Healthy Cervix Research Articles

Value of the International Federation for Cervical Pathology and Colposcopy (IFCPC) Terminology in Predicting Cervical Disease

To evaluate the colposcopic accuracy according to the International Federation for Cervical Pathology and Colposcopy (IFCPC) 2002 terminology. A series of 3,040 women derived from a general population were screened by means of Pap smear, unaided visual inspection, and high-risk human papillomavirus testing. All colposcopic examination results with abnormal findings and with biopsy confirmation (n = 468) were recorded, reviewed by 2 blinded colposcopists according to the IFCPC nomenclature, and included in this analysis. The IFCPC terminology was easily reproduced by the 2 observers with excellent interobserver agreement (kappa =.843). Colposcopy had a sensitivity of 86% and a specificity of 30.3% in distinguishing healthy cervix from that with cervical intraepithelial neoplasia (CIN)/carcinoma. In distinguishing healthy cervix/low-grade lesions (CIN 1) from that with high-grade lesions (CIN 2/3)/carcinoma, colposcopy had a sensitivity of 61.1% and a specificity of 94.4%. Colposcopic findings graded as major changes had the highest positive predictive value for detecting high-grade lesion/carcinoma. The colposcopic abnormalities within the transformation zone and large lesions were more closely related to high-grade lesion/carcinoma, whereas a sharp outer border, multiple colposcopic abnormalities, and iodine negativity were not statistically related to severe lesions. Colposcopy using the new IFCPC classification is a potentially effective screening method; when used for diagnosis, a histological sampling is necessary. The categorization of major changes and minor changes is appropriate. It is important to describe the lesion localization in relation to the transformation zone and the lesion size because these characteristics are related to high-grade lesions.

Importance of microbiologic examination of vaginal secretions in the reproductive period

Vaginal infections, during reproductive period are frequent and although not life treating, they can affect their normal functions. They can also affect women's fertility as well as the course of pregnancy. The outcome of pregnancy can be endangered due to the possibility of infection of newborn while passing trough birth canal of the infected mother. As statistically shown, bacterial vaginosis is considerably more often found with the patients having precancerous changes on cervix, or diagnosed cancer of cervix, comparing with women with healthy cervix. It can also cause the appearance of postoperative pelvic cellulitis after hysterectomy. On the other side, the presence of S. agalactiae in vaginal secretion may cause very serious and lethal infections of the newborn such as meningitis, pneumonia and sepsis. As for protozoa T. vaginalis it has been shown that it could cause reduced fertility ability and that during pregnancy it could damage fetal membranes and bring to its premature rupture and premature birth. There is also increased risk of cervix cancer. During reproductive period of women especially if risk factors are existing such as hormone therapy, diabetes mellitus type 1 and applications of wide range antibiotics, vaginal fungal infections caused by Candida can frequently appear. These infection apart from the discomfort like itch and affluent secretion they can also mean diagnostic and therapeutical problem. Regular microbiological test of women are highly recommended during reproductive period as standard for bacterial vaginosis, fungal and trichomonas infections. If those results appear negative, further microbiological tests are necessary. Such tests which are more elaborate, more timely and more expensive are referring to tests on chlamydia, microplasma and some viruses that can also be the cause of vaginal secretion disbalance in women during reproductive period.

Microfilaria in cervical smear

A 32-year-old female Indian patient presented with a 4-month history of flu-like illness troublesome bloodstained vaginal discharge and a swelling in her left lower limb. She had normal vaginal deliveries in the past and her periods were fairly regular. There was no history of any significant previous medical or surgical illness. There was no history of tubercular contact. A general examination revealed non-pitting oedema and thickened skin in her left thigh and inguinal region. Inguinal lymphadenopathy was also present on the left side. Vaginal examination showed a healthy cervix although a reddish brown discharge was noted. A cervical smear was performed. Full blood count erythrocyte sedimentation rate and a chest X-ray were all normal except for a raised eosinophil count (0.8 x 109 I/l). Serological examinations performed at the time were positive for filariasis. The cervical smear examination detected sheathed microfilarial larvae. The larvae measured approximately 300 microns in length and were nucleated throughout the central axis except for the terminal ends. An increased number of polymorph-nuclear cells were noted in the smear sample. (excerpt)

Power Doppler Angiographic Appearance and Blood Flow Velocity Waveforms in Invasive Cervical Carcinoma

Objectives. The aim of this study was to investigate the effectiveness of transvaginal power Doppler angiography in predicting cervical malignancy by detecting intratumoral blood flow and to understand the relationship between squamous cell carcinoma (SCC) serum levels and intratumoral blood flow analysis of invasive cervical carcinoma before treatment.Methods. Thirty-eight patients with cervical carcinoma (35 with stages Ia to IVb invasive carcinoma, 3 with cervical carcinoma in situ) were enrolled for the evaluation of tumor flow using transvaginal ultrasound accompanied with power Doppler angiography before surgery. The pulsatility, resistance index, and vascular index of tumor flow were measured. Thirty patients with proven healthy cervices were used as the control group. Pretreatment SCC serum levels were obtained in 34 women with cervical carcinoma.Results. The pulsatility index and resistance index were significantly lower in the study group than in the control group (P < 0.0001). The vascular index was also significantly lower in the study group than in the control group (P < 0.0001). There were no significant differences among patients with SCC type and non-SCC type cervical carcinoma (P > 0.05) among the six parameters. There was no significant correlation between the pretreatment SCC serum levels with any of the six parameters obtained from the intratumoral blood flow analysis in the SCC group.Conclusions. Transvaginal ultrasound with power Doppler angiography is a valuable diagnostic tool for differentiating benign tumors of the cervix from malignant ones. Intratumoral blood flow of the cervix supplied us with practical diagnostic information before surgery and may aid in early prediction and management of cervical carcinoma. The use of transvaginal ultrasound with power Doppler angiography in the grading of vascularity ratio within cervical masses provided more sonographic characteristics among the different subclassifications of cervical cancer and is more useful than color Doppler imaging in the visualization of sonographic morphology.

Results of clinically downstaging cervical cancer in a cytological screening programme.

The study was aimed at clinically downstaging cancer of the cervix during a cytological Screening Programme to find out whether such a strategy may help in yielding a large number of early cases of cancer. A cohort of 6,178 women with different cervical lesions were cytologically examined from April 1971 at Queen Mary's Hospital, Lucknow, India. The 8,718 asymptomatic women with healthy cervices were taken as controls. The incidence of cervical dysplasia and malignancy in the study group was found to be 11.2% and 1.9%, which was statistically highly significant compared to control values of 3.3% and 0.02%, respectively. Dysplastic smears were seen maximally in women whose cervix bled to the touch, and the rate of cervical cancer was high in women with suspicious cervix. Dysplastic smears were seen frequently in all age and parity groups, but malignancy was common in women of high age (over 30 years) and high parity (two and above). The incidence of three sexually transmitted diseases, namely Trichomonas vaginalis, Herpes simplex, and condyloma revealed highly significant values, especially in women whose cervix bled to the touch. The study highlights the strategy of clinically downstaging cervical cancer, which is very useful in detecting a large number of dysplasia and frank malignancy cases and also the presence of any associated sexually transmitted pathogens whose treatment would aid in restricting the rising incidence of the dreaded disease in this country.

Subtotal vaginal hysterectomy: A new role for an old procedure

Patients with persistent uterine bleeding that is unresponsive to conservative therapy may opt for endometrial ablation over total hysterectomy because of concerns over subsequent sexual dysfunction or other nonclinical issues. Twelve such women with healthy cervices who failed endometrial ablation, and eight candidates for ablation were offered subtotal vaginal hysterectomy as a definitive primary surgical intervention instead of endometrial ablation. Our experience suggests the safety and utility of subtotal vaginal hysterectomy in properly selected patients. Randomized, comparative studies of this technique as an alternative to hysteroscopic ablation or resection may be warranted.

Discovering asymptomatic non-precancerous lesions with cervical cytologic mass-screening campaigns: is it a benefit or a cost?

A total of 3357 women (88.1% married, 82.0% parous) were examined at least once in the mass-screening program carried out by the Legnano Hospital Screening Center in Nerviano (a small town near Milan with 15,600 inhabitants) in 1974, 1977 and 1980. Married women with visible portio and adequate smear were 2758: a visibly healthy cervix was found only in 1143 subjects (41.4%). A total of 1516 married women were examined at least in 2 consecutive campaigns: 1279 (84.4%) reported "no gynecologic treatment in the previous 5 years" at the first campaign, and 899 (59.3%) reported "no gynecologic treatment in the previous 3 years" at their second one. Of 350 women with "medical lesions" and 525 with "surgical lesions" recorded at the first visit, 111 (31.7%) and 232 (44.2%) reported, respectively, a "medical treatment" or a "surgical treatment" at the second visit. In women with "medical lesions" at the first visit, at the second visit a healthy cervix was found in 66.2% of the treated women and in 72.6% of the untreated patients. In those with "surgical lesions" a healthy cervix was successively found in 91.6% of treated and in 40.7% of the untreated patients.

Sex steroid receptors in gynaecological malignancy

SummaryOestrogen and progestagen receptors have been determined in cytosol prepared from normal, malignant and benign neoplastic tissues from the female reproductive tract. In normal healthy cervix and squamous carcinoma of the cervix both steroid receptors were only present in 1 of the 6 and 6 of the 17 tissues respectively. With adenocarcinoma of the cervix, 5 out of 6 tissues had receptors present. In normal endometrium receptors were found in 24 of the 25 samples examined. In 10 out of 13 cases of well differentiated endometrial carcinoma there were receptors, but only 27 per cent of poorly differentiated tumours contained receptors for either steroid. Benign endometriotic tissue had little receptor activity.Most samples of uncommon malignancies of the female reproductive tract were steroid receptor negative, except those in glandular tissues of Müllerian origin which had some oestrogen receptors present, and granulosa cell tumours of the ovary, which contained only progesterone receptors. A maternal stilboestrol-associated clear cell adenocarcinoma of the vagina was receptor positive for both oestrogen and progesterone.Sex steroid receptors may be found in neoplastic alteration in tissue of Müllerian duct origin or derived from associated coelomic epithelium. Studies of sex steroid receptor content may possibly give rise to a predictive index for survival and response to hormone therapy.

The importance of cauterization to maintain a healthy cervix: Long-term study from a private gynecologic practice

A total of 13,897 patients from a private gynecologic practice were retrospectively analyzed with special regard to the benefits obtained from hot linear cautery. This has been performed as an office procedure since 1937, providing unique long-term follow-up. The exposed cervical transitional zone and mild, atypical, or dysplastic cervical cytology were so treated in 6,364 patients. A significantly higher percentage of carcinoma in situ and invasive disease was found in the noncauterized cervices. With the trend of cervical intraepithelial neoplasia (CIN) toward development at an earlier age in today's population, the importance of office cauterization in preventing cervical cancer becomes apparent.

Cervical cytological study in unhealthy and healthy looking cervix

Aim: To compare cervical cytology in women with healthy/unhealthy cervix. Methods: A prospective study on Pap smear was performed including 200 women, 100 with healthy and 100 with unhealthy cervix, attending outpatient Gynaecology clinic of the Department of Ob/Gyn TU Teaching Hospital, Kathmandu. The cytology report was compared in the two groups. Results: Cervical dysplasia was seen in 8 women with unhealthy cervix, 7 were mild and one was severe dysplasia. In the women with healthy cervix, 5 had mild and one had moderate dysplasia. Eighty two percent of women with healthy cervix and 83% of women with unhealthy cervix had non-specific inflammation. Women who were married before 20 years (p=0.04) and had higher parity (3.3 Vs 2.8) were more likely to have unhealthy cervix (p=0.03). Excessive vaginal discharge was common in women with unhealthy cervix (p=0.0009). Conclusion: Dysplasia was slightly higher among the women with unhealthy cervix in comparision to healthy cervix but the difference was not statistically significant. Hence this study emphasizes on the importance of universal screening of both the healthy and unhealthy looking cervix. Key Words: carcinoma cervix, visual screening, Pap smear, cervical cytology, cervical dysplasia doi:10.3126/njog.v2i2.1454 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 42 - 47

A Clinical Study on PCOS Patients in a Tertiary Hospital

Polycystic ovary syndrome (PCOS) is a common condition characterized by menstrual abnormalities and clinical or biochemical features of hyperandrogenism and may manifest at any age. The present study was carried out at Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2008 to March 2009, on 50 women with PCOS which was diagnosed by three criteria: (1) oligo and/or anovulation, (2) hyperandrogenism and (3) polycystic ovaries, to evaluate their characteristics and laboratory investigation findings. Most common age was 2125 years (44%), mean BMI 27.10 kg/m2, menstrual cycle irregularity 80%, oligomenorrhoea 28%, dysmenorrhoea 18%, nulliparity 90%, history of abortion 10%, acne in 52%, hirsutism in 50%, and per vaginal findings were anteverted uterus 100%, free fornices 98% and healthy cervix 94%. Laboratory findings were low (2.8 mIU/ml) serum FSH 2%, raised (&gt;14.7 mIU/ml) serum LH 56%, raised (7.8 mmol/L) blood sugar (2hr after 75 g glucose load) 30%, raised (&gt;25 ng/ml) serum prolactin 14%, raised (&gt;4 ?IU/ml) serum TSH 2%, low &lt;3.5 ng/dl), ultrasound of lower abdomen showed evidence of PCOS in 100% cases. Infertility in women with PCOS can be treated successfully in most women by diet and exercise, clomiphene citrate with or without metformin, laparoscopic ovarian diarthermy, or ovulation induction with gonadotrophins. Key words: PCOS; Infertility DOI: 10.3329/medtoday.v22i1.5604 Medicine Today Vol.22(1) 2010. 34-37

VIABILITY OF SPERMATOZOA IN THE CERVICAL CANAL: PRELIMINARY REPORT

This is the report of an interesting observation that I made on the viability of a specimen of semen obtained from a donor and introduced into the cervical canal of five different patients on the same day by means of a cannula. It is interesting because a great deal of work has been done on the p H of cervical secretions, and the variation of the p H in the cervical canal. I refer to cases other than those infected with such conditions as gonorrhea, confining my reference to these five cases presenting normal healthy cervices. Dec. 10, 1935, five patients were artificially inseminated from one donor. The semen was deposited by a cannula against the internal os. The uterus was not entered and very little pressure was used during insertion so as to avoid any forcible opening of the internal os. In cases 1 and 2 there were large cervical plugs of