Genital Symptoms Research Articles

Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients' Needs.

IntroductionMedical providers may not be familiar with the genitourinary and sexual symptoms of transgender and non-binary (TGNB) individuals. This lack of familiarity may hinder a provider's ability to address these issues as patients may hesitate to report symptoms due to fear of stigma, misgendering, and being treated disrespectfully.AimTo describe the array of genitourinary and sexual symptoms in transfeminine individuals.MethodsUpon institutional review board approval, researchers used semi-structured interviews with 25 transfeminine individuals assigned male at birth to explore urinary and sexual symptoms on a sample of convenience. Participants were recruited and interviews were conducted until saturation was achieved. Two research assistants independently coded all de-identified transcripts and resolved discrepancies.OutcomesThematic codes pertaining to genitourinary and sexual symptoms were defined and assessed in this study.ResultsSome genitourinary symptoms unrelated to hormone therapy or genital gender-affirming surgery (GGAS) included frequency, urgency, nocturia, and incontinence, while those attributed to GGAS included slow stream, spraying, and retention. Sexual symptoms unrelated to hormone therapy or GGAS included sexually transmitted infections, erectile dysfunction, and low libido. Sexual symptoms related to GGAS included delayed ejaculation, penile pain, scar tissue pain, and pain with receptive vaginal penetration.Clinical ImplicationsIncreased provider awareness of and accountability for the treatment of genital and sexual symptoms of transfeminine individuals.Strengths and LimitationsOpen-ended questions were used to generate a range of responses and perspectives through conversation instead of quantifiable data. Findings are not applicable to all TGNB people since participants were limited to transfeminine adults assigned male at birth only. Recruitment was limited by the sensitive nature of the topic and hard-to-reach populations and relied on convenience through flyers and a chain-referral sampling approach.ConclusionTransfeminine individuals experience a wide array of genitourinary and sexual symptoms both similar and different to their cis gender counterparts.Chung PH, Swaminathan V, Spigner S, et al. Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients’ Needs. Sex Med 2022;10:100566.

Comparison of the Clinical Profile of Prepubertal versus Pubertal Female Child Sexual Abuse in a Tertiary Hospital

Objective. This study aimed to compare the clinical profile of prepubertal and pubertal female child sexual abuse.
 Methods. A cross-sectional analytical study involving 43 sexually abused children was done. Each patient was categorized as prepubertal or pubertal based on the Tanner stage. Medical history was gathered using a structured interview and physical examination done with proper documentation after obtaining consent. Blind review by child protection specialists was done on genital images. Descriptive statistics were utilized for all variables.
 Results. This study showed 11.97% and 22.22% prevalence for prepubertal and pubertal child sexual abuse, respectively. Most prepubertal children disclosed digital vaginal penetration by the father and non-relative household members, while most pubertal children reported penile-vaginal penetration by the boyfriend. Fondling was common to both groups. The majority were repeated abuse and usually happened at the perpetrator’s house. Behavioral changes and genital symptoms were common in prepubertal children. Findings of hymenal trauma were found in 25% of prepubertal girls and half of the pubertal adolescents. The interobserver variability of these hymenal findings was fair. The prevalence of sexually transmitted infections (STIs) was low, none for the prepubertal children, and only 6% of the adolescent had STI, which was Hepatitis B.
 Conclusion. The clinical profile of sexually abused prepubertal children differed from that of pubertal adolescents. There was a higher incidence of hymenal trauma and STIs in adolescents.

Absence of lower genital tract lesions among women of reproductive age infected with Schistosoma mansoni: A cross-sectional study using a colposcope in Western Kenya.

BackgroundFemale genital schistosomiasis (FGS) constitutes four different lesions known to be caused by Schistosoma haematobium ova deposited in the genital tract. Schistosoma mansoni ova may also be found in the genital tract. However, it is not known if S. mansoni causes lower genital tract lesions characteristic of FGS.MethodologyThis study was conducted in 8 villages along the shores of Lake Victoria, western Kenya. Stool and urine samples, collected from women of reproductive age on three consecutive days, were analysed for S. mansoni and S. haematobium infection. S. mansoni positive and S. haematobium negative willing participants, aged 18–50 years were invited to answer a questionnaire (demographics, symptoms), undergo a gynaecological examination and cytology specimen collection by an FGS expert.Principal findingsGynaecologic investigations were conducted in 147 S. mansoni-positive women who had a mean infection intensity of 253.3 epg (95% CI: 194.8–311.9 epg). Nearly 90% of them used Lake Victoria as their main water source. None were found to have cervicovaginal grainy sandy patches or rubbery papules. Homogenous yellow patches were found in 12/147 (8.2%) women. Women with homogenous yellow patches were significantly older (47 years) than the rest (34 years, p = 0.001). No association was found between intensity of S. mansoni infection and homogenous yellow patches (p = 0.70) or abnormal blood vessels (p = 0.14). S. mansoni infection intensity was not associated with genital itch, bloody or malodorous vaginal discharge.ConclusionS. mansoni infection was neither associated with lower genital tract lesions nor symptoms typically found in women with FGS.

Clinical presentations of genitourinary syndrome of menopause (GSM) among menopause women

Genitourinary syndrome of menopause (GSM) is a new term that describes a variety of menopausal symptoms and signs that include not only genital symptoms, sexual symptoms, and impaired function, but also urinary tract symptoms. GSM is caused not only by estrogen deficiency but also by degenerative effects and other bladder and pelvic floor processes. This study aimed to detect GSM symptoms in menopausal women in order to be able to provide effective therapy that is appropriate for improving menopausal women's quality of life. A cross-sectional study was conducted in which data of 32 menopausal women who met the inclusion criteria from December to May 2022 were collected at Arifin Achmad Hospital in Pekanbaru, Riau, Indonesia. The age of menopausal women included in this study ranged between 40?71 years and 43.8% patients had 15 years of length menopause. There were 40.6% of patient reported vaginal dryness, 72% felt pain or heat during urination and 96.9% had no recurrent urinary tract infections. Other complaints that were also reported were feeling less orgasm during sexual intercourse (54.9%) and having vaginal discharge (21.9%). Mother bothersome symptoms (MBS) was also reported that included phonophobia (9.4%), nausea (16.1%), and photophobia (6.6%). In conclusion, several complaints of menopausal individuals were reported this included vagina dryness, pain or burning when urinating, less orgasm during sexual intercourse, having vaginal discharge, and having complaints of fear, anger, and anxiety when hearing certain sounds that trigger negative emotions. These findings can be used to understanding the menopausal individuals and to be able to provide appropriate measures to ensure good quality of life to this community.

New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review

Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. The currently available therapies include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and Ospemifene. Considering, however, that such therapies have some problems that include contraindications, ineffectiveness, and low compliance, finding an innovative, effective, and safe treatment is crucial. The present data suggest great efficacy and safety of a vaginal laser in the treatment of genital symptoms and improvement in sexual function in patients affected by VVA. The beneficial effect tends to be sustained over the long-term, and no serious adverse events have been identified. The aim of this review is to report up-to-date efficacy and safety data of laser energy devices, in particular the microablative fractional carbon dioxide laser and the non-ablative photothermal Erbium-YAG laser.

Gonococcal arthritis: case series of 58 hospital cases.

Extra-genital manifestations of gonococcal infection are rare (0.5-3%). Among them, gonococcal arthritis (GA) is the most frequent, accounting for 30-90% of disseminated infections. Our study aimed to describe all hospital cases of GA in Reunion Island, a French overseas territory. We conducted a retrospective, multicentric, observational study of all cases of certain, probable or possible GA from 2008 to 2020. We identified 58 cases of GA, mostly certain cases (n = 48). Sex ratio was balanced, but men were older than women (51 vs 27years, p < 0.001). A total of 41% had travelled abroad during the previous 3months, mostly in Madagascar or South-East Asia. The most frequently infected joint was the knee, followed by ankle, wrist and fingers or carpal joints. Only 16% of cases had genital symptoms, but 50% had another extra-genital manifestation, mainly skin lesions (40%). Positivity rate of joint puncture was 91%, with a purulent liquid. Only 58% had a positive culture, and 33% had only a positive PCR. There was no 3GC-resistant strain. In comparison with gonococcal infection without arthritis, patients were older and had fewer genital but more extra-genital symptoms. On discharge 60% had persistent articular symptoms. GA represented 18% of all hospitalised septic arthritis cases with microbial identification in 2019. GA is rare but it is important to make an early diagnosis and treat promptly, as joint destruction may be important, leading to persistent symptoms after discharge. PCR use in joint puncture is useful in cases with negative culture.

MO636: How to Prevent Genital Infections in Post-Menopausal Women with Type 2 Diabetes Mellitus Upon Initiation of Sodium–Glucose Cotransporter-2 (SGLT2) Inhibitors: A Real-Life Multi-Center Observational Study

Abstract BACKGROUND AND AIMS Patients with type 2 diabetes mellitus (T2DM) often discontinue sodium–glucose cotransporter-2-inhibitors (SGLT2 i) despite high efficacy and safety due to genital infection (GI). SGLT2i, also called gliflozins, represent the newest class of anti-hyperglycemic agents [1] whose effects depend on the ability to dramatically reduce the threshold for maximum glucose tubular resorption rate in patients with type 2 diabetes mellitus (T2DM), with consequently enhanced glycosuria. Due to elevated urinary glucose output, T2DM increases the risk for urinary tract infections (UTIs) and non-sexually transmitted genital infections (GIs) [15]. Massive glycosuria might, indeed, already cause commensal genital microorganism overgrowth in people with T2DM [16] and is likely to increase the risk for GIs and UTIs when further aggravated by SGLT2i. To assess real-life GI risk profile in post-menopausal T2DM patients educated on strict hygiene-based prevention practices (SHBPPs) due to their intrinsic GI susceptibility. METHOD 21 post-menopausal T2DM patients willing to follow SHBPPs were randomly assigned to three different SGLT2-Is (intervention group, IG, n = 318) or other drugs (control group, CG, n = 403) for 3 months. Before and after treatment, they underwent routine lab tests and completed a specific questionnaire. The present study was carried out by a network of five identically organized outpatient diabetes care units (DCUs) previously documented to attain the same performance levels and to come from a single institution. For the study, we specifically prepared the Female Genital Infection Symptoms Questionnaire (FGISQ) based on GIPR recommendations and checked for appropriate question comprehension and answer concordance as described below by previously administering it to 40 post-menopausal women with T2DM three times at 5-day intervals. Answer concordance was 97%. Based on a specific nurse’s inquiry and help request rate by patients completing the test, question comprehension was 98%. FGISQ consisted of sections A and B (Figure 1/A and 1/B). In greater detail, we changed question n.5 from Section A by considering that some women had Figure 1A: Female Genital Infection Symptoms Questionnaire. Part A (FGISQ-A) is addressed to the general prevention recommendations of GIs in women, taken from the recommendations (reference number 28, and Supplementary data, Table S1A, supplementary material), only six of which have been transformed into general questions. Part B (FGISQ-B), investigating GI symptoms and sexual habits is unscored and resumes GIPR questions 5 and 8 (see supplementary material), kept sexually active, and question n.8 to assess the intensity of eventually occurring GI symptoms. We also refrained from formulating any question related to recommendation n.9 as useless (all were post-menopausal, indeed). RESULTS: GIs more often occurred (9.6%; P &amp;lt; 0.001) among IG women non-adhering to SHBPPs (41.5%) versus the 2.9% of adhering ones. Conversely CG women had superimposable GI rates (2.7% versus 3.1%, respectively, p n.s.) whether or not adhering to SHBPPs (51.4% versus 49.6%, respectively, p n.s.). The typical profile of women on SGLT2-Is at higher risk for GIs included (i) poor adherence to SHBPPs, (ii) older age, (iii) higher BMI, (iv) poor glucose control as witnessed by high HbA1c levels, and (v) antihypertensive drug utilization. CONCLUSION Physicians should consider the importance of strict hygiene control in their post-menopausal T2DM patients undergoing SGLT2-I treatment and thus utilize better-focused education strategies in that specific subgroup to prevent or rehabilitate from repeated GIs.

Insight on the intracrinology of menopause: androgen production within the human vagina

ABSTRACT Introduction The human vagina is extremely sensitive to hormonal changes occurring during the woman's lifetime, in particular the decline in estrogens that characterizes the menopause is known to induce a range of genital and sexual symptoms (dryness, burning, irritation, lack of lubrication, discomfort, pain), known as “genitourinary syndrome of menopause” (GSM). However, this reduction in estrogen levels is also accompanied by a progressive ageing-dependent decline in androgens for which the role of androgens in the development and treatment of GSM has received more attention. It is known that peripheral tissues compensate for circulating hormonal imbalances through the in-situ production of small quantities of sex hormones deriving from inactive precursors metabolized by specific cellular enzymes. This non-classical production and local activity of hormones is defined as “intracrinology”. Objective The aim of the study was to investigate whether the human vagina possesses the specific enzymatic machinery to convert weak androgen precursors, such as DHEA, into active androgens [Δ4-androstenedione (A), testosterone (T) and dihydrotestosterone (DHT)] as already described in other species. Methods In this study, a well established model of human smooth muscle cells (hSMCs), isolated from vagina tissues of women undergoing surgery for benign gynecological diseases, was used. Semi-quantitative RT-PCR was employed in order to evaluate the mRNA expression of the steroidogenic markers in hSMCs and corrispective tissue. The production of androgens was quantified in hSMCs medium by liquid chromatography tandem-mass spectrometry (LC-MS/MS). Results In vaginal tissues, AR mRNA was significantly less expressed than estrogen receptor α (ERα), whereas in hvSMCs, its mRNA expression was higher than progestin and both estrogen receptors. In hvSMCs and in vaginal tissue, when compared to ovaries, the mRNA expression of pro-androgenic steroidogenic enzymes (HSD3β1/β2, HSD17β3/β5), along with 5α-reductase isoforms and sulfo-transferase, resulted as being more abundant. In addition, enzymes involved in androgen inactivation were less expressed than in the ovaries. The LC-MS/MS analysis revealed that, in hvSMCs, short term DHEA supplementation increased Δ4-androstenedione levels in spent medium, while increasing testosterone (T) and dihydrotestosterone (DHT) secretion after longer incubation. Finally, androgenic signaling activation was evaluated through AR-dependent marker mRNA expression, after DHEA and T stimulation. Conclusions This study provides evidence for the presence of steroidogenic machinery in the human vagina, supporting, for the first time, the construct of intracrinology in this organ, emphasizing that the vagina is an androgen-dependent organ. These observations suggest the potential mechanism and resulting action of intravaginally administered DHEA, recently indicated for the treatment of GSM and open new perspectives for the treatment of this common and bothersome condition. Disclosure Work supported by industry: no.

Cytidine nucleoside analog is an effective antiviral drug against Trichomonasvirus.

Trichomonas vaginalis is the causative agent of a sexually transmitted disease in humans. The virulence of the parasite depends on multiple factors, including the presence of endosymbiotic dsRNA viruses. The presence of Trichomonasviruses (TVV) was associated with more severe genital symptoms, increased proinflammatory host reactions, and modulated parasite sensitivity to metronidazole. However, no efficient antiviral drugs are available against TVV to derive isogenic TVV-positive and TVV-negative cell lines that are essential for investigations of the TVV impact on T. vaginalis biology. 7-Deaza-2'-C-methyladenosine (7d2CMA) and 2'-C-methylcytidine (2CMC) were used for TVV inhibitory assay. TVV replication was monitored using quantitative reverse transcription PCR (RT qPCR) and western blotting. Modeling of TVV1 RNA-dependent RNA polymerase (RdRp) was performed to visualize the inhibitor-RdRp interaction. Susceptibility to metronidazole was performed under aerobic and anaerobic conditions. We demonstrated that 2CMC but not 7d2CMA is a potent inhibitor of TVV replication. Molecular modeling suggested that the RdRp active site can accommodate 2CMC in the active triphosphate nucleotide form. The effect of 2CMC was shown on strains infected with a single and multiple TVV species. The optimal 2CMC concentration (10μM) demonstrated strong selectivity for TVVs over trichomonad growth. The presence of TVV has no effect on T. vaginalis metronidazole susceptibility in derived isogenic cell lines. 2CMC acts against TVVs and represents a new inhibitor against Totiviridae viruses. Our isogenic clones are now available for further studies of various aspects of T. vaginalis biology related to TVV infection.

“Pattern of Sexually Transmitted Infections: Treated in A Private Clinic at Dhaka, Bangladesh”

Background: Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), continue to present major health, social, and economic problems in the developing world, leading to considerable morbidity, mortality, stigma and long-term disability, economic loss and death throughout the world. Despite the availability of effective treatment and preventive measures, incidence of STIs is increasing even in developed countries. Objectives: To determine the pattern of sexually transmitted infections in patients presenting with genital symptoms. Material and Methods: A cross sectional, descriptive study was carried in the Dermatology-Venereology Clinic of Holy Lab Diagnostic &amp; Consultation Centre, Uttara, Dhaka, Bangladesh from January to December 2019. During one year period, a total of 140 consecutive cases were enrolled in this study. The diagnosis of infections was made clinically with relevant laboratory investigations and they were interviewed for their sexual behaviour after taking consent and assuring confidentiality. Results: A total of one hundred forty (140) patients who presented with genital symptoms were studied. The average age of this population was 28.84 years (±9.15) and it ranged from 18-58 years. 3.7% belonged to age group 18-27 years, followed by 28-37 years (22.1%); 38-47 yrs (52.8%); 48-57 yrs (18.5%) and &gt; 57 yrs (2.8%). Majority patients of 38-47 yrs 74 cases 52.8%. Males outnumbered females, constituting 76.2% of the total patients, with male to female ratio of 3.37:1. Out of the total 140, some had multiple complaints while others were asymptomatic. Majority cases of burning micturition in both male and female patients 39(24%). Burning micturition and discharge from genitalia was also observed in both sexes. The most frequently encountered infection in both male and female was Gonococcal Urethritis (GU) 42 (30%). The infections were common among both married and unmarried people. Other group of people who had no STI (23.5%) was suffering from venereophobia, pearly penile papules and some form of dermatitis. No case of HIV infection was encountered in this study. Gonococcal Urethritis was common mainly among businessman, transportation worker, security personnel and housewives. Other infections were equally dispersed in all other occupation groups. Conclusions: The prevention and control of STI is based on health education, appropriate diagnosis and treatment. Sexually active people adolescents and young adults should be provided with proper sex education about delaying sex debut and protective measures (correct and consistent use of barrier method during every sexual act) to prevent these infections with especial focus on monogamous relationship.

Exclusive manual perineal rehabilitation with lidocaine 2% gel in the treatment of provoked vestibulodynia: results from a single-arm interventional study.

As of now, there is no adequate therapeutic strategy for provoked vestibulodynia (PVD). Pelvic Floor Muscle Therapy (PFMT) is a widely used technique in general pelvic floor rehabilitation. The objective of this study is to examine the effects of exclusive manual perineal rehabilitation with lidocaine 2% gel on PVD. During the first session, recruited patients (n = 68; mean age 31 ± 8.6; range: 18–52) received a questionnaire (Q1) on general well-being and health, pain of the genital area, sexual function, and symptoms during vaginal penetration. This questionnaire was based on a generalised questionnaire on the quality of life, the Medical Outcomes Study 36-item (SF-36), the Female Sexual Function Index (FSFI), and the Visual Analogue Scale (VAS). A second identical questionnaire with an additional set of open-ended questions concerning the assessment of the treatment was collected after treatment (Q2). A total of 45 questionnaires were completed. Statistical results showed a significant improvement of all items before and after treatment (p < 0.001): perceived general well-being and health, perceived vulvar pain, perceived sexual function, and perceived vaginal penetration. In conclusion, exclusive manual perineal rehabilitation using lidocaine 2% gel seems to be a safe and effective treatment option for vulvodynia in women.

Genitourinary Syndrome of Menopause and the Role of Nurse Practitioners

Genitourinary syndrome of menopause (GSM) encompasses menopausal genital and urinary symptoms associated with estrogen declines, which can have a negative impact on quality of life. Several options are available for treatment, with over-the-counter vaginal lubricants and moisturizers as first-line therapy, followed by local vaginal estrogens that treat the underlying condition. Nurse practitioners are positioned to help diagnose GSM as they are comfortable initiating the conversations necessary to put women at ease to disclose information necessary for an accurate diagnosis. They can then effectively communicate various options for treating the symptoms of GSM.

Management of Genital Herpes Infection through Pregnancy

Background: Genital herpes is a lethal infection prevalent in fertility age women and can lead into mortality and morbidity of neonates on transmission. Objective: To analyze the management techniques for genital herpes infection during gestation. Study Design: Retrospective study Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Saadan Hospital Allaho Chowk Johar Town, Lahore from 10-01-2020 to 09-07-2020. Methodology: Fifty females presenting genital herpes clinical symptoms were completely analyzed through symptoms and laboratory analysis and managed for their genital herpes through anti- viral drugs. Results: The mean age was 28.9±3.2 years. Thirty-two females were having genital herpes at their third trimester. The anti-viral drugs reduced genital herpes in 90% cases with 1.2% transmission rate in caesarean delivery while 7% transmission risk in vaginal delivery. Conclusion: Genital herpes can be managed by using antiviral medications and c sections in majority of the cases. Keywords: Genital herpes, Caesarean, Transmission

Uterine tumor resembling ovarian sex cord tumor: we can diagnose it if we consider it. Case report and literature review

Uterine tumor resembling ovarian sex cord tumor (UTROSCT) represents a rare uterine neoplasm with un­certain malignant potential. Several reports have described re­cur­rences, me­tas­ta­ses and even deaths associated with these generally considered benign tumors, thus making them a controversial disease entity. UTROSCT has an un­clear histogenesis and it possesses a polyphenotypic im­mu­no­phe­no­type. We present a case of UTROSCT in a patient accusing ab­nor­mal genital bleeding and symptoms associated with anemia. After per­for­ming a total abdominal hysterectomy with bilateral sal­pin­gec­tomy, the final pathology report revealed UTROSCT with no sarcomatous features. The pa­tient is still disease-free after 30 months of follow-up. We also present the data avai­la­ble in literature regarding this relative new type of uterine tu­mor. We are of the opinion that a high index of suspicion is of paramount importance when examining a patient with an uterine mass in order to promptly identify the risk factors that may predict agressive tumor behaviour.

Bacterial sexually transmitted infections and syndromic approach: a study conducted on women at Moroccan University Hospital.

In Morocco, a syndromic approach has been implemented for sexually transmitted infections (STIs) management. However, those infections can be asymptomatic and the use of the syndromic approach to their management can be inappropriate and lead to dissemination of infection. Therefore, it would be important to determine the epidemiology and risk factors of bacterial STIs (Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG)) in a Moroccan population and their association with symptoms to assess the appropriacy of the use of the syndromic approach. Cervical samples were collected from symptomatic and asymptomatic consenting women attending the University Hospital of Fez and were tested by PCR for NG, CT and MG using specific primers. We assessed the infection status and its association with different risk factors and genital STIs-related symptoms. Of 809 tested for CT, NG and MG, 16.6% tested positive for at least one STI. Of the 134 participants who tested positive for at least one bacterial STI, 74.2% had no genital STIs-related symptoms. Moreover, the results showed a significantly high rate of NG and MG infections in asymptomatic women. However, the determined risk factors for NG, MG and CT infections were menopause (p=0.002), oral contraception (p=0.036) and a high number of parities (p=0.048), respectively. This investigation shows a predominance of NG infection and a high prevalence of STIs in asymptomatic patients. These results highlight that the adopted syndromic approach will not be adapted in the management of these STIs. Thus, the implementation of a systematic diagnostic program in order to enhance their management is needed.

Royal jelly for genitourinary syndrome of menopause: A randomized controlled trial

ObjectiveGenitourinary syndrome of menopause is a progressive condition characterized by a decrease in estrogen, which causes bothersome genital symptoms. The purpose of the study was to determine the effect of royal jelly on the genitourinary syndrome of menopause. Materials and methodsA randomized controlled trial was carried out from November 2018 to June 2019 in Bandar Abbas, Iran. The trial was registered in the Iranian Registry of Clinical Trials (1RCT20181107041585N1) with the main objective of determining if royal jelly could reduce the genitourinary syndrome of menopausal women. Eligible women were randomly assigned to receive either daily 1g of oral royal jelly or placebo for 8 weeks. The urogenital subscale of the Menopausal Rating Scale was used to determine genitourinary syndrome. Independent samples t-test was used for inter-group comparisons and paired samples t-test for pre-and post-treatment comparisons. ResultsThere were no differences in the severity of sexual problems, bladder complications, or vaginal dryness between groups before intervention. Although the intervention group's bladder complications improved slightly after eight weeks of royal jelly treatment compared to the control group (p ​= ​0.04), there were no significant changes in vaginal dryness, sexual problems, or total urogenital score. The within-group changes (before and after treatment) also showed no differences in urogenital symptoms. ConclusionsA daily dose of 1g royal jelly taken orally for 8 weeks did not alleviate menopausal genitourinary syndrome. No serious side effects were observed. To make more reliable decisions about the use and safety of royal jelly in the future, different doses of royal jelly and longer trials are required.

A Comparison of Single-Dose Versus Multidose Metronidazole by Select Clinical Factors for the Treatment of Trichomonas vaginalis in Women.

In a randomized controlled trial of 2 g (single-dose) metronidazole (MTZ) versus 500 mg twice daily for 7 days (multidose) for Trichomonas vaginalis treatment, multidose was superior. We examined if the effect was similar by select clinical factors to determine if treatment recommendations could be targeted. The primary outcome was T. vaginalis repeat infection at test-of-cure (TOC) 4 weeks after completion of therapy. Analyses were stratified by T. vaginalis history, baseline genital symptoms, and concurrent diagnosis of bacterial vaginosis (BV) per Nugent score at baseline. Women who returned for TOC (n = 540) were included. At baseline, 52.9% had a self-reported history of T. vaginalis; 79.3%, genital symptoms; 5.8%, a gonorrhea diagnosis; and 47.5%, BV. During follow-up, 97.4% took all MTZ as instructed and 34.5% had interval condomless sex with a baseline partner. At TOC, 14.8% tested positive for T. vaginalis. In stratified analysis, women randomized to single-dose MTZ had a higher rate of TOC T. vaginalis positivity than those randomized to multidose if they were symptomatic at baseline (21.4% vs. 10.8%, P = 0.003) or had a reported history of T. vaginalis (24.1% vs. 12.6%, P = 0.01). Test-of-cure T. vaginalis positivity was higher for women receiving a single dose (18.9%) versus multidose (10.8%), irrespective of baseline BV status (P > 0.06). In multivariable analysis, only a history of T. vaginalis and single-dose MTZ were independently associated with a positive TOC for T. vaginalis. Although multidose MTZ is recommended for all women with T. vaginalis, it is especially important for women with a T. vaginalis history and, given high posttreatment infection rates, a TOC should be performed.

The Effect of Instructional Guidelines on Women that Suffer from Genital Prolapse

Genital prolapse is one of the most frequent causes of gynecological morbidities among women in the world. The symptoms of genital prolapse can be extremely debilitating and have an appreciable impact on quality of life. The present study aimed to evaluate the effect of instructional guidelines on women that suffer from genital prolapse . Quazi experimental design was conducted at the out-patient’s clinics of Fayoum University hospital and General hospital (obstetrics and gynecology clinic). Purposive sample 73 women was included in the study. Data were collected through four types of tools (structured interviewing questionnaire sheet, Pelvic Organ Prolapse Quantification system (POP–Q) . It was used to assess genital prolapse, Pelvic organ prolapse-symptoms score (POP-ss),it was used to assess symptoms of genital prolapse and Instructional guidelines follow up sheet was designed to assess the manifestations. The results of this study revealed that there were a statistically no significant differences between the women with satisfactory level of knowledge and genital prolapsed symptoms, and its stages before instructional guidelines. While the result is almost statistically significant between the women with satisfactory level of knowledge and symptoms and stages after instructional guidelines, there were a statistically significant differences between the genital prolapsed symptoms and its stages before and after instructional guidelines. The study concluded that instructional guidelines was effective in improving women' knowledge and stages regarding genital prolapse. As well a reduction in prolapse symptoms which lead to better quality of life at follow-up periods.

Clinical features and burden of genital attacks in hereditary angioedema

Hereditary angioedema (HAE) is a rare disease characterized by swelling of several anatomical areas.1 Genital and urinary symptoms are well-known but poorly described manifestations of HAE because the literature is currently limited to case reports and series. We sought to characterize clinical features related to HAE genital attacks.

Ocular involvement and complications of lichen planus, lichen planus pigmentosus, and lichen planopilaris: A comprehensive review

Ocular involvement of lichenoid dermatoses, such as lichen planus (LP), lichen planus pigmentosus (LPP), and lichen planopilaris (LPL), although uncommon, is associated with skin manifestations. Isolated ocular involvement is very rare. When lesions are confined to the skin, the dermatologist inquires and evaluates for oral and genital symptoms and lesions, respectively; hence, eye manifestations are commonly neglected by the non-ophthalmologist. Ocular involvement in LP, LPP, and LPL may result in significant morbidity. An ophthalmic interrogatory and a gross ophthalmic evaluation performed by the dermatologist may unravel ocular signs and symptoms that require evaluation by an eye specialist. Ocular surface inflammation and scarring, when untreated, results in serious complications such as corneal perforation and permanent vision loss. This review aims to present an up-to-date overview for the dermatologist of the ocular involvement and complications of LP, LPP, and LPL, and when to refer to the ophthalmologist to prevent blinding complications.