Cervical Ulcers Research Articles

The effect of Henna (Lawsonia inermis) vaginal suppository combined with antibiotic therapy in the treatment of cervicitis: An RCT.

Cervicitis is a prevalent gynecologic disease, which does not usually respond to conventional treatments. Long-term cervicitis can cause serious health problems such as inflammation, infertility, and cancer. Henna oil, an herbal product in Persian medicine, is recommended for uterine diseases like cervicitis. This study aims to evaluate the efficacy of Henna oil as a vaginal suppository in combination with an antibiotic regimen in the treatment of cervicitis. This randomized placebo-controlled trial, included 92 non-menopausal women with cervicitis at the Baqaipur Clinic of Shahid Sadoughi hospital in Yazd and the Persian Medicine Health Center in Ardakan, Yazd, Iran. Participants were further divided into either the Henna oil vaginal suppository group or the placebo group (n = 46/each group). During the study, the antibiotic treatment was administered to both groups. Cervicitis symptoms were compared between the groups and within each group. Of 92 included individuals, 41 in each group completed the study. Results revealed that significant differences were observed in some outcomes, including vaginal discharge (p 0.001), cervical ulcer size (p 0.001), dyspareunia (p = 0.046), and postcoital bleeding (p 0.001), indicating that the treatment was more effective in the henna group compared to the placebo group. Findings supported that the vaginal suppository of Henna oil in combination with antibiotic therapy could be effective in the improvement of clinical symptoms of cervicitis regardless of its pathology.

A review: The study of pathogenic bacteria that cause antibiotic-resistant cervical ulcers in young women

Cervicitis is the medical term for infection of the cervix in females. usually spread sexually. Upper vaginal tract issues can result from the silent infection cervicitis, which is typically asymptomatic. Increasing vaginal discharge, whether or not there is vaginal bleeding, is the most significant. The microorganisms known to cause cervicitis include the genus Chlamydia trachomatis, Neisseria gonorrhea, and Mycoplasma genitalium. molecular methods and cultures are used to determine the diagnosis. the females who are most likely to contract these diseases.

Cervical ulcer caused by group B streptococcus with bacterial vaginosis: a case report

The female genital ulcer is a manifestation of many diseases, which may vary depending on the etiology, disease duration, age, and host immunity. A middle-aged (40–50 years) woman had a 4-month history of vaginal bleeding. The results of syphilis, herpes, the cervical cancer, tuberculosis, and fungi or acute cervical inflammation caused by Chlamydia trachomatis and Mycoplasma hominis were negative through the blood test and the biopsy. Cervical discharge culture revealed positive for group B Streptococcus and bacterial vaginosis. The patient was treated with oral antibiotics for 7 days. One month later, repeat colposcopy revealed a smooth cervix and complete ulcer disappearance, while cervical discharge culture retested no group B Streptococcus and bacterial vaginosis. The patient was diagnosed with cervical ulcer. Complete medical history taking and bacterial culture of cervical discharge are important for identifying the etiology of the cervical ulcer and deciding the appropriate treatment for the disease.

DETECTION OF ABNORMAL CERVICAL CYTOLOGY BY LBC (LIQUID BASED CYTOLOGY)

Introduction: Cancer cervix is the fourth most common cancer among women globally. It is responsible for 7.7% of all female cancer death.It takes around 15-20 years in normal immunity patients and 5-10 years in immune-compromised patients to convert precancerous lesions of the cervix into cancer cervix. Cervical cytology plays a very important role in the early diagnosis and management of these precancerous lesions to improve prognosis.quite low Pap smear sensitivity, in the range of 50%, but as low as 20%10 has been reported by some recent meta-analysis studies. LBC was introduced in the mid-1990s as an alternative technique to process cervical smear samples for cytological evaluation.11Studies of the accuracy of liquid-based preparations reports sensitivity of 61-66% and specicity of 82- 91%. A retrospective study was done at a private clinic and pathology lab in Di Materials And Methods: strict Shivpuri (MP) from 1st October 2020to 30th November 2022 on 760 patients. Inclusion criteria:-Patients in the age group of 21-65 years with complaints of abnormal vaginal discharge, intermenstrual bleeding, ostmenopausal bleeding, post-coital bleeding, dyspareunia, foul-smelling discharge, backache, and Lower abdominal pain were included in this study. Sample was taken with Broom, and Cyto-brush from the transformation zone and endocervix and placed in liquid xative buffered methanol solution and send to the pathology lab. Results Most of the patient 42% were between 31-40 years of age group. The majority 48.42% of them were educated up to High school. Most of them 84.07%were from rural back ground, multiparous 86.05%, and married 99.73%. 25% ofwomen visited OPD with complaints of abnormal vaginal discharge followed by menstrual abnormalities in 20.79%, other complaints were, Pain abdomen 16.97%, Vulval itching12.11%, Low back pain 3.95%, Dyspareunia 3.03% and others 5.13%. (Loss of weight and appetite, STD/genital warts) .9.08% women came for routine checkup. The most common nding on per speculum examination was Cervical ectopy in 33.95% .Normal cervix was found in 26.05%. Other ndings on Per-speculum examination were, Hypertrophied cervix, Inammation, Cervical Polyp, UV Prolapse/ cystocele, Cervical Ulcer ,Cervix ushed with the vagina and Cervical growth in. 20%, 9.08%, 4.34% 4.61% 3.03% 0.13% and 0.13% respectively. Out of 760 cases, 61.05% of patients were reported as negative for intraepithelial lesion (NILM). The most common non-neoplastic cytological nding was an inammatory smear in 25.00% of cases. Various Infections were found in 6.18% of cases, and epithelial cell abnormalities were found in 3.42% of cases. The most common abnormalities were ASC-US 0.92% and ASC-H 0.92%, followed by LSIL 0.53%, HSIL 0.66%, AGUS 0.26%, and SCC 0.13%. Bacterial vaginosis 2.37% was the most common infective organism found in cytology followed by Candida albicans 1.97%, Trichomonas vaginalis 1.71%, and Herpes simplex virus 0.13%. The cytology-based screening program is still the mainstay in the earl Conclusion y diagnosis of cancer cervix. To improve diagnostic accuracy as sensitivity and specicity in the eld of cervical cytology, Liquid-based cytology (LBC) is preferred. Its advantages over conventional Pap smears include proper visualization of cellular features due to a reduction in air-drying artifacts and reduced number of unsatisfactory smears. The residual specimens from the LBC technique can be used to detect human papillomavirus DNA through immune-cytochemistry if needed. thus, LBC is recommended as a cervical cytology screening tool to achieve the WHO elimination strategy.

Antibacterial and anti-trichomunas characteristics of local landraces of Lawsonia inermis L.

BackgroundHenna (Lawsonia inermis) with anti-bacterial properties has been widely used in traditional medicine especially Persian medicine. Henna oil is suggested for diseases of infectious origin, such as cervical ulcers. Group B Streptococcus agalactiae, Pseudomonas aeruginosa and, Trichomonas vaginalis are involved in the infection of women especially cervicitis. Henna grows in dry and tropical regions. The main important landraces of henna landraces are cultivated in Kerman, Sistan and Baluchestan, Hormozgan, and Bushehr provinces in Iran.Proper use of antimicrobial agents, use of new antimicrobial strategies, and alternative methods, such as herbal methods may help reduce drug resistance in the future. This study’s objective was to investigate the anti-Trichomonas vaginalis activity of three different henna landraces and antimicrobial effects against group B Streptococcus agalactiae and, Pseudomonas aeruginosa.MethodsTotal phenol content was measured by Folin ciocaltu method. Antibacterial effect of landraces of Henna against P. aeruginosa and S. agalactiae were assayed by well diffusion method and minimal inhibitory concentration assessments were done using the broth micro-dilution technique. Anti-Trichomonas effect of Henna landraces were assayed by Hemocytometery method.ResultsTotal phenol content of Shahdad, Rudbar-e-Jonub, and Qaleh Ganj was 206.51, 201.96, and 254.85 μg/ml, respectively. Shahdad, Rudbar-e-Jonub, and Qaleh Ganj had MIC against GBS at 15, 15 and, 4 μg/ml. The growth inhibition diameter of the most effective henna (Shahdad landrace) at a concentration of 20 μg/ml on P. aeruginosa was 2.46 ± 0.15 cm and in the MIC method at a concentration of 5 μg/ml of Shahdad landrace, P. aeruginosa did not grow. IC50 of shahdad Henna after 24 h, 48 h, and 72 h was 7.54, 4.83 and 20.54 μg/ml, respectively. IC50 of Rudbar-e-Jonub extract was 5.76, 3.79 and 5.77 μg/ml in different days. IC50 of Qaleh Ganj extract was 6.09, 4.08 and 5.74 μg/ml in different days.ConclusionsThe amount of total phenol in Qaleh Ganj was higher than the other varieties. In the well diffusion method, Qaleh Ganj was more effective against group B Streptococcus (Gram-positive bacterium) than the other two landraces, and Shahdad landrace was more effective against P. aeruginosa (Gram-negative bacterium) than other. In the MIC method, the same result was obtained as in the well diffusion method, but at a lower concentration.

Assessment of alternative approaches of primary cervical cancer screening among women in low-income environments

Alternative techniques for detecting cancer of the cervix uteri alongside its early precancerous lesions still remain necessary for low income environments since morbidity and mortality due to cervical cancer continues to be on the rise. We recruited one thousand and seventy-seven women aged 15-55 years from selected study hospitals in Eastern Uganda and examined them using Papanicolaou (Pap) smear, direct visual inspection with 5% acetic acid solution (VIA), and human papillomavirus (HPV) DNA testing. Study participants detected with high-grade lesions (HSIL) or cancer cells on Pap smear test, positive VIA test (acetowhite lesions, cervical ulcer or growth), and positive high-risk HPV DNA (relative light units (RLU) were immediately scheduled for colposcopy and cervical biopsy. Of the forty percent of the women confirmed with pap smear positive, 43 of the 63 women had invasive carcinoma (68.3%), while 89 out of 137 women with confirmed biopsy were diagnosed with high grade CIN (CIN2,3) (65%). DVI identified 46 of 63 carcinomas (73%) as well as 47 of 74 high grades CIN (CIN 2, 3) (64%). There was a variation in HPV DNA results due to the cutoff value considered in defining the final result. HPV DNA of high-risk HPV types was detected 39 (61.9%) out the 63 women diagnosed invasive cervical cancer, while 66 (73.3%) or 46 (51%) was detected in the biopsy of women diagnosed with high grade CIN (CIN 2,3). Similarity in identification of high-grade cervical abnormalities was registered by the testing methods. Both VIA and HPV genetic testing methods diagnosed similar numbers of high grade CIN 2,3 and invasive cancer cases as Pap smears. Nevertheless, individual test methods categorized study participants with no cervical disease as being positive. Key words: Visual inspection with acetic acid (VIA), cervical intraepithelial neoplasia (CIN), human papillomavirus (HPV).

S. S. Zayitsky. - Three cases of Schroeder's extirpation of a cancerous-born uterus through the vagina using Richelot tweezers. (Medical Review., 1895, No. 9)

Judging by the description given by Richelot, the course of his operation seems to be the same as that of Schrder, only ligatures are used instead of tweezers in the last day. The idea of using the tweezers belongs to Pan proper. Seeing the speed of the operation as a guarantee of its success, the author decided to try Richelot's way mainly, in view of the speed that should belong to this method. 1st patient. 24 years old. Cervical ulcer and infiltration in the left parameters. 2 tweezers were applied, which lasted for 2 days, causing severe pain. Operation 30 minutes.

The Study of Relationship Between Risk Factors for Cervical Cancer and Knowledge and Attitude of Health Workers Toward Pap Smear in Isfahan and Its Comparison with Chaharmahal and Bakhtiari Province, Iran

Background: Cervical cancer is one of the most common cancers in the female reproductive system. Awareness of cervical cancer diagnosis, risk factors and screening can lead to rapid treatment and their well-being. Methods: This cross-sectional study was conducted on 1900 female health workers in Isfahan province and 230 similar women in Chaharmahal and Bakhtiari province. A researcher-made questionnaire was used to collect data about knowledge and attitude. Numerical outcomes were analyzed using ANOVA and linear regression methods and categorical outcomes were applied to the chi-squared test. Data were analyzed at 5% significant level using SPSS 23. Results: The result of linear regression showed that there was a significant difference in the mean score of knowledge about Pap smear in both provinces (P = 0.001). There was a significant relationship between the mean scores of knowledge about Pap smear in Isfahan province and marriage at an early age (P = 0.001), smoking (P = 0.005) and Chaharmahal and Bakhtiari province with cervical ulcer (P = 0.03). In addition, there was a significant difference in the mean score of attitude toward Pap smear between both provinces (P = 0.001) and there was a significant relationship between the mean scores attitude toward Pap smear in Isfahan province and marriage at an early age (P = 0.001), cervical ulcer (P = 0.002), and smoking (P = 0.001) and Chaharmahal and Bakhtiari province with genital infection (P = 0.012) increase the number of pregnancies (P = 0.002). Conclusions: Considering the importance of knowledge and attitude of female health worker in both provinces, it is necessary to carry out educational programs especially in the provinces of Chaharmahal and Bakhtiari.

Uterine prolapse with complete placenta praevia and umbilical hernia in pregnancy: a case report

Background: Uterine prolapse in pregnancy is rare but it can cause various complications including abortion, preterm labor, cervical ulceration, urinary tract infection, etc. Risk factors include older age, ethnicity, family history, increased body mass index, higher parity, vaginal delivery, and constipation. Case: A nulliparous woman presented with uterine prolapse complicated with complete placenta previa and umbilical hernia. Magnesium sulfate and corticosteroids were administered and prophylactic antibiotic therapy was initiated. A selective low-segment cesarean section was performed at 36+3 week because of complete placenta previa and irregular uterine contractions. Conclusion: Uterine prolapse is rare in pregnancy but usually complicated with infection and preterm labor. Treatment for uterine prolapse in pregnancy needs to be based on patient's will, gestation, severity of prolapse, and other complications. An elective near-term cesarean section may be the safest delivery mode.

Laparoscopic Sacrohysteropexy in a Woman at 12 Weeks' Gestation

Study ObjectiveTo demonstrate laparoscopic sacrohysteropexy for a case of uterine prolapse in a 12 weeks, 3 days pregnant woman. To our knowledge this is the first case of laparoscopic sacrohysteropexy performed at 12 weeks of gestation to be reported in literature. DesignA step-by-step explanation of the surgical procedure (Canadian Task Force classification III). SettingMaltepe University Hospital. PatientA 37-year-old pregnant woman. InterventionLaparoscopic sacrohysteropexy. Institutional Review Board ruled that approval was not required for this study. Measurements and Main ResultsUterine prolapse is very rare condition, manifesting in an estimated 10 000 to 15 000 pregnancies [1]. The management plan must be individualized, and the obstetrician should aware of possible complications, such as preterm labor, high incidence of abortion, cervical ulceration, and cervical dystocia. In general, bedrest, good genital hygiene, and pessary use is recommended. Alternatively, in cases where conservative solutions have failed, laparoscopic surgery in the pregnant patient may be considered. To date, only 1 case of laparoscopic promontohysteropexy at 10th weeks of gestation was reported by Pirtea et al [2]. A 37-year-old woman, at 12 weeks and 3 days of gestation, with stage III pelvic organ prolapse was referred to our clinic. Conservative management with pessary failed. The patient underwent laparoscopic sacrohysteropexy after written informed consent form was obtained. In exploration, uterine manipulation was difficult because of softness and large size of the uterus. First, the sigmoid colon was suspended at the abdominal wall to gain an adequate surgical field. The promontorium was dissected and the parietal peritoneum incised on the right pelvic side wall after ureter visualization. A polypropylene mesh was fixed to the cervix at the level of the uterosacral ligaments. The other edge of the mesh was fixed at the level of the promontory using the Uplift device (Neomedic International, Barcelona, Spain). Then, the peritoneum was sutured to cover the mesh. The patient was discharged 2 days after surgery. At the examination the pelvic floor was detected to be normal. The patient delivered a healthy baby weighing 3030 g by cesarean section at 38 weeks of gestation. The position of the mesh was controlled during surgery. There was no peritoneal fold detected on the cervical part of mesh; however, no adhesion was observed. ConclusionLaparoscopic sacrohysteropexy may be an alternative and safe approach, if conservative treatment fails, for pelvic organ prolapse during pregnancy.

Hodgkin lymphoma of the uterine cervix

An important cause of malignancy in women, cervical neoplasia commonly takes the form of either invasive squamous cell carcinoma or glandular neoplasms. Classical Hodgkin's lymphoma of the uterine cervix is rare with limited cases recorded in the 1960s and 70s.1–4 We present a case of classical Hodgkin lymphoma of the cervix in a 50-year-old immunosuppressed patient with known sarcoidosis, who presented with prominent B symptoms and radiographic features suggestive of cervical malignancy with associated nodal disease. The lesion was initially biopsied and treated with ABVD with radiographic nodal response but minimal response in the primary. Subsequent hysterectomy revealed a 35 mm cervical mass with cervical ulceration. Histologically, the mass comprised enlarged and atypical lymphocytes, many with Reed-Sternberg appearance, occurring amongst a mixed inflammatory background rich in eosinophils, with extensive fibrosis and focal necrosis. A classical Hodgkin lymphoma phenotype was seen on immunohistochemistry, with negativity for CD45 and CD20, strong positivity for CD30, MUM-1 and EBER-ISH, weak positivity for Pax-5, CD15 and Oct-2, but with complete negativity for BOB-1. EBV-positive mucocutaneous ulcers, which histopathologically and immunohistochemically mimic classic Hodgkin lymphoma, have been reported in the literature5 usually occurring in immunocompromised patients. Clinical and radiological correlation is important when distinguishing between these two entities.

Carcinome épidermoïde associé à une dépigmentation volontaire

Women widely use skin-lightening products for cosmetic purposes in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. The occurrence of epidermoid carcinoma has long been reported, but only three cases have been published so far. We report the first case in Mali. A 30-year old woman with no noteworthy medical history was seen at our outpatient center for cervical ulceration that had been present for the last 5 years. She had used cosmetic bleaching cream over a period of around ten years. Physical examination revealed extensive ulceration on the left side of her neck. Blood tests for viral hepatitis and human immunodeficiency virus were negative. The pathological examination of the skin biopsy confirmed the diagnosis of squamous cell carcinoma. After failure of the initial excision with early relapse, multiple surgical ablations were performed 3 months later. The high prevalence of skin-lightening cosmetic use contrasts with the rarity of epidermoid carcinoma in depigmented skin. However, a large chronic ulcer on uncovered parts of the upper body, particularly the neck, should prompt physicians to consider skin cancer. Appropriate preventive measures include the promotion of educational messages for the general population, the use of sun-protection devices, and routine skin biopsy for all women presenting chronic cervical ulceration after long-term use of skin-lightening products.

Old but Gold: The Importance of Medical History in Diagnosing Neutrophilic Dermatoses Characterized by Pathergy. A Case of Pyoderma Gangrenosum

We describe the case of an 84-years old woman referred to our clinic without an established diagnosis in 2015 for the presence of multiple cervical ulcers since 2013, when she underwent vascular surgery of the carotid arteries. The ulcers had infiltrated and actively inflamed violaceous borders; they were itchy and showed signs of scratching. The patient had already been prescribed different antibiotic treatments, without any clinical improvement. Multiple biopsies had also been performed, but histology was not diagnostic, showing a non-specific dermal inflammatory infiltrate. Despite optimal wound care treatment, we observed a dramatic worsening of the skin lesions, spreading from the neck to the vertex, especially at sites of minor trauma (for example, starting from scratch lesions). The presence of pathergy, which consists in the occurrence of lesions at sites of trauma, suggested the diagnosis of pyoderma gangrenosum. Systemic glucocorticoid therapy was then prescribed, with quick improvement and nearly completes clinical remission. Our case confirms the importance of anamnesis and detailed collection of symptoms associated with the clinical manifestations in dermatological dermatoses such as pyoderma gangrenosum where imaging, histology and laboratory findings are often not very helpful for a correct diagnosis.

Repair of cervical postradiation ulcer following radical mastectomy with lower trapezius myocutaneous flap

To explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy. Six patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back. Pain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well. On the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.

Procidentia in pregnancy: a systematic review and recommendations for practice.

Pelvic organ prolapse (POP) in pregnancy is a rare condition with decreasing incidence and improved management and outcome world-widerecently. Systematic review of the literature for cases of POP in pregnancy published since 1990 was carried out to identify common factors in presentation, management and outcomes. One case from our own practice was added to the analysis. An extensive search of the Pubmed/Medline, Scopus and Google Scholar databases was performed to identify all cases of POP in pregnancy since 1990. Published case reports of POP in pregnancy were reviewed and summarized in tables to find similarities in history, course, management and outcome of the pregnancies. Of the 43 cases and one case series, 41 case studies were eligible for analysis. Two types of POP in pregnancy were identified: preexisting is less common (14 vs 27 cases), often resolves during pregnancy (5 out of 14) and always recurs after delivery (14 out of 14); acute onset of POP in pregnancy rarely resolves in pregnancy (2 out of 27), but often resolves after delivery (18 out of 27). Most patients were managed with bed rest (20 out of 41), pessary (15 out of 41), manual reduction (6 out of 41) and local treatment (6 out of 41). The most common complications reported include preterm labour (14 out of 41), cervical ulcerations (9 out of 41), infection (3 out of 41) and obstructed labour (4 out of 41). About a half of the women delivered vaginally (22 out of 41), caesarean section due to prolapse was required in 15 cases. Two distinct entities were identified based on similarities regarding onset, course and outcome of POP in pregnancy. Concise recommendations for practice were derived from the analysis of case studies published since 1990.

A Question for Women's Health: Chemicals in Feminine Hygiene Products and Personal Lubricants

Vaginal research got a desperately needed boost at the National Institutes of Health (NIH) in 1992. That’s when Penny Hitchcock took over the Sexually Transmitted Diseases Branch at the National Institute of Allergy and Infectious Diseases and Nancy Alexander became chief of the Contraceptive Development Branch in the NIH Center for Population Research—posts previously held by men. “Those two got together and discovered NIH had no programs for vaginal research,” says Richard Cone, a Johns Hopkins biophysics professor. Cone had begun developing vaginal contraceptives that would protect against sexually transmitted infections (STIs) in 1980, and until then, struggled to get funding. Mucous membranes in the vagina and vulva rapidly absorb chemicals without metabolizing them. But until recently scant research existed on how chemicals in feminine hygiene products and personal lubricants may affect women’s health. Hitchcock and Alexander soon initiated research programs on vaginal physiology, immunology, and microbicides, eventually funding Cone’s work. These new programs led to groundbreaking discoveries in animals and humans that certain chemicals—including glycerin (glycerol), a common base for personal lubricants—can damage or irritate vaginal1 and rectal2 epithelial cells, potentially increasing the transmission of STIs such as herpes and human immunodeficiency virus. When it comes to reproductive health, research on contraceptives and STIs continues to garner interest worldwide. But a related area—chemical exposures from feminine hygiene products and personal lubricants—has received much less attention. In the United States alone, women spend well over $2 billion per year on feminine hygiene products,3 including tampons, pads, feminine washes, sprays, powders, and personal wipes. But until recently, scant research existed on how chemicals in these products may affect women’s health. As scattered findings emerge, several scientists and interest groups are calling for more research to fill in the gaps.4,5 A recent report by the nonprofit Women’s Voices for the Earth (WVE) points out that feminine hygiene products may use ingredients that are known or suspected endocrine-disrupting chemicals (EDCs), carcinogens, or allergens. And while nearly all women use tampons and sanitary pads, black and Latina women use douches, wipes, powders, and deodorizers more often than women of other races, putting them at greater risk of potential chemical exposures.4 “It’s a little bit edgy. People have been shocked, saying things like ‘I’ve never really thought about [the vagina] being an important internal link to your body,’” says Alexandra Scranton, director of science and research for WVE. “Although it is well known that the vaginal ecosystem is more sensitive and more absorbent than typical skin, there is surprisingly little research out there on feminine care products.” Surveys conducted in the 1990s–2000s gave a sense not only of how commonly some products are used but also how widely use can vary across racial/ethnic groups.

Cytological diagnosis of tuberculous cervicitis: A case report with review of literature

Tuberculosis of cervix is a rare disease. Tuberculosis usually affects women of childbearing age, indicating hormone dependence of infection. The patient presents with menstrual irregularities, infertility or vaginal discharge. Cervical lesions presents as papillary/vegetative growth or ulceration mimicking cervical cancer. Cervical Papanicolaou (Pap) smear plays an important role in diagnosing the disease by non-invasive technique in which the presence of epithelioid cells and Langhan's type of giant cells is diagnostic. However, other causes of granulomatous cervicitis should be considered and ruled out. Ziehl-Neelsen (ZN) stain for acid fast bacilli, fluorescent technique, biopsy and culture help in confirming the disease. We present the case of a 45-year-old female, who presented with vaginal discharge, dysfunctional uterine bleeding, first degree uterine descent with grade II cystocele and rectocele and cervical ulcer. Pap smear revealed epithelioid cells and Langhan's type of giant cells, confirmed by ZN stain of cervical smear, fluorescent technique and culture.

Repeated pregnancy in a woman with uterine prolapse from a rural area in Nepal

Pelvic organ prolapse is common in rural women in Nepal. Pregnancy in a woman with pelvic organ prolapse is uncommon and rarely continues beyond the second trimester. If it proceeds after that, the uterus usually ascends with progression of pregnancy and becomes abdominal, leaving little trace of prolapse. Pregnancy continuing to term with uterine prolapse is very rare. The case reported here is of a pregnant woman from a remote district in Nepal who had nine pregnancies and at 38 weeks of pregnancy presented at the district hospital with severe uterine prolapse, a large cervical ulcer and the baby's foot protruding from the cervix. Air transport was the only means of reaching the nearest hospital with emergency obstetric care, 200km away. The baby was delivered stillborn at the airport by the auxiliary nurse-midwife who accompanied her. Her husband was counselled for and had a vasectomy. The woman was fitted with a ring pessary but could not afford to go to the nearest town for surgery for the prolapse. People in remote areas of Nepal often seek medical advice very late. This and the lack of education, low utilisation of family planning services, and lack of skilled birth attendance and safe delivery centres at local level contribute to high maternal morbidity and mortality.

Concomitant Malacoplakia and Granuloma Inguinale of the Cervix in Acquired Immune Deficiency Syndrome

We describe concomitant granuloma inguinale (GI) and malacoplakia of the cervix in 2 acquired immune deficiency syndrome (AIDS) patients aged 27 and 36 years. Both patients presented with a bloody foul-smelling vaginal discharge. Speculum examination confirmed cervical ulceration, prompting the diagnosis of cervical carcinoma in both patients. Cervical punch biopsies confirmed the characteristic features of GI; granulation tissue containing a dense plasma cell infiltrate, aggregates of neutrophils, and vacuolated enlarged histiocytes containing Donovan bodies were noted. Many of these histiocytes and sheets of von Hansemann cells contained intracytoplasmic Michaelis-Gutmann bodies, confirming concomitant malacoplakia. Michaelis-Gutmann bodies were also present in extracellular locations. Ultrastructural examination confirmed these histopathologic findings. One patient died of disseminated tuberculosis before treatment was initiated. The other patient did not return for a follow-up visit of her cervical lesion. Concomitant GI and malacoplakia is unreported in genital and extragenital sites; Klebsiella granulomatis must therefore be added to the list of bacteria associated with malacoplakia. Malacoplakia of the female genital tract is documented rarely and remains unreported, to date, in AIDS patients. Similar to the pathogenetic mechanisms described for AIDS-associated malacoplakia in extragenital sites, it is hypothesized that, in addition to abnormal macrophage functioning and an inability to degrade bacteria, special constituents of K. granulomatis are undigestable by lysosomal enzymes in human immunodeficiency virus-infected patients.

Clinical practice. Genital herpes.

A 22-year-old woman presents to her gynecologist with genital lesions. Examination reveals bilateral labial ulcerations, cervical ulcerations, and mildly tender inguinal lymphadenopathy. To her knowledge, neither she nor any of the four sexual partners she has had, including her husband of two years, has ever had herpes. How should this patient's case be managed?