass. The same trends are predicted by the state-of-the-art, semi-analytic model by Somerville et al. In this model, bulges and black holes grow hand in hand through merging and/or disk instabilities, and feedback from active galactic nuclei shuts off star formation. Further observations will be required to pin down star formation quenching mechanisms, but our results imply that they must be internal to the galaxies and closely associated with bulge growth.

Process optimization of joining by upset bulging with local heating

NASA Astrophysics Data System (ADS)

Rusch, Michael; Almohallami, Amer; Sviridov, Alexander; Bonk, Christian; Behrens, Bernd-Arno; Bambach, Markus

2017-10-01

Joining by upset bulging is a mechanical joining method where axial load is applied to a tube to form two revolving bulges, which clamp the parts to be joined and create a force and form fit. It can be used to join tubes with other structures such as sheets, plates, tubes or profiles of the same or different materials. Other processes such as welding are often limited in joining multi-material assemblies or high-strength materials. With joining by upset bulging at room temperature, the main drawback is the possible initiation of damage (cracks) in the inner buckling zone because of high local stresses and strains. In this paper, a method to avoid the formation of cracks is introduced. Before forming the bulge the tube is locally heated by an induction coil. For the construction steel (E235+N) a maximum temperature of 700 °C was used to avoid phase transformation. For the numerical study of the process the mechanical properties of the tube material were examined at different temperatures and strain rates to determine its flow curves. A parametrical FE model was developed to simulate the bulging process with local heating. Experiments with local heating were executed and metallographic studies of the bulging area were conducted. While specimens heated to 500 °C showed small cracks left, damage-free flanges could be created at 600 and 700 °C. Static testing of damage-free bulges showed improvements in tensile strength and torsion strength compared to bulges formed at room-temperature, while bending and compression behavior remained nearly unchanged. In cyclic testing the locally heated specimens underwent about 3.7 times as many cycles before failure as the specimens formed at room temperature.

The Chemical Composition of the Galactic Bulge and Implications for its Evolution

NASA Astrophysics Data System (ADS)

McWilliam, Andrew

2016-08-01

At a bulge latitude of b = -4°, the average [Fe/H] and [Mg/H] values are +0.06 and +0.17 dex, roughly 0.2 and 0.7 dex higher than the local thin and thick disk values, respectively, suggesting a large bulge effective yield, perhaps due to efficient retention of supernova ejecta. The bulge vertical [Fe/H] gradient, at ∼0.5 dex/kpc, appears to be due to a changing mixture of sub-populations (near +0.3 dex and -0.3 dex and one possibly near -0.7 dex) with latitude. At solar [Fe/H], the bulge [Al/Fe] and [α/Fe] ratios are ∼ +0.15 dex. Below [Fe/H] ∼ -0.5 dex, the bulge and local thick disk compositions are very similar; but the measured [Mg/Fe], [/Fe], [La/Eu] and dramatic [Cu/Fe] ratios suggest higher SFR in the bulge. However, these composition differences with the thick disk could be due to measurement errors and non-LTE effects. Unusual zig-zag trends of [Cu/Fe] and [Na/Fe] suggest metallicity-dependent nucleosynthesis by core-collapse supernovae in the Type Ia supernova time-delay scenario. The bulge sub-population compositions resemble the local thin and thick disks, but at higher [Fe/H], suggesting a radial [Fe/H] gradient of -0.04 to -0.05 dex/kpc for both the thin and thick disks. If the bulge formed through accretion of inner thin and thick disk stars, it appears that these stars retained vertical scale heights characteristic of their kinematic origin, resulting in the vertical [Fe/H] gradient and [α/Fe] trends seen today.

Vaginal Repair of Cesarean Section Scar Diverticula that Resulted in Improved Postoperative Menstruation.

PubMed

Zhou, Jieru; Yao, Min; Wang, Husheng; Tan, Weilin; Chen, Pin; Wang, Xipeng

2016-01-01

Owing to the increase in cesarean sections (C-sections) worldwide, long-term complications such as postmenstrual spotting, chronic pelvic pain, and C-section scar ectopic pregnancies have created a new medical era of gynecologic disease. A new type of vaginal repair is evaluated to repair C-section diverticulum (CSD) and rebuild the muscular layer to improve symptoms of abnormal uterine bleeding and decrease the risk of uterine rupture. Retrospective cohort study (Canadian Task Force classification II-2). University hospital. A total of 121 patients with CSD diagnoses by transvaginal ultrasound (TVU) presented with postmenstrual spotting between June 2012 and March 2015. All patients had undergone at least 1 C-section delivery and had no history of postmenstrual spotting before undergoing C-section. Vaginal excision and suture of CSD. The mean duration of menstruation was 14.87 ± 3.46 days preoperatively and decreased to 8.22 ± 2.73 days at 1 month after surgery, 8.89 ± 2.67 days at 3 months after surgery, and 9.02 ± 2.47 days at 6 months after surgery (p < .01). The length, width, depth, and thickness of the remaining muscular layer (TRM) at 1 month, 3 months, and 6 months assessed by TVU also improved significantly after surgery (p < .05). However, postoperative menstruation and imaging data did not differ markedly between 3 months and 6 months, suggesting that follow-up at 3 months represents an adequate endpoint for evaluating the effectiveness of surgery. At 6 months, 80.3% of patients (94 of 117) reached ≤10 days of menstruation. Further study revealed that a TRM at 6 months of ≥8.5 mm measured by TVU (relative risk [RR], 6.418; 95% confidence interval [CI], 1.478-28.443) and an interval between CS and vaginal repair of ≤2.5 years (RR, 12.0; 95% CI, 1.541- 93.454) were good prognostic factors associated with surgery. Vaginal repair of CSD improved the symptoms of postmenstrual spotting and anatomically corrected the scars. An interval between C-section and a surgery of ≤2.5 years was optimal for vaginal repair, and a TRM at 6 months of ≥8.5 mm represented the standard healing of CSD. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Formation of the Lunar Fossil Bulges and Its Implication for the Early Earth and Moon

NASA Astrophysics Data System (ADS)

Qin, Chuan; Zhong, Shijie; Phillips, Roger

2018-02-01

First recognized by Laplace over two centuries ago, the Moon's present tidal-rotational bulges are significantly larger than hydrostatic predictions. They are likely relics of a former hydrostatic state when the Moon was closer to the Earth and had larger bulges, and they were established when stresses in a thickening lunar lithosphere could maintain the bulges against hydrostatic adjustment. We formulate the first dynamically self-consistent model of this process and show that bulge formation is controlled by the relative timing of lithosphere thickening and lunar orbit recession. Viable solutions indicate that lunar bulge formation was a geologically slow process lasting several hundred million years, that the process was complete about 4 Ga when the Moon-Earth distance was less than 32 Earth radii, and that the Earth in Hadean was significantly less dissipative to lunar tides than during the last 4 Gyr, possibly implying a frozen hydrosphere due to the fainter young Sun.

Milky Way demographics with the VVV survey. I. The 84-million star colour-magnitude diagram of the Galactic bulge

NASA Astrophysics Data System (ADS)

Saito, R. K.; Minniti, D.; Dias, B.; Hempel, M.; Rejkuba, M.; Alonso-García, J.; Barbuy, B.; Catelan, M.; Emerson, J. P.; Gonzalez, O. A.; Lucas, P. W.; Zoccali, M.

2012-08-01

Context. The Milky Way (MW) bulge is a fundamental Galactic component for understanding the formation and evolution of galaxies, in particular our own. The ESO Public Survey VISTA Variables in the Vía Láctea is a deep near-IR survey mapping the Galactic bulge and southern plane. Particularly for the bulge area, VVV is covering ~315 deg2. Data taken during 2010 and 2011 covered the entire bulge area in the JHKs bands. Aims: We used VVV data for the whole bulge area as a single and homogeneous data set to build for the first time a single colour - magnitude diagram (CMD) for the entire Galactic bulge. Methods: Photometric data in the JHKs bands were combined to produce a single and huge data set containing 173 150 467 sources in the three bands, for the ~315 deg2 covered by VVV in the bulge. Selecting only the data points flagged as stellar, the total number of sources is 84 095 284. Results: We built the largest colour-magnitude diagrams published up to date, containing 173.1+ million sources for all data points, and more than 84.0 million sources accounting for the stellar sources only. The CMD has a complex shape, mostly owing to the complexity of the stellar population and the effects of extinction and reddening towards the Galactic centre. The red clump (RC) giants are seen double in magnitude at b ~ -8° -10°, while in the inner part (b ~ -3°) they appear to be spreading in colour, or even splitting into a secondary peak. Stellar population models show the predominance of main-sequence and giant stars. The analysis of the outermost bulge area reveals a well-defined sequence of late K and M dwarfs, seen at (J - Ks) ~ 0.7-0.9 mag and Ks ≳ 14 mag. Conclusions: The interpretation of the CMD yields important information about the MW bulge, showing the fingerprint of its structure and content. We report a well-defined red dwarf sequence in the outermost bulge, which is important for the planetary transit searches of VVV. The double RC in magnitude seen in the outer bulge is the signature of the X-shaped MW bulge, while the spreading of the RC in colour, and even its splitting into a secondary peak, are caused by reddening effects. The region around the Galactic centre is harder to interpret because it is strongly affected by reddening and extinction. Based on observations taken within the ESO VISTA Public Survey VVV, Programme ID 179.B-2002.The VVV survey data are available through the ESO archive http://www.eso.org/sci/archive.html

Sexual function and postpartum depression 6 months after attempted operative vaginal delivery according to fetal head station: A prospective population-based cohort study

PubMed Central

Hamel, Jean-François; Brun, Stéphanie; Madar, Hugo; Merlot, Benjamin; Sentilhes, Loïc

2017-01-01

Objective To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD), and specifically midpelvic or low aOVD, on female and male sexual function and symptoms of postpartum depression (PPD) at 6 months. Design Prospective population-based cohort study. Setting 1,941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital. Methods Symptoms of female sexual dysfunction using the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12), symptoms of PPD using the Edinburgh Postnatal Depression Scale (EPDS) score, symptoms of male sexual dysfunction using the International Index of Erectile Function (IIEF-15) and perineal pain were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of female and male sexual function and symptoms of PPD at 6 months using multiple regression and adjusting for demographics, and risk factors of sexual dysfunction, symptoms of PPD and perineal pain with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results The study included 907 women (46.7%) who responded to the questionnaire; 18.4% (167/907) had midpelvic aOVD, and 81.6% (740/907) low. Most women (873/907 [96.3%]) of those with partners reported sexual activity at 6 months. No significant difference was observed for PISQ-12, EPDS, IIEF-15 scores and perineal pain between mid and low pelvic groups. Compared with low pelvic aOVD, midpelvic aOVD was not significantly associated with either female or male sexual dysfunction (p = 0.89 and p = 0.76, respectively), or maternal symptoms of PPD (p = 0.83). Perineal pain significantly increased the risk of male and female sexual dysfunction and maternal symptoms of PPD at 6 months (p = 0.02, p = 0.006, and p = 0.02, respectively). Conclusion Midpelvic compared with low pelvic aOVD was not associated with an increase in sexual dysfunction, nor with symptoms of PPD at 6 months. PMID:28591209

Revisiting the Stellar Mass–Angular Momentum–Morphology Relation: Extension to Higher Bulge Fraction and the Effect of Bulge Type

NASA Astrophysics Data System (ADS)

Sweet, Sarah M.; Fisher, David; Glazebrook, Karl; Obreschkow, Danail; Lagos, Claudia; Wang, Liang

2018-06-01

We present the relation between stellar specific angular momentum j *, stellar mass M *, and bulge-to-total light ratio β for The H I Nearby Galaxy Survey, the Calar Alto Legacy Integral Field Area Survey, and Romanowsky & Fall data sets, exploring the existence of a fundamental plane between these parameters, as first suggested by Obreschkow & Glazebrook. Our best-fit M *–j * relation yields a slope of α = 1.03 ± 0.11 with a trivariate fit including β. When ignoring the effect of β, the exponent α = 0.56 ± 0.06 is consistent with α = 2/3 that is predicted for dark matter halos. There is a linear β–j */M * relation for β ≲ 0.4, exhibiting a general trend of increasing β with decreasing j */M *. Galaxies with β ≳ 0.4 have higher j * than predicted by the relation. Pseudobulge galaxies have preferentially lower β for a given j */M * than galaxies that contain classical bulges. Pseudobulge galaxies follow a well-defined track in β–j */M * space, consistent with Obreschkow & Glazebrook, while galaxies with classical bulges do not. These results are consistent with the hypothesis that while growth in either bulge type is linked to a decrease in j */M *, the mechanisms that build pseudobulges seem to be less efficient at increasing bulge mass per decrease in specific angular momentum than those that build classical bulges.

Effect of an upstream bulge configuration on film cooling with and without mist injection.

PubMed

Wang, Jin; Li, Qianqian; Sundén, Bengt; Ma, Ting; Cui, Pei

2017-12-01

To meet the economic requirements of power output, the increased inlet temperature of modern gas turbines is above the melting point of the material. Therefore, high-efficient cooling technology is needed to protect the blades from the hot mainstream. In this study, film cooling was investigated in a simplified channel. A bulge located upstream of the film hole was numerically investigated by analysis of the film cooling effectiveness distribution downstream of the wall. The flow distribution in the plate channel is first presented. Comparing with a case without bulge, different cases with bulge heights of 0.1d, 0.3d and 0.5d were examined with blowing ratios of 0.5 and 1.0. Cases with 1% mist injection were also included in order to obtain better cooling performance. Results show that the bulge configuration located upstream the film hole makes the cooling film more uniform, and enhanceslateral cooling effectiveness. Unlike other cases, the configuration with a 0.3d-height bulge shows a good balance in improving the downstream and lateral cooling effectiveness. Compared with the case without mist at M = 0.5, the 0.3d-height bulge with 1% mist injection increases lateral average effectiveness by 559% at x/d = 55. In addition, a reduction of the thermal stress concentration can be obtained by increasing the height of the bulge configuration. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bulge Growth Through Disc Instabilities in High-Redshift Galaxies

NASA Astrophysics Data System (ADS)

Bournaud, Frédéric

The role of disc instabilities, such as bars and spiral arms, and the associated resonances, in growing bulges in the inner regions of disc galaxies have long been studied in the low-redshift nearby Universe. There it has long been probed observationally, in particular through peanut-shaped bulges (Chap. 14 10.1007/978-3-319-19378-6_14"). This secular growth of bulges in modern disc galaxies is driven by weak, non-axisymmetric instabilities: it mostly produces pseudobulges at slow rates and with long star-formation timescales. Disc instabilities at high redshift (z > 1) in moderate-mass to massive galaxies (1010 to a few 1011 M⊙ of stars) are very different from those found in modern spiral galaxies. High-redshift discs are globally unstable and fragment into giant clumps containing 108-9 M⊙ of gas and stars each, which results in highly irregular galaxy morphologies. The clumps and other features associated to the violent instability drive disc evolution and bulge growth through various mechanisms on short timescales. The giant clumps can migrate inward and coalesce into the bulge in a few 108 years. The instability in the very turbulent media drives intense gas inflows toward the bulge and nuclear region. Thick discs and supermassive black holes can grow concurrently as a result of the violent instability. This chapter reviews the properties of high-redshift disc instabilities, the evolution of giant clumps and other features associated to the instability, and the resulting growth of bulges and associated sub-galactic components.

Observational prospective study on Lactobacillus plantarum P 17630 in the prevention of vaginal infections, during and after systemic antibiotic therapy or in women with recurrent vaginal or genitourinary infections.

PubMed

Cianci, Antonio; Cicinelli, Ettore; De Leo, Vincenzo; Fruzzetti, Franca; Massaro, Maria Giulia; Bulfoni, Alessandro; Parazzini, Fabio; Perino, Antonio

2018-07-01

We performed a prospective cohort parallel observational study on the use of Lactobacillus plantarum P 17630 in the prevention of vaginal infections. Eligible were women with a diagnosis of bacterial vaginosis (<15 days) and documented history of recurrent vaginal infections; and/or cystitis (<15 days); and/or treatment with antibiotics for bacterial respiratory tract infections during the week before the study entry. Study subjects were prescribed Lactobacillus plantarum P 17630 > 100.000.000 UFC one vaginal capsule per day for 6 days, then a capsule per week for 16 weeks. Eligible subjects were enrolled in two parallel cohorts: 85 women using (group A) and 39 not using (group B) Lactobacillus plantarum P 17630. The risk of recurrent infection within 4 months from the study entry, was higher among untreated women: multivariate OR 2.6 (95%CI 0.7-9.4). The modification of presence/intensity or symptoms was significant in both the study groups (p < .001). Impact statement What is already known on this subject? The Lactobacillus plantarum P 17630 has been shown to be active in the treatment of bacterial vaginosis and vaginal candidiasis. No data are available on its efficacy in the prevention of recurrent vaginal or urological infection or as a prevention strategy during systemic treatment with antibiotics. What do the results of this study add? This observational study suggests that Lactobacillus plantarum given for 4 months may lower the risk of recurrent infection in women with recurrent vaginal or genitourinary infection or after antibiotic systemic treatment for bacterial respiratory tract infection. The finding, however, is not statistically significant, possibly due to the lower than expected rate of infection observed in our population and consequently the limited power of the study. What are the implications of these findings for clinical practice and/or further research? New studies are needed in order to evaluate in different populations the role of Lactobacillus plantarum in lowering the risk of recurrent infection in a high-risk populations.

Can Lactobacillus fermentum LF10 and Lactobacillus acidophilus LA02 in a slow-release vaginal product be useful for prevention of recurrent vulvovaginal candidiasis?: A clinical study.

PubMed

Murina, Filippo; Graziottin, Alessandra; Vicariotto, Franco; De Seta, Francesco

2014-01-01

To assess the effectiveness of the association of 2 specific strains, Lactobacillus fermentum LF10 (DSM 19187) and Lactobacillus acidophilus LA02 (DSM 21717), specifically formulated in slow-release effervescent tablets, in patients with recurrent vulvovaginal candidiasis. The study was a clinical trial of 58 women diagnosed with recurrent VVC (≥4 culture-confirmed episodes in a 12-mo period). All patients were given 200 mg of fluconazole orally as an induction dose for 3 alternate days during the first treatment week. Afterward, the patients were given a new product formulated in slow-release vaginal tablets containing at least 0.4 billion live cells of each of lactobacillus L. fermentum LF10 and L. acidophilus LA02 (first phase of the prophylactic period), on alternate days for 10 consecutive nights. Patients who were still free of symptoms were given 1 vaginal tablet every week for the next 10 weeks (second phase of the prophylactic period). Patients asymptomatic after the total duration of the observation phase (7 mo) were considered as responders. During the second 10-week prophylactic phase, 49 of 57 (86.0%) patients remained free of clinical recurrence, whereas symptomatic VVC occurred in 8 patients (14.0%). During the 7-month follow-up, 42 patients of 49 (85.7%) were symptom free at the end of the protocol, whereas clinical recurrences occurred in 7 women (14.3%). Overall, 42 of 58 women enrolled in the study (72.4%) experienced no clinical recurrence throughout the 7-month observation phase (responders). This study strengthens the evidence supporting the use of specific lactobacilli with well-demonstrated activities associated with the creation and maintenance of a vaginal biofilm that hinders the persistence of an infection caused by Candida.

Role of Molecular Biology in Diagnosis and Characterization of Vulvo-Vaginitis in Clinical Practice.

PubMed

Donders, Gilbert G G; Ravel, Jacques; Vitali, Beatrice; Netea, Mihai G; Salumets, Andres; Unemo, Magnus

2017-01-01

The diagnosis of vulvo-vaginal complaints has always been enigmatic in obstetrics and gynecology. Patients with clear, pathognomonic symptoms end up with a proper diagnosis and treatment most of the time, but unfortunately we are now living in a world where women reach out to the Internet and readily get all information as to which disease their symptoms correspond to and also find the appropriate treatment "over-the-counter." Because of this trend, we as specialists are increasingly confronted with patients with complex and combined conditions. At the same time, extremely sensitive and accurate diagnostic tools are now being developed at a rapid pace, allowing the physicians to diagnose vulvo-vaginal disease with a substantially increased precision. Moreover, many of these molecular biology (MB)-based tests have become so common and affordable that self-sampling and self-testing are no longer utopia. On the other hand, too much information that is too readily available and that is too affordable also encompasses pitfalls, leading to gross overtreatment and psychological burden. As experienced caregivers, we should supervise these evolutions, define their place and proper use as diagnostic tools, utilize their potential as ad hoc tools to follow-up treatment efficacy and guide how such tools can be used for responsible self-testing. In the present paper, responding to the need for appropriate, quality assured and accessible tests for vulvo-vaginitis and the huge potential delivered by the rapidly developing MB methods, we recommend the need for a broad and regular discussion forum, composed of both clinical and technical experts and opinion makers, in order to match the needs with the huge opportunities and ideally combine the initiatives and forces into the same direction. This forum should then translate conceived strategies into regularly updated, evidence-based national and international guidelines. © 2017 S. Karger AG, Basel.

Predictors of Locally Advanced Disease at Presentation and Clinical Outcomes Among Cervical Cancer Patients Admitted at a Tertiary Hospital in Botswana.

PubMed

Nassali, Mercy Nkuba; Tadele, Melese; Nkuba, Robert Michael; Modimowame, Jamieson; Enyeribe, Iwuh; Katse, Edwin

2018-05-23

The aim of this study was to determine predictors of locally advanced disease at presentation and clinical outcomes among cervical cancer patients in Botswana to inform interventional strategies. Retrospective review of 149 medical records of new cervical cancer patients was conducted between August 2016 and February 2017 at the Princess Marina Hospital. Data collected included sociodemographics, presenting symptoms, stage of disease, comorbidities, interventions, and clinical outcomes. STATA 12 was used for data analysis. Frequencies were used to describe patient demographics and clinical variables. Bivariate and multivariate binary logistic regression analyses were used to determine association between stage of disease at presentation and patient characteristics. P ≤ 0.05 was considered significant. Mean age was 49.5 years. Nine (89.2%) in 10 patients had locally advanced cervical cancer (stage IB1-IVB). Two thirds (65.1%) were human immunodeficiency virus positive. Previous cervical cancer screening was low at 38.3%. Common symptoms were abnormal vaginal bleeding, low abdominal pain, and malodorous vaginal discharge reported among 75.8%, 66.4%, and 39.6% of cases, respectively. Overall, 32 (21.5%) were declared cured, 52 (34.9%) improved, and 11 (7.4%) opted for home-based care. Hospital deaths were 41 (27.5%). Major causes of death were renal failure (48.7%) and severe anemia (39%). Thirteen (8.7%) were lost to follow-up. Being unmarried (odds ratio [OR], 3.9), lack of cervical cancer screening (OR, 6.68), presentation with vaginal bleeding (OR, 7.69), and low abdominal pain (OR, 4.69) were associated with advanced disease at presentation. Lack of cervical cancer screening, vaginal bleeding, low abdominal pain, and unmarried status were associated with advanced disease at presentation. We recommend scale-up of cervical cancer screening and its integration into routine human immunodeficiency virus care. Capacity building in gynecologic oncology and palliative care services is currently critical.

[Bacterial vaginosis].

PubMed

Romero Herrero, Daniel; Andreu Domingo, Antonia

2016-07-01

Bacterial vaginosis (BV) is the main cause of vaginal dysbacteriosis in the women during the reproductive age. It is an entity in which many studies have focused for years and which is still open for discussion topics. This is due to the diversity of microorganisms that cause it and therefore, its difficult treatment. Bacterial vaginosis is probably the result of vaginal colonization by complex bacterial communities, many of them non-cultivable and with interdependent metabolism where anaerobic populations most likely play an important role in its pathogenesis. The main symptoms are an increase of vaginal discharge and the unpleasant smell of it. It can lead to serious consequences for women, such as an increased risk of contracting sexually transmitted infections including human immunodeficiency virus and upper genital tract and pregnancy complications. Gram stain is the gold standard for microbiological diagnosis of BV, but can also be diagnosed using the Amsel clinical criteria. It should not be considered a sexually transmitted disease but it is highly related to sex. Recurrence is the main problem of medical treatment. Apart from BV, there are other dysbacteriosis less characterized like aerobic vaginitis of which further studies are coming slowly but are achieving more attention and consensus among specialists. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Vaginal microbiota and its role in HIV transmission and infection.

PubMed

Petrova, Mariya I; van den Broek, Marianne; Balzarini, Jan; Vanderleyden, Jos; Lebeer, Sarah

2013-09-01

The urogenital tract appears to be the only niche of the human body that shows clear differences in microbiota between men and women. The female reproductive tract has special features in terms of immunological organization, an epithelial barrier, microbiota, and influence by sex hormones such as estrogen. While the upper genital tract is regarded as free of microorganisms, the vagina is colonized by bacteria dominated by Lactobacillus species, although their numbers vary considerably during life. Bacterial vaginosis is a common pathology characterized by dysbiosis, which increases the susceptibility for HIV infection and transmission. On the other hand, HIV infections are often characterized by a disturbed vaginal microbiota. The endogenous vaginal microbiota may protect against HIV by direct production of antiviral compounds, through blocking of adhesion and transmission by ligands such as lectins, and/or by stimulation of immune responses. The potential role of probiotics in the prevention of HIV infections and associated symptoms, by introducing them to the vaginal and gastrointestinal tract (GIT), is also discussed. Of note, the GIT is a site of considerable HIV replication and CD4(+) T-cell destruction, resulting in both local and systemic inflammation. Finally, genetically engineered lactobacilli show promise as new microbicidal agents against HIV. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

ON THE TREATMENT OF CHANGES IN THE VAGINA FOLLOWING RADIOTHERAPY FOR GYNECOLOGIC CANCER (in German)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Picha, E.

1962-02-01

The clinical management of 152 women showing vaginal changes as a result of radiotherapy is reported. These changes occurred in addition to the general radiation syndrome, leucopenia, and injury to the bladder and rectum in some cases. Of prime importance are changes in the bacterial flora of the vagina following irradiation and leukorrhea was a common symptom, which in some cases appeared months after radiotherapy. Leukorrhea developed in response partly to increased bacterial proliferation in vagina and partly to radionecrosis of normal and tumor tissue. However, necrosis and ulceration of vaginal mucosa was usually self-correcting, and healing followed without furthermore » treatment. On the other hand, necrosis immediately around the tumor, which may have resulted from excessive radiation dosage, does require treatment. The vaginal changes frequently resemble senile colpitis, and may respond to estrogen therapy for a 8- 10 day period. Leukorrhea and necrosis responded best to local applications of salve or ointment containing 50% sulfonamides, 5% lactic acid, and 12.5% salicylic acid. Sulfonamides reduce infection, lactic acid lowers vaginal pH and promotes development of the normal flora (especially Doederlein' s bacillus), and salicylic acid inhibits scar formation. Successful results with this treatment, applied for weeks or months, are described. (BBB)« less

The stellar population and luminosity function in M31 bulge and Inner Disk Fields

NASA Technical Reports Server (NTRS)

Rich, R. Michael; Mould, J. R.; Graham, James R.

1993-01-01

We report infrared photometry and stellar identifications for stars in five fields in the M31 bulge located from 2 to 11 arcmin from the nucleus. These fields have been chosen such that the bulge/disk star ratio predicted from Kent's (1989) small bulge model varies from 7:1 to 1:5, allowing a study of near pure disk and near pure bulge stellar populations. We reject the hypothesis of Davies et al. (1991) that luminous stars found within 500 pc of the nucleus are due to a contaminating disk population. We find that the bulge contains stars in excess of M(sub bol) = -5 mag and that the bulge luminosity function has a distinct shape different from the disk fields. We find many stars redder than (J-K) = 2 mag, and suggest that these stars may be the counterparts of the IRAS-selected Galactic bulge Miras studied by Whitelock et at. (1991). The number of bright stars (M(sub bol) is less than -5 mag) falls off more rapidly than the r band surface brightness. By building model fields out of a bulge luminosity function and artificial stars, we are able to show that the change in the luminosity function toward the center cannot be explained simply by the mismeasurement of overcrowded star images. However, these tests also raise the possibility that the asymptotic giant branch (AGB) tip may be approximately equal to 1 mag fainter than actually measured in our most crowded field, reaching only M(sub bol) = -5. We compare observed counts of AGB stars with those predicted from theoretical lifetimes using a technique of general interest for this problem, the Fuel Consumption Theorem of Renzini & Buzzoni (1986) Spectral Evolution of Galaxies (Reidel, Dordrecht). Our methodology is generally applicable to the study of other resolved extragalactic stellar populations. The number of observed stars per magnitude up to a luminosity of M(bol) = -5.5 mag is consistent with AGB evolution of the whole population of the innermost bulge field with the standard lifetime on the AGB of 1.3 Myr/mag. We advance the possibility that the bulge of M31 may be younger than the oldest Galactic globular clusters. We note that M33 has recently been found to have an r(exp 1/4)-law spheroid consisting of intermediate-age stars; bulges can form later than the old halo population.

Voiding dysfunction: another etiology of vulvovaginitis in young girls.

PubMed

Romero, P; Rodríguez, E; Muñoz, M; Delucchi, A; Guerrero, J L; Lillo, A M; Cano, F; Matilde Osses, Sra; Romero, M I; Gonzalez Roca, C

2011-08-01

To determine the prevalence of voiding dysfunction (VD) in patients with persistent vulvovaginitis (PVV), and to evaluate the clinical response of PVV in the treatment of VD. Girls four years or older who consulted for PVV for at least one month and who did not respond to general measures. A physical examination was performed with visual inspection and colposcopy; vaginal samples for culture and vaginoscopy were carried out. On every patient urodynamic studies were performed. Girls who were diagnosed with VD were treated. A pediatric gynecologist did the follow-up; a successful response was considered when inflammatory symptoms and vaginal discharge ceased. Twenty patients were included, mean age 8.6 years (range: 4.6-14 years); 75% prepubertal symptoms lasted for 1.8 years; 19 (95%) had urodynamia, 10 (52.6%) had an overactive bladder, 8 (42.1%) external bladder sphincter dyssynergia, 1 (5.2%) hypotonic bladder, and 13 (65%) showed improvement. VD is an important cause when considering the etiology of PVV. 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Enterovaginal or Vesicovaginal Fistula Control Using a Silicone Cup.

PubMed

Russell, Katie W; Robinson, Ryan E; Mone, Mary C; Scaife, Courtney L

2016-12-01

An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications. For low-volume fistulae, tampons or pads may be used. With high-volume fistulae, frequent product change can be painful and unpredictable in terms of efficacy. The psychologic distress is profound. Surgery may not be an option, making symptom control the priority. We report the use of a reusable menstrual silicone vaginal cup placed to divert and contain drainage. The menstrual cup provided significant symptom relief. Drainage is immediately diverted from tissue, unlike with tampon or pad use, which involves longer contact periods with caustic fluids. A system was created by adapting the end of the cup by adding silastic tubing and an external leg bag to provide long-term drainage control. Improvement in quality of life is of primary importance when dealing with fistula drainage. This simple and inexpensive device should be considered in those cases in which the drainage can be diverted as a viable option, especially in those who are symptomatic and awaiting surgical repair or in those for whom surgery cannot be performed.

Severe latex allergy after a vaginal examination during labor: a case report.

PubMed

Santos, R; Hernández-Ayup, S; Galache, P; Morales, F G; Batiza, V A; Montoya, D

1997-12-01

There has been an alarming increase in latex allergy, which can be a potential cause of occupational atopic disease. Physicians should be aware of this entity in high-risk groups and in patients with other allergies. A 32-year-old pregnant woman, with an allergy to orange juice, was first seen with a 39-week pregnancy in the labor room, where she had on two occasions a severe atopic reaction when examined with a latex glove. A latex allergy was suspected, and management with hydrocortisone resulted in remission of symptoms. Two hours later a vaginal delivery was performed with nonlatex, nonvinyl gloves. A week later immunoglobulin E antilatex antibodies determined by radioallergosorbent test were still positive at 585 IU. It is concluded that symptoms of latex allergy may develop in high-risk groups or in those with other known allergies. Because of the increasing frequency of this entity, physicians should take greater care and give more attention to the clinical history, as well as be aware of this possibility in these groups of patients.

The Optical Gravitational Lensing Experiment. BVI Maps of Dense Stellar Regions. III. The Galactic Bulge

NASA Astrophysics Data System (ADS)

Udalski, A.; Szymanski, M.; Kubiak, M.; Pietrzynski, G.; Soszynski, I.; Wozniak, P.; Zebrun, K.; Szewczyk, O.; Wyrzykowski, L.

2002-09-01

We present the VI photometric maps of the Galactic bulge. They contain VI photometry and astrometry of about 30 million stars from 49 fields of 0.225 square degree each in the Galactic center region. The data were collected during the second phase of the OGLE microlensing project. We discuss the accuracy of data and present color-magnitude diagrams of selected fields observed by OGLE in the Galactic bulge. The VI maps of the Galactic bulge are accessible electronically for the astronomical community from the OGLE Internet archive.

A HIGH-VELOCITY BULGE RR LYRAE VARIABLE ON A HALO-LIKE ORBIT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kunder, Andrea; Storm, J.; Rich, R. M.

2015-07-20

We report on the RR Lyrae variable star, MACHO 176.18833.411, located toward the Galactic bulge and observed within the data from the ongoing Bulge RR Lyrae Radial Velocity Assay, which has the unusual radial velocity of −372 ± 8 km s{sup −1} and true space velocity of −482 ± 22 km s{sup −1} relative to the Galactic rest frame. Located less than 1 kpc from the Galactic center and toward a field at (l, b) = (3, −2.5), this pulsating star has properties suggesting it belongs to the bulge RR Lyrae star population, yet a velocity indicating it is abnormal,more » at least with respect to bulge giants and red clump stars. We show that this star is most likely a halo interloper and therefore suggest that halo contamination is not insignificant when studying metal-poor stars found within the bulge area, even for stars within 1 kpc of the Galactic center. We discuss the possibility that MACHO 176.18833.411 is on the extreme edge of the bulge RR Lyrae radial velocity distribution, and also consider a more exotic scenario in which it is a runaway star moving through the Galaxy.« less

JASMINE: constructor of the dynamical structure of the Galactic bulge

NASA Astrophysics Data System (ADS)

Gouda, N.; Kobayashi, Y.; Yamada, Y.; Yano, T.; Tsujimoto, T.; Suganuma, M.; Niwa, Y.; Yamauchi, M.

2008-07-01

We introduce a Japanese space astrometry project which is called JASMINE. JASMINE (Japan Astrometry Satellite Mission for INfrared Exploration) will measure distances and tangential motions of stars in the Galactic bulge with yet unprecedented precision. JASMINE will operate in z-band whose central wavelength is 0.9 micron. It will measure parallaxes, positions with accuracy of about 10 micro-arcsec and proper motions with accuracy of about 10 micro- arcsec/year for the stars brighter than z=14 mag. The number of stars observed by JASMINE with high accuracy of parallaxes in the Galactic bulge is much larger than that observed in other space astrometry projects operating in optical bands. With the completely new “map of the Galactic bulge” including motions of bulge stars, we expect that many new exciting scientific results will be obtained in studies of the Galactic bulge. One of them is the construction of the dynamical structure of the Galactic bulge. Kinematics and distance data given by JASMINE are the closest approach to a view of the exact dynamical structure of the Galactic bulge. Presently, JASMINE is in a development phase, with a target launch date around 2016. We comment on the outline of JASMINE mission, scientific targets and a preliminary design of JASMINE in this paper.

Discovery of carbon-rich Miras in the Galactic bulge

NASA Astrophysics Data System (ADS)

Matsunaga, Noriyuki; Menzies, John W.; Feast, Michael W.; Whitelock, Patricia A.; Onozato, Hiroki; Barway, Sudhanshu; Aydi, Elias

2017-08-01

Only one carbon-rich (C-rich, hereinafter) Mira variable has so far been suggested as a member of the Galactic bulge and this is in a symbiotic system. Here we describe a method for selecting C-rich candidates from an infrared colour-colour diagram, (J - Ks) versus ([9] - [18]). Follow-up low-resolution spectroscopy resulted in the detection of eight C-rich Mira variables from a sample of 36 candidates towards the Galactic bulge. Our near-infrared photometry indicates that two of these, including the known symbiotic, are closer than the main body of the bulge while a third is a known foreground object. Of the five bulge members, one shows He I and [O II] emission and is possibly another symbiotic star. Our method is useful for identifying rare C-rich stars in the Galactic bulge and elsewhere. The age of these C-rich stars and the evolutionary process which produced them remain uncertain. They could be old and the products of either binary mass transfer or mergers, I.e. the descendants of blue stragglers, but we cannot rule out the possibility that they belong to a small in situ population of metal-poor intermediate age (<5 Gyr) stars in the bulge or that they have been accreted from a dwarf galaxy.

Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause.

PubMed

Behnia-Willison, Fariba; Sarraf, Sara; Miller, Joseph; Mohamadi, Behrang; Care, Alison S; Lam, Alan; Willison, Nadia; Behnia, Leila; Salvatore, Stefano

2017-06-01

To evaluate the safety and long-term efficacy of fractional CO 2 laser treatment in reducing the severity of symptoms of genitourinary syndrome of menopause (GSM) in menopausal women. 102 women presenting with symptomatic GSM were treated with the fractional CO 2 laser (MonaLisa Touch, DEKA) system across a series of treatments delivered at intervals of six or more weeks. The Australian Pelvic Floor Questionnaire was used to gather data on sexual function and side-effects at three time-points across the study period (prospective panel design study). Wilcoxon signed-rank tests were used to detect statistically and clinically significant changes in sexual function and side-effects occurring from pre- to post-treatment. The primary outcome of this study was an improvement of the symptoms of GSM. The secondary outcome included bladder function and prolapse symptoms. A total of 102 women suffering from moderate to severe GSM were recruited. Eighty-four percent experienced significant improvement in their symptoms after CO 2 laser treatment. Scores on measures of sexual function, dyspareunia, and bothersomeness of sexual issues were improved from pre-treatment to long-term (12-24 month) follow-up. Furthermore, there were improvements on measures of bladder function (P=0.001), prolapse (P=0.001), vaginal sensation (P=0.001), vaginal lubrication (P<0.001) and urge incontinence (P=0.003) from the pre-treatment assessment to the second assessment (i.e. after the third treatment). In this study, fractional microablative CO 2 laser treatment was associated with an improvement in symptoms of GSM and sexual function. Copyright © 2017. Published by Elsevier B.V.

Characterization of Pelvic Floor Symptoms in Women of Northeastern Liberia

PubMed Central

Bowling, C. Bryce; Munoz, Oxana; Gerten, Kimberly A.; Mann, MerryLynn; Taryor, Rebecca; Norman, Andy M.; Szychowski, Jeff M.; Richter, Holly E.

2013-01-01

Objective To characterize prevalence and quality of life (QoL) impact of urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) symptoms in women of Liberia. Methods A questionnaire addressing symptoms and QoL impact of UI, FI and POP was administered to women in a community setting in Ganta, Liberia. Questionnaires were analyzed to determine prevalence rates, QoL impact, and risk factors for these conditions. Results 424 participants were surveyed; 1.7% reported UI, 0.10% reported any form of FI, and 3.3% reported some degree of POP symptoms. QoL responses varied among symptom groups. Previous hysterectomy, cesarean delivery, vaginal deliveries, and body mass index had no significant association with UI, FI, or POP. Participants with UI symptoms were more likely to report FI symptoms (p=0.002). Conclusion Prevalence rates for UI, FI and POP in this population are low; there was a significant association of FI symptoms in subjects with UI. PMID:20206351

The bulge-disc decomposed evolution of massive galaxies at 1 < z < 3 in CANDELS

NASA Astrophysics Data System (ADS)

Bruce, V. A.; Dunlop, J. S.; McLure, R. J.; Cirasuolo, M.; Buitrago, F.; Bowler, R. A. A.; Targett, T. A.; Bell, E. F.; McIntosh, D. H.; Dekel, A.; Faber, S. M.; Ferguson, H. C.; Grogin, N. A.; Hartley, W.; Kocevski, D. D.; Koekemoer, A. M.; Koo, D. C.; McGrath, E. J.

2014-10-01

We present the results of a new and improved study of the morphological and spectral evolution of massive galaxies over the redshift range 1 < z < 3. Our analysis is based on a bulge-disc decomposition of 396 galaxies with M* > 1011 M⊙ uncovered from the Cosmic Assembly Near-infrared Deep Extragalactic Legacy Survey (CANDELS) Wide Field Camera 3 (WFC3)/IR imaging within the Cosmological Evolution Survey (COSMOS) and UKIRT Infrared Deep Sky Survey (UKIDSS) UDS survey fields. We find that, by modelling the H160 image of each galaxy with a combination of a de Vaucouleurs bulge (Sérsic index n = 4) and an exponential disc (n = 1), we can then lock all derived morphological parameters for the bulge and disc components, and successfully reproduce the shorter-wavelength J125, i814, v606 HST images simply by floating the magnitudes of the two components. This then yields sub-divided four-band HST photometry for the bulge and disc components which, with no additional priors, is well described by spectrophotometric models of galaxy evolution. Armed with this information, we are able to properly determine the masses and star formation rates for the bulge and disc components, and find that: (i) from z = 3 to 1 the galaxies move from disc dominated to increasingly bulge dominated, but very few galaxies are pure bulges/ellipticals by z = 1; (ii) while most passive galaxies are bulge dominated, and most star-forming galaxies disc dominated, 18 ± 5 per cent of passive galaxies are disc dominated, and 11 ± 3 per cent of star-forming galaxies are bulge dominated, a result which needs to be explained by any model purporting to connect star formation quenching with morphological transformations; (iii) there exists a small but significant population of pure passive discs, which are generally flatter than their star-forming counterparts (whose axial ratio distribution peaks at b/a ≃ 0.7); (iv) flatter/larger discs re-emerge at the highest star formation rates, consistent with recent studies of sub-mm galaxies, and with the concept of a maximum surface density for star formation activity.

MASSIVE GALAXIES IN COSMOS: EVOLUTION OF BLACK HOLE VERSUS BULGE MASS BUT NOT VERSUS TOTAL STELLAR MASS OVER THE LAST 9 Gyr?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jahnke, Knud; Cisternas, Mauricio; Inskip, Katherine

2009-12-01

We constrain the ratio of black hole (BH) mass to total stellar mass of type-1 active galactic nuclei (AGNs) in the COSMOS survey at 1 < z < 2. For 10 AGNs at mean redshift z approx 1.4 with both Hubble Space Telescope (HST)/ACS and HST/NICMOS imaging data, we are able to compute the total stellar mass M {sub *,total}, based on rest-frame UV-to-optical host galaxy colors which constrain mass-to-light ratios. All objects have virial M {sub BH} estimates available from the COSMOS Magellan/IMACS and zCOSMOS surveys. We find within errors zero difference between the M {sub BH}-M {sub *,total}more » relation at z approx 1.4 and the M {sub BH}-M {sub *,bulge} relation in the local universe. Our interpretation is (1) if our objects were purely bulge-dominated, the M {sub BH}-M {sub *,bulge} relation has not evolved since z approx 1.4. However, (2) since we have evidence for substantial disk components, the bulges of massive galaxies (M {sub *,total} = 11.1 +- 0.3 or log M {sub BH} approx 8.3 +- 0.2) must have grown over the last 9 Gyr predominantly by redistribution of the disk into the bulge mass. Since all necessary stellar mass exists in galaxies at z = 1.4, no star formation or addition of external stellar material is required, but only a redistribution, e.g., induced by minor and major merging or through disk instabilities. Merging, in addition to redistributing mass in the galaxy, will add both BH and stellar/bulge mass, but does not change the overall final M {sub BH}/M {sub *,bulge} ratio. Since the overall cosmic stellar and BH mass buildup trace each other tightly over time, our scenario of bulge formation in massive galaxies is independent of any strong BH feedback and means that the mechanism coupling BH and bulge mass until the present is very indirect.« less

Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period.

PubMed

Cyr, Marie-Pierre; Kruger, Jennifer; Wong, Vivien; Dumoulin, Chantale; Girard, Isabelle; Morin, Mélanie

2017-03-01

Pelvic floor muscles are subject to considerable stretching during vaginal birth. In 13-36% of women, stretching results in avulsion injury whereby the puborectalis muscle disconnects from its insertion points on the pubis bone. Until now, few studies have investigated the effect of this lesion on pelvic floor muscles in the early postpartum period. The primary aim of this study was to compare pelvic floor muscle morphometry and function in primiparous women with and without puborectalis avulsion in the early postpartum period. Our secondary objective was to compare the 2 groups for pelvic floor disorders and impact on quality of life. In all, 52 primiparous women diagnosed with (n = 22) or without (n = 30) puborectalis avulsion injury were assessed at 3 months postpartum. Pelvic floor muscle morphometry was evaluated with 3-/4-dimensional transperineal ultrasound at rest, maximal contraction, and Valsalva maneuver. Different parameters were measured in the midsagittal and axial planes: bladder neck position, levator plate angle, anorectal angle, and levator hiatus dimensions. The dynamometric speculum was used to assess pelvic floor muscle function including: passive properties (passive forces and stiffness) during dynamic stretches, maximal strength, speed of contraction, and endurance. Pelvic floor disorder-related symptoms (eg, urinary incontinence, vaginal and bowel symptoms) and impact on quality of life were evaluated with the International Consultation on Incontinence Questionnaire and the Pelvic Floor Impact Questionnaire-Short Form. Pelvic Organ Prolapse Quantification was also assessed. In comparison to women without avulsion, women with avulsion presented an enlarged hiatus area at rest, maximal contraction, and Valsalva maneuver (P ≤ .013) and all other ultrasound parameters were found to be significantly altered during maximal contraction (P ≤ .014). They showed lower passive forces at maximal and 20-mm vaginal apertures as well as lower stiffness at 20-mm aperture (P ≤ .048). Significantly lower strength, speed of contraction, and endurance were also found in women with avulsion (P ≤ .005). They also presented more urinary incontinence symptoms (P = .040) whereas vaginal and bowel symptoms were found to be similar in the 2 groups. Pelvic Organ Prolapse Quantification revealed greater anterior compartment descent in women with avulsion (P ≤ .010). The impact of pelvic floor disorders on quality of life was found to be significantly higher in women with avulsion (P = .038). This study confirms that pelvic floor muscle morphometry and function are impaired in primiparous women with puborectalis avulsion in the early postpartum period. Moreover, it highlights specific muscle parameters that are altered such as passive properties, strength, speed of contraction, and endurance. Copyright © 2016 Elsevier Inc. All rights reserved.

Bulge Growth and Quenching Since Z=2.5 in Candels/3D-HST

NASA Technical Reports Server (NTRS)

Lang, Phillip; Wuyts, Stijn; Somerville, Rachel S.; Schreiber, Natascha M. Foerster; Genzel, Reinhard; Bell, Eric F.; Brammer, Gabe; Dekel, Avishai; Faber, Sandra M.; Ferguson, Henry C.;

Endometriosis presenting as a vaginal mass.

PubMed

Nelson, Philippa

2018-01-23

A 43-year-old woman with an anterior vaginal wall mass was referred to gynaecology outpatient for diagnosis and management. Clinical assessment was indicative of a urethral diverticulum, however MRI and ultrasound imaging suggested a Gartner's duct cyst. Following excision of the lesion, histology revealed evidence of an endometriotic cyst. The patient had no other symptoms of endometriosis and remained asymptomatic 3 months following excision. This case highlights the widespread locations in which endometrial tissue can be found, and therefore the range of symptomatology. This in turn lends itself to diagnostic difficulty without histological confirmation. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Is sensory urgency part of the same spectrum of bladder dysfunction as detrusor overactivity?

PubMed

Haylen, Bernard T; Chetty, Naven; Logan, Vanessa; Schulz, Serena; Verity, Louise; Law, Matthew; Zhou, Jialun

2007-02-01

It has been suggested that the urogynecological diagnosis of sensory urgency is an early form of detrusor overactivity and may be just earlier in the spectrum of disease. The former term is generally defined as increased perceived bladder sensation during filling, a low first desire to void and low bladder capacity in the absence of recorded urinary tract infection (UTI) or detrusor overactivity. The aims of this study are to determine the prevalence and associations of sensory urgency in comparison with detrusor overactivity, and whether sensory urgency is shown to be in the same spectrum of bladder dysfunction as detrusor overactivity. Five hundred and ninety-two women attending for an initial urogynecological/urodynamic assessment took part in this prospective study. In addition to a full clinical assessment, all women underwent free uroflowmetry, residual urine volume measurement (by vaginal ultrasound) and multichannel filling and voiding cystometry. Data were separated into those having (1) sensory urgency or (2) detrusor overactivity. Apart from prevalence figures, comparative associations were sought for (3) age; (4) parity; (5) presenting symptoms; (6) presence of at least one (medically) documented UTI in the previous 12 months; (7) two or more (recurrent) documented UTIs in the previous 12 months; (8) prior hysterectomy; (9) prior continence surgery; (10) menopause; (11) menopause and HRT use; (12) sign of clinical stress leakage; (13) retroverted uterus; (14) anterior vaginal wall prolapse; (15) uterine prolapse; (16) posterior vaginal wall prolapse; (17) apical vaginal prolapse; (18, 19) maximum, average urine flow rate (MUFR, AUFR) centiles, Liverpool Nomograms; (20) median residual urine volume (RUV) in milliliters; (21, 22) voiding difficulty: VD1,VD2 (MUFR, AUFR under 10th centile Liverpool Nomogram and/or RUV >30 ml); (23) diagnosis of urodynamic stress incontinence and (24) diagnosis of uterine and/or vaginal prolapse (grade >0). The prevalence of sensory urgency was 13%. The only differences in the clinical and urodynamic profiles of it and detrusor overactivity were (1) significantly increased prevalence of the symptom of urge incontinence and (2) (by definition) abnormal detrusor contractions during filling cystometry in women with detrusor overactivity. Overall, sensory urgency and detrusor overactivity appear to be part of the same spectrum of bladder dysfunction.

[Cervugid ovules in cervico-vaginal infections and cervix uteri precancerous conditions treatment].

PubMed

Zanoschi, Ch; Anton, C; Anton, E; Costăchescu, Gh; Teleman, S; Costăchescu, G; Ciupilan, I; Cărăuleanu, M; Cărăuleanu, A; Leica, V; Pânzaru, C; Grigore, M; Merticaru, I; Huianu, O; Huianu, L; Chifan, M

2004-01-01

This medicine was authorized by the National Drug Agency (ANM, Bucureşti) in 2001. To evaluate the effectiveness and the tolerance to Cervugid-ovules, a preparation that combines the polyvalent local antiinflammatory action of chloramphenicol, metronidazole and nystatin with the effect of hydrocortisone acetate, an unspecific anti-inflammatory agent; they all are embedded in a Lipex-403, semisynthetic fat. The evaluation of 500 patients ages between 15 and 85 years with genital infections, registered in the files of "Cl. II Obst. and Gynecology" of the Cuza-Vodă Hospital from Iaşi has been studied. We studied the subjective manifestations (local discomfort and pelvic pains, local burning and dryness,vulvovaginal itching and dyspareunia) and objective manifestations (vaginal and cervical secretion, the cytotest performed and colored though the Papanicolaou method and reported in the Bethesda system). Healing of the subjective symptoms in 98%, healing of the leukorrhea--as a main objective symptom--in 95%; The Bethesda system cytotest was one of the inflammatory type in the most of the cases and there wew found in 85 cases: 6 ASCUS, 41 LSIL, and 37 HSIL. The use of Cervugid had a healing response in most of the cases when used in acute and chronic cervico-vaginal inflammatory processes. Cervugid may be considered as an important agent in the treatment of the precancerous affections af the cervix uteri on the following reasons: zhe cure of the infections caused by chlamydia, involved in the etiology of cervical neoplasms, the cure of the HPV infection under episome form, classified in the Bethesda system within the ASCUS, AGUS or LSIL classes. When the cytotest was in the HSIL class, a conization in the LLETZ method was performed. Cervugid is conceived for those three main categories of pathogenic factors related to the etiology of cervico-vaginitis: microbia germs, protozoa and mycosis. In addition, it is active on chlamydia and mycoplasms, always sensitive to chloramphenicol therapy. That is why Cervugid with in local administration is indicated in the microbial, trichomoniasis and mycotic vaginitis caused by one category of pathogenic agents or by associated forms, in cervicitis, in the pelvic inflammatory processes (pelvic congestion, metritis, adnexitis, and inflammatory processes associated with benign or malignant tumors of the genital apparatus). The results obtained proved that Cervugid is highly effective medicine.

Estrous Cyclicity in Mice During Simulated Weightlessness

NASA Technical Reports Server (NTRS)

Moyer, E. L.; Talyansky, Y.; Scott, R. T.; Tash, J. S.; Christenson, L. K.; Alwood, J. S.; Ronca, A. E.

2017-01-01

Hindlimb unloading (HU) is a rodent model system used to simulate weightlessness experienced in space. However, some effects of this approach on rodent physiology are under-studied, specifically the effects on ovarian estrogen production which drives the estrous cycle. To resolve this deficiency, we conducted a ground-based validation study using the HU model, while monitoring estrous cycles in 16-weeks-old female C57BL6 mice. Animals were exposed to HU for 12 days following a 3 day HU cage acclimation period, and estrous cycling was analyzed in HU animals (n=22), normally loaded HU Cage Pair-Fed controls (CPF; n=22), and Vivarium controls fed ad libitum (VIV; n=10). Pair feeding was used to control for potential nutritional deficits on ovarian function. Vaginal cells were sampled daily in all mice via saline lavage. Cells were dried and stained with crystal violet, and the smears evaluated using established vaginal cytology techniques by two individuals blinded to the animal treatment group. Estrous cyclicity was disrupted in nearly all HU and CPF mice, while those maintained in VIV had an average normal cycle length of 4.8+/- 0.5 days, with all stages in the cycle visibly observed. CPF and HU animals arrested in the diestrous phase, which precedes the pre-ovulatory estrogen surge. Additionally, infection-like symptoms characterized by vaginal discharge and swelling arose in several HU animals, which we suspect was due to an inability of these mice to properly groom themselves, and/or due to the change in the gravity vector relative to the vaginal opening, which prevented drainage of the lavage solution. Pair-feeding resulted in similar weight gains of HU and CPF (1.5% vs 3.0%, respectively). The current results indicate that pair-feeding controlled weight gain and that the HU cage alone influenced estrous cyclicity. Thus, longer acclimation needs to be tested to determine if and when normal estrous cycling resumes in non-loaded mice in HU cages prior to HU testing. Future studies might also examine whether modifications to the vaginal lavage procedure might prevent the onset of the infection-like symptoms, and allow estrous cyclicity to be measured in this model system. Research supported by NNX15AB48G to JST.

Before the Bar: Kinematic Detection of a Spheroidal Metal-poor Bulge Component

NASA Astrophysics Data System (ADS)

Kunder, Andrea; Rich, R. M.; Koch, A.; Storm, J.; Nataf, D. M.; De Propris, R.; Walker, A. R.; Bono, G.; Johnson, C. I.; Shen, Juntai; Li, Z.-Y.

2016-04-01

We present 947 radial velocities of RR Lyrae variable stars in four fields located toward the Galactic bulge, observed within the data from the ongoing Bulge RR Lyrae Radial Velocity Assay (BRAVA-RR). We show that these RR Lyrae stars (RRLs) exhibit hot kinematics and null or negligible rotation and are therefore members of a separate population from the bar/pseudobulge that currently dominates the mass and luminosity of the inner Galaxy. Our RRLs predate these structures and have metallicities, kinematics, and spatial distribution that are consistent with a “classical” bulge, although we cannot yet completely rule out the possibility that they are the metal-poor tail of a more metal-rich ([{Fe}/{{H}}]˜ -1 dex) halo-bulge population. The complete catalog of radial velocities for the BRAVA-RR stars is also published electronically.

Is complementary and alternative therapy effective for women in the climacteric period?

PubMed

Kim, Mi Young; Choi, Seung Do; Ryu, Aeli

2015-04-01

Vasomotor symptoms start about 2 years prior to menopause in women who are approaching menopause, and early menopause symptoms appear including emotional disturbance and anxiety, followed by physical changes such as vaginal dryness, urinary incontinence and skin wrinkles. As time progresses, osteoporosis, cardiovascular diseases, and dementia occur consecutively. Hormone therapy is primarily considered for the relief of menopause symptoms in postmenopausal women. However, as hormone replacement has emerged as a therapy that increases the potential risk of thrombosis, cerebral infarction and breast cancer, complementary and alternative medicine has drawn much attention. This study aimed to examine the types and effects of evidence-based complementary and alternative therapies that are currently used.

Bulge growth and quenching since z = 2.5 in CANDELS/3D-HST

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lang, Philipp; Wuyts, Stijn; Schreiber, Natascha M. Förster

2014-06-10

Exploiting the deep high-resolution imaging of all five CANDELS fields, and accurate redshift information provided by 3D-HST, we investigate the relation between structure and stellar populations for a mass-selected sample of 6764 galaxies above 10{sup 10} M {sub ☉}, spanning the redshift range 0.5 < z < 2.5. For the first time, we fit two-dimensional models comprising a single Sérsic fit and two-component (i.e., bulge + disk) decompositions not only to the H-band light distributions, but also to the stellar mass maps reconstructed from resolved stellar population modeling. We confirm that the increased bulge prominence among quiescent galaxies, as reportedmore » previously based on rest-optical observations, remains in place when considering the distributions of stellar mass. Moreover, we observe an increase of the typical Sérsic index and bulge-to-total ratio (with median B/T reaching 40%-50%) among star-forming galaxies above 10{sup 11} M {sub ☉}. Given that quenching for these most massive systems is likely to be imminent, our findings suggest that significant bulge growth precedes a departure from the star-forming main sequence. We demonstrate that the bulge mass (and ideally knowledge of the bulge and total mass) is a more reliable predictor of the star-forming versus quiescent state of a galaxy than the total stellar mass. The same trends are predicted by the state-of-the-art, semi-analytic model by Somerville et al. In this model, bulges and black holes grow hand in hand through merging and/or disk instabilities, and feedback from active galactic nuclei shuts off star formation. Further observations will be required to pin down star formation quenching mechanisms, but our results imply that they must be internal to the galaxies and closely associated with bulge growth.« less

CONSTRAINTS ON THE FORMATION OF THE GALACTIC BULGE FROM Na, Al, AND HEAVY-ELEMENT ABUNDANCES IN PLAUT's FIELD

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Christian I.; Rich, R. Michael; Kobayashi, Chiaki

2012-04-20

We report chemical abundances of Na, Al, Zr, La, Nd, and Eu for 39 red giant branch (RGB) stars and 23 potential inner disk red clump stars located in Plaut's low-extinction window. We also measure lithium for a super Li-rich RGB star. The abundances were determined by spectrum synthesis of high-resolution (R Almost-Equal-To 25,000), high signal-to-noise (S/N {approx} 50-100 pixel{sup -1}) spectra obtained with the Blanco 4 m telescope and Hydra multifiber spectrograph. For the bulge RGB stars, we find a general increase in the [Na/Fe] and [Na/Al] ratios with increasing metallicity, and a similar decrease in [La/Fe] and [Nd/Fe].more » Additionally, the [Al/Fe] and [Eu/Fe] abundance trends almost identically follow those of the {alpha}-elements, and the [Zr/Fe] ratios exhibit relatively little change with [Fe/H]. The consistently low [La/Eu] ratios of the RGB stars indicate that at least a majority of bulge stars formed rapidly ({approx}<1 Gyr) and before the main s-process could become a significant pollution source. In contrast, we find that the potential inner disk clump stars exhibit abundance patterns more similar to those of the thin and thick disks. Comparisons between the abundance trends at different bulge locations suggest that the inner and outer bulges formed on similar timescales. However, we find evidence of some abundance differences between the most metal-poor and metal-rich stars in various bulge fields. The data also indicate that the halo may have had a more significant impact on the outer bulge initial composition than the inner bulge composition. The [Na/Fe], and to a lesser extent [La/Fe], abundances further indicate that the metal-poor bulge, at least at {approx}1 kpc from the Galactic center, and thick disk may not share an identical chemistry.« less

ALMA observations of molecular absorption in four directions toward the Galactic bulge

NASA Astrophysics Data System (ADS)

Liszt, H.; Gerin, M.

2018-02-01

Context. Alma Cycle 3 observations serendipitously showed strong absorption from diffuse molecular gas in the Galactic bulge at -200 km s-1 < v < -140 km s-1 toward the compact extragalactic continuum source J1744-3116 at (l, b) = -2.13∘, - 1.00∘. Aims: We aimed to test whether molecular gas in the bulge could also be detected toward the three other, sufficiently strong mm-wave continuum sources seen toward the bulge at |b| < 3∘. Methods: We took absorption profiles of HCO+ (1-0), HCN(1-0), C2H(1-0), CS(2-1) and H13CO+(1-0) in ALMA Cycle 4 toward J1713-3418, J1717-3341, J1733-3722 and J1744-3116. Results: Strong molecular absorption from disk gas at |ν| ≲ 30 km s-1 was detected in all directions, and absorption from the 3 kpc arm was newly detected toward J1717 and J1744. However, only the sightline toward J1744 is dominated by molecular gas overall and no other sightlines showed molecular absorption from gas deep inside the bulge. No molecular absorption was detected toward J1717 where H I emission from the bulge was previously known. As observed in HCO+, HCN, C2H and CS, the bulge gas toward J1744 at v < -135 km s-1 has chemistry and kinematics like that seen near the Sun and in the Milky Way disk generally. We measured isotopologic ratios N(HCO+)/N(H13CO+) > 51(3σ) for the bulge gas toward J1744 and 58 ± 9 and 64 ± 4 for the disk gas toward J1717 and J1744, respectively, all well above the value of 20-25 typical of the central molecular zone. Conclusions: The kinematics and chemistry of the bulge gas observed toward J1744 more nearly resemble that of gas in the Milky Way disk than in the central molecular zone.

Diffraction and Smith-Purcell radiation on the hemispherical bulges in a metal plate

NASA Astrophysics Data System (ADS)

Syshchenko, V. V.; Larikova, E. A.; Gladkih, Yu. P.

2017-12-01

The radiation resulting from the uniform motion of a charged particle near a hemispheric bulge on a metal plane is considered. The description of the radiation process based on the method of images is developed for the case of non-relativistic particle and a perfectly conducting target. The spectral-angular and spectral densities of the diffraction radiation on the single bulge (as well as the Smith-Purcell radiation on the periodic string of bulges) are computed. The possibility of application of the developed approach to the case of relativistic incident particle is discussed.

Using 3D Spectroscopy to Probe the Orbital Structure of Composite Bulges

NASA Astrophysics Data System (ADS)

Erwin, Peter; Saglia, Roberto; Thomas, Jens; Fabricius, Maximilian; Bender, Ralf; Rusli, Stephanie; Nowak, Nina; Beckman, John E.; Vega Beltrán, Juan Carlos

2015-02-01

Detailed imaging and spectroscopic analysis of the centers of nearby S0 and spiral galaxies shows the existence of ``composite bulges'', where both classical bulges and disky pseudobulges coexist in the same galaxy. As part of a search for supermassive black holes in nearby galaxy nuclei, we obtained VLT-SINFONI observations in adaptive-optics mode of several of these galaxies. Schwarzschild dynamical modeling enables us to disentangle the stellar orbital structure of the different central components, and to distinguish the differing contributions of kinematically hot (classical bulge) and kinematically cool (pseudobulge) components in the same galaxy.

VizieR Online Data Catalog: OGLE II. VI photometry of Galactic Bulge (Udalski+, 2002)

NASA Astrophysics Data System (ADS)

Udalski, A.; Szymanski, M.; Kubiak, M.; Pietrzynski, G.; Soszynski, I.; Wozniak, P.; Zebrun, K.; Szewczyk, O.; Wyrzykowski, L.

2003-09-01

We present the VI photometric maps of the Galactic bulge. They contain VI photometry and astrometry of about 30 million stars from 49 fields of 0.225 square degree each in the Galactic center region. The data were collected during the second phase of the OGLE microlensing project. We discuss the accuracy of data and present color-magnitude diagrams of selected fields observed by OGLE in the Galactic bulge. The VI maps of the Galactic bulge are accessible electronically for the astronomical community from the OGLE Internet archive (2 data files).

K-band observations of boxy bulges - I. Morphology and surface brightness profiles

NASA Astrophysics Data System (ADS)

Bureau, M.; Aronica, G.; Athanassoula, E.; Dettmar, R.-J.; Bosma, A.; Freeman, K. C.

2006-08-01

In this first paper of a series on the structure of boxy and peanut-shaped (B/PS) bulges, Kn-band observations of a sample of 30 edge-on spiral galaxies are described and discussed. Kn-band observations best trace the dominant luminous galactic mass and are minimally affected by dust. Images, unsharp-masked images, as well as major-axis and vertically summed surface brightness profiles are presented and discussed. Galaxies with a B/PS bulge tend to have a more complex morphology than galaxies with other bulge types, more often showing centred or off-centred X structures, secondary maxima along the major-axis and spiral-like structures. While probably not uniquely related to bars, those features are observed in three-dimensional N-body simulations of barred discs and may trace the main bar orbit families. The surface brightness profiles of galaxies with a B/PS bulge are also more complex, typically containing three or more clearly separated regions, including a shallow or flat intermediate region (Freeman Type II profiles). The breaks in the profiles offer evidence for bar-driven transfer of angular momentum and radial redistribution of material. The profiles further suggest a rapid variation of the scaleheight of the disc material, contrary to conventional wisdom but again as expected from the vertical resonances and instabilities present in barred discs. Interestingly, the steep inner region of the surface brightness profiles is often shorter than the isophotally thick part of the galaxies, itself always shorter than the flat intermediate region of the profiles. The steep inner region is also much more prominent along the major-axis than in the vertically summed profiles. Similarly to other recent work but contrary to the standard `bulge + disc' model (where the bulge is both thick and steep), we thus propose that galaxies with a B/PS bulge are composed of a thin concentrated disc (a disc-like bulge) contained within a partially thick bar (the B/PS bulge), itself contained within a thin outer disc. The inner disc likely formed secularly through bar-driven processes and is responsible for the steep inner region of the surface brightness profiles, traditionally associated with a classic bulge, while the bar is responsible for the flat intermediate region of the surface brightness profiles and the thick complex morphological structures observed. Those components are strongly coupled dynamically and are formed mostly of the same (disc) material, shaped by the weak but relentless action of the bar resonances. Any competing formation scenario for galaxies with a B/PS bulge, which represent at least 45 per cent of the local disc galaxy population, must explain equally well and self-consistently the above morphological and photometric properties, the complex gas and stellar kinematics observed, and the correlations between them.

Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women.

PubMed

Gunther, Luciene Setsuko Akimoto; Martins, Helen Priscila Rodrigues; Gimenes, Fabrícia; Abreu, André Luelsdorf Pimenta de; Consolaro, Marcia Edilaine Lopes; Svidzinski, Terezinha Inez Estivalet

2014-01-01

Vulvovaginal candidiasis (VVC) is caused by abnormal growth of yeast-like fungi on the female genital tract mucosa. Patients with diabetes mellitus (DM) are more susceptible to fungal infections, including those caused by species of Candida. The present study investigated the frequency of total isolation of vaginal Candida spp., and its different clinical profiles - colonization, VVC and recurrent VVC (RVVC) - in women with DM type 2, compared with non-diabetic women. The cure rate using fluconazole treatment was also evaluated. Cross-sectional study conducted in the public healthcare system of Maringá, Paraná, Brazil. The study involved 717 women aged 17-74 years, of whom 48 (6.7%) had DM type 2 (mean age: 53.7 years), regardless of signs and symptoms of VVC. The yeasts were isolated and identified using classical phenotypic methods. In the non-diabetic group (controls), total vaginal yeast isolation occurred in 79 (11.8%) women, and in the diabetic group in 9 (18.8%) (P = 0.000). The diabetic group showed more symptomatic (VVC + RVVC = 66.66%) than colonized (33.33%) women, and showed significantly more colonization, VVC and RVVC than seen among the controls. The mean cure rate using fluconazole was 75.0% in the diabetic group and 86.7% in the control group (P = 0.51). We found that DM type 2 in Brazilian women was associated with yeast colonization, VVC and RVVC, and similar isolation rates for C. albicans and non-albicans species. Good cure rates were obtained using fluconazole in both groups.

Improved Model for Predicting the Free Energy Contribution of Dinucleotide Bulges to RNA Duplex Stability.

PubMed

Tomcho, Jeremy C; Tillman, Magdalena R; Znosko, Brent M

2015-09-01

Predicting the secondary structure of RNA is an intermediate in predicting RNA three-dimensional structure. Commonly, determining RNA secondary structure from sequence uses free energy minimization and nearest neighbor parameters. Current algorithms utilize a sequence-independent model to predict free energy contributions of dinucleotide bulges. To determine if a sequence-dependent model would be more accurate, short RNA duplexes containing dinucleotide bulges with different sequences and nearest neighbor combinations were optically melted to derive thermodynamic parameters. These data suggested energy contributions of dinucleotide bulges were sequence-dependent, and a sequence-dependent model was derived. This model assigns free energy penalties based on the identity of nucleotides in the bulge (3.06 kcal/mol for two purines, 2.93 kcal/mol for two pyrimidines, 2.71 kcal/mol for 5'-purine-pyrimidine-3', and 2.41 kcal/mol for 5'-pyrimidine-purine-3'). The predictive model also includes a 0.45 kcal/mol penalty for an A-U pair adjacent to the bulge and a -0.28 kcal/mol bonus for a G-U pair adjacent to the bulge. The new sequence-dependent model results in predicted values within, on average, 0.17 kcal/mol of experimental values, a significant improvement over the sequence-independent model. This model and new experimental values can be incorporated into algorithms that predict RNA stability and secondary structure from sequence.

The Bulging Behavior of Thick-Walled 6063 Aluminum Alloy Tubes Under Double-Sided Pressures

NASA Astrophysics Data System (ADS)

Cui, Xiao-Lei; Wang, Xiao-Song; Yuan, Shi-Jian

2015-05-01

To make further exploration on the deformation behavior of tube under double-sided pressures, the thick-walled 6063 aluminum alloy tubes with an outer diameter of 65 mm and an average thickness of 7.86 mm have been used to be bulged under the combined action of internal and external pressures. In the experiment, two ends of the thick-walled tubes were fixed using the tooth and groove match. Three levels of external pressure (0 MPa, 40 MPa, and 80 MPa), in conjunction with the internal pressure, were applied on the tube outside and inside simultaneously. The effect of external pressure on the bulging behavior of the thick-walled tubes, such as the limiting expansion ratio, the bulging zone profile, and the thickness distribution, has been investigated. It is shown that the limiting expansion ratio, the bulging zone profile, and the thickness distribution in the homogeneous bulging area are all insensitive to the external pressure. However, the external pressure can make the thick-walled tube achieve a thinner wall at the fracture area. It reveals that the external pressure can only improve the fracture limit of the thick-walled 6063 tubes, but it has very little effect on their homogeneous bulging behavior. It might be because the external pressure can only increase the magnitude of the hydrostatic pressure for the tube but has no effect on the Lode parameter.

Role of the CCA bulge of prohead RNA of bacteriophage ø29 in DNA packaging.

PubMed

Zhao, Wei; Morais, Marc C; Anderson, Dwight L; Jardine, Paul J; Grimes, Shelley

2008-11-14

The oligomeric ring of prohead RNA (pRNA) is an essential component of the ATP-driven DNA packaging motor of bacteriophage ø29. The A-helix of pRNA binds the DNA translocating ATPase gp16 (gene product 16) and the CCA bulge in this helix is essential for DNA packaging in vitro. Mutation of the bulge by base substitution or deletion showed that the size of the bulge, rather than its sequence, is primary in DNA packaging activity. Proheads reconstituted with CCA bulge mutant pRNAs bound the packaging ATPase gp16 and the packaging substrate DNA-gp3, although DNA translocation was not detected with several mutants. Prohead/bulge-mutant pRNA complexes with low packaging activity had a higher rate of ATP hydrolysis per base pair of DNA packaged than proheads with wild-type pRNA. Cryoelectron microscopy three-dimensional reconstruction of proheads reconstituted with a CCA deletion pRNA showed that the protruding pRNA spokes of the motor occupy a different position relative to the head when compared to particles with wild-type pRNA. Therefore, the CCA bulge seems to dictate the orientation of the pRNA spokes. The conformational changes observed for this mutant pRNA may affect gp16 conformation and/or subsequent ATPase-DNA interaction and, consequently, explain the decreased packaging activity observed for CCA mutants.