Postcoital Bleeding Research Articles

Clinico-Cytological Correlation of Cervical Pap Abnormality

Background: Few studies reported in Iraq about the clinicopathological correlation of Pap Smear results, and non was reported about this correlation among private clinic patient, as the knowledge of the authors. Therefore, this study was developed to study the clinic-pathological correlation of the Pap smear cytology results and the clinical presentation of the private clinic patients. Patient and Method : Cross sectional study of (144) patients presented to the privet clinic, during the period 1st January-1st September 2018. Information regarding age, job parity, marital status symptoms and patient complain and clinical examination of the patient was obtained via a structured questionnaire. The presenting signs & symptoms were compared with the Pap-smear findings and other factors. Cytological study done by cytopathology specialist. Conventional pap smear were used. Cytology was reported using Bethesda system. A single combined smear, was done for each patient by sampling the endocervix, first to obtain the cell sample. Scraping the ectocervix with the spatula and spreading the material rapidly onto the upper end of the slide. Spreading the endocervical material through the ectocervical material to the end of the slide. This procedure Performed quickly to prevent drying artifacts. Fixation of the slide done using spray fix by thoroughly soaking the cellular sample while holding the spray fixative container about 6-8 inches from the slide. Then allowing spray fixative to evaporate. Results: NILM (negative for intraepithelial lesion or malignancy) found among 21(14.6%) of the patients 20 (13.9%) had cervicitis, and 1(0.7%) had atrophic changes in the cervix), Atypical Squamous Cell Undetermined Significant (ASCUS) 73(50.7%), followed by Low-grade squamous intra-epithelial lesion (LSIL) 39(27.1%), and High-grade squamous intra-epithelial lesions (HSIL) 9(6.3%). Squamous cell carcinoma was found among 2(1.4%) of the cases. Conclusion: Iraqi women attending the priate clinic had high level of intraepithelial abnormality, even if it lower than other countries but it in need to be controlled by cervical cancer screening program, the common presenting symptom with increased rate of with various stages of intraepithelial lesion were post coital bleeding, and Irregular vaginal bleeding.

Metachronic Small Bowel Metastasis of a Squamous Cell Carcinoma of The Cervix.

Clinical Image We report a case of a woman 33 years old with past medical fact of hypertension, in whom squamous cell carcinoma of the cervix was diagnosed within post coital bleeding. The tumor was classified stage Ib according to FIGO classification and were treated with brachytherapy followed by hysterectomy with oophorectomy and external iliac lymphadenectomy. The evolution was favorable and she remained asymptomatic for 3 years. She was than hospitalized for obstructive syndrome. Abdominal X ray showed hydro-aeric levels and abdominal computed tomography showed grelic tumor with distension of the small bowel.

Metachronic Small Bowel Metastasis of a Squamous Cell Carcinoma of The Cervix.

Clinical Image We report a case of a woman 33 years old with past medical fact of hypertension, in whom squamous cell carcinoma of the cervix was diagnosed within post coital bleeding. The tumor was classified stage Ib according to FIGO classification and were treated with brachytherapy followed by hysterectomy with oophorectomy and external iliac lymphadenectomy. The evolution was favorable and she remained asymptomatic for 3 years. She was than hospitalized for obstructive syndrome. Abdominal X ray showed hydro-aeric levels and abdominal computed tomography showed grelic tumor with distension of the small bowel.

Treatment Modality with Concurrent Chemo-Radiation for Locally Advanced Carcinoma Cervix, Four Field Technique EBRT Is Better Responsive than Two Field Technique

Background: Carcinoma of the cervix is the fourth most common cancer in women in the world.In 2018,an estimated 570000 women were diagnosed with cervical cancer worldwide and about 311000 women died from the disease. Bangladesh has the highest level of incidence and mortality rates due to cervical cancer among women due to lack of screening, high prevalence of risk factors and poor socio-economic condition. Methods: In this prospective observational study total 90 number of subjects were enrolled to compare the effectiveness of external beam radiation therapy by four field box technique versus two field technique in the treatment of locally advanced carcinoma of uterine cervix. Clinically and histologically diagnosed squamous cell carcinoma of uterine cervix patients were selected as study population. Results: In this study the highest number of patients were in between 46 to 55 years. Most of the subject used Oral contraceptive pill more than 5 years. Most of the patients were in stage IIB.Most of the patients were presented with postcoital bleeding, anemia, vaginal discharge , loss of appetite , Intermenstrual bleeding and pelvic pain. After completion of treatment follow-up per vaginal examination revealed that 73.33% subjects had complete response in four field group (Arm A). In two field group (Arm B), 57.78% had complete response. Common toxicities related to treatment were nausea, vomiting, diarrhea, skin reaction, anemia, leucopenia, bladder toxicity and rectal toxicity. Conclusion: From this study it can be concluded that four field box technique in EBRT was statistically effective in relieving symptoms and achieving complete response than two field technique in the treatment of locally advanced carcinoma of uterine cervix.

Evaluation of Outcome Measures of Hysteroscopy Polypectomy in Women with Abnormal Uterine Bleeding

Introduction: The most common causes of Abnormal Uterine Bleeding (AUB) in women of reproductive age are uterine polyps. Operative hysteroscopy is the management of choice to remove polyp. However, the certainty of the treatment remains to be examined. Aim: To investigate the outcome of hysteroscopy polypectomy in women with AUB. Materials and Methods: This was a cross-sectional study on the samples of women with AUB who underwent a hysteroscopy polypectomy. Patients were assessed pre and postoperatively and were asked to respond to a number of outcome measures including duration of monthly cycle, menstruation cycle, heavy menstrual bleeding, the number of pads used in day and night and improvement of inter-menstrual bleeding, postcoital bleeding, and limited activity. Pre-and postsurgery data were compared using Wilcoxon and McNemar tests. Results: In all, 83 patients were entered into the study. The mean age of participants was 41.8 (±8.37) years. The most common preoperative complaint was heavy menstrual bleeding (n=63, 76%) followed by intermenstrual bleeding (n=40, 48%). There were significant differences between preoperative and postoperative symptoms (p-values <0.05). Perceived complete recovery (n=54, 65%), partial recovery (n=13, 15.7%) and satisfaction (n=66, 79.5%) were high after hysteroscopy. Conclusion: AUB due to polyp might be improved with hysteroscopy. Further investigations are needed to confirm the results and to study on co-existence of other causes of AUB after hysteroscopy polypectomy.

Screening for Cervical Cancer by Sequential Examination of the Cervix

Background: cervical cancer carries a death sentence in the mind of every patient. Since it has a long history; it can be cured if caught early. Pap smear screening has been effective in reducing rates of cervical cancer, still, it has some draws back especially low sensitivity. The study aimed to increase the detection of Pap- tests by sequential examination of the cervix by Pap smear and colposcopy and to demonstrate the demographic criteria of those affected.
 Material and method: A Comparative clinical study, conducted in the department of Obstetrics and Gynecology in AL-Yarmouk hospital /Baghdad, Iraq from 2017-2018. One hundred sexually active female fits into our inclusion and exclusion criteria were invited to participate after we explain it is aim, all participant filled a questioner sheet and were screened by Pap-smear then immediately by colposcopy exam.
 Result: history of post-coital bleeding and bleeding on touch scored meaningful P-value<0.05, Pap-smear examination shows 20% as abnormal study stratified into 13/20 CIN I [Cervical Intraepithelial Neoplasm], 3/20 CIN II, 2/20 CIN III, and 2/20 malignant cases. The colposcopy exam showed 32/100 abnormal cases necessitating directed histological biopsies. Examination confirms 20/32 CIN I, 7/32 CIN II, 2/32 CIN III, and 3/32 cases with cervical malignancy.
 Conclusions: cervical smear had specificity and positive predictive value of 100% yet it missed 11 cases diagnosed with colposcopy one was malignant. As a result, Pap-smear alone can detect up to 18% of the pre-cancerous lesion of the cervix, this figure increases to 29% when dumbing the results of the colposcopic directed biopsy. The sensitivity of the test was 62.5% with a false-negative percentage of 37.5%, having a total 88% accuracy rate and a negative predictive value of 85%, this study confirms the benefits of the combined method of screening and may be used to increase pap-smear sensitivity.

A Comparative Study between Conventional Pap Smear and Liquid-Based Cytology: A Clinco-Cytological Study of Iraqi Women with Some Health Problems of Cervix

A cervical screening by Pap test is necessary in recognizing precancerous and cancerous cases to reduce mortality due to cervical cancer among women. Regular screening and follow up can make it easier to early diagnose and eventually, to treat and control cervical cancer.
 This study aimed to detect atypical pathological changes of the vagina and uterine cervix of a sample of Iraqi women by macro- and micro-examination, and to determine the link with the demographic features. Also the study aimed to evaluate the two Pap smear techniques; the conventional and the base liquid methods.
 The study included 50 women with genital health problems (18-50 years old) who were referred to the National Cancer Research Center (NCRC), the University of Baghdad, during the period from 1st April to 30st of September 2018. Both visual inspection of the uterine cervix and Papanicolaou smear were performed for all of the participants.
 The results showed that most patient women (96%) were married and sexually active, with 51% being married under 20 years of age .Visual inspection of the cervix showed that 30% of the women had translucent, opaque or erosion lesions. Upon cytology examination, 92% of the women showed nonspecific inflammation, 70% revealed reactive squamous metaplasia, 10% had Koilocytotic atypia, and 8% suffered from cervical intraepithelial neoplasia (CIN1) or low grade squamous intraepithelial lesion (LGSIL). Contraception was used by 82% of the patients, while 36% used pills. The causes of the referral to the centre were abnormal vaginal discharge (44%) and post-coital bleeding "and\or" dyspareunia (20% each). Lastly, 74% of the participants did not make this test previously. Liquid-based cytology technique outperformed conventional pap smears because of improved fixation, decreased impurities factors, and standardization of cell transfer.
 We conclude that routine screening and Pap smear testing for uterine cervix and vagina might be useful to prevent the occurrence of precancerous lesions in the genital system of sexually active women. We recommend to apply this test before and after treatment and to activate the cellular examination in the basal fluid method

Association of cesarean scar defect with abnormal uterine bleeding: The results of a prospective study

ObjectiveTo evaluate the relationship between cesarean scar defect and abnormal uterine bleeding at one year after cesarean section (CS). Study designA prospective observational cohort study was conducted in 401 women who delivered by CS between January 2016 and January 2017. Women were screened for isthmocele with sonohysterography six months after CS and followed by electronic questionnaires at 12, 13 and 14 months after CS. The main outcome measure was the prevalence of postmenstrual spotting. Secondary outcome measures were the duration of menstrual bleeding, prevalence of postcoital bleeding, dyspareunia or dysmenorrhea, usage of painkillers, and absence from work or other activities. ResultsThe response rate was 88 %. In the isthmocele group, the prevalence of postmenstrual spotting was 20.0 % compared to 8.3 % in women without isthmocele (OR 2.75 [95 % CI 1.39–5.44]; P = 0.004). Additionally, women with isthmocele reported more frequently postcoital bleeding (8.3 % vs. 2.4 %; OR 3.73 [95 % CI 1.18–11.83]; P = 0.026). The prevalence of postmenstrual spotting was even higher in the subgroup of large isthmoceles, (25.9 % vs. 9.5 %; (OR 3.34 [95 % CI 1.72–6.49]; P < 0.001). ConclusionThe prevalence of postmenstrual spotting among isthmocele patients was 20.0 %. Additionally, postmenstrual spotting was associated with the presence of isthmocele inquired at 1 year after CS.

HPV TİP 16 VE 18 DIŞINDA POZİTİF, SMEAR SONUCU NORMAL HASTALARIN KOLPOSKOPİK İNCELENMESİ

<div><!--block-->Objective: To assess the colposcopic examination findings and biopsy results in women who tested positive for oncogenic Human Papilloma Virus (HPV) types other than HPV-16 and 18 while having otherwise normal Pap test results.&nbsp;<br><br>Material and Method: This paper analyzes the results from a total of 300 women who tested positive for non-16/18 HPV types but had otherwise normal Pap test and underwent a colposcopic examination in our hospital between January 2017 and December 2017. The study subjects presented with postcoital bleeding, had a family history of cancer or exhibited macroscopic examination findings which were suspected to be malign. A co-test was scheduled one year later for 39 patients (13%) who had no lesions suspected of malignancy and a colposcopy-guided tissue sample was performed on 261 patients.&nbsp;<br><br>Results: Histological examination results included inflammation (in 186 patients [62%]), CIN 1 (in 61 patients [20.33%]), CIN 2 (in 9 patients [3%], CIN 3 (in 3 patients [1%]) and cervical cancer (in 2 patients [%0.67]).&nbsp;<br><br>Conclusion: One should keep in mind that a diagnosis of CIN 2 or more severe lesions or even cervical cancer can be made using a colposcopy-guided biopsy in women who test positive for non 16/18 HPV types but have otherwise normal Pap smear test.&nbsp;</div>

1957 Robotic Assisted Mesh Removal: Posterior Vaginal Mesh Kit and Perivesical Mesh Invading Obturator Internus

Video Objective This video depicts a surgical approach in a patient with both a complicated and unclear surgical history, with inability to obtain complete surgical record. It demonstrates a robotic assisted laparoscopic approach to removal of mesh in a patient with persistent pelvic pain with an unclear or unknown mesh location. Setting This is a 60 year old woman with a remote history of hysterectomy for benign indications. Per patient, she subsequently developed symptomatic prolapse for which she underwent a “bladder sling” and two “hernia repairs” which necessitated suprapubic catheter post-operatively. She then experienced worsening pelvic pain since that time, now years later, and with constant rectal pressure and more recent post-coital bleeding. The patient is adamant on complete mesh removal. This was performed as an ambulatory surgery within a hospital setting. Interventions Pelvic examination revealed noticeable tenderness of anterior vaginal wall, with no exposed mesh or bleeding. The video itself depicts a robotic assisted laparoscopic removal of bilateral posterior vaginal mesh kit and left perivesical mesh invading obturator internus. Careful surgical technique involving bladder dissection off vaginal cuff, ureterolysis, and dissection throughout the space of Retzius down to the obturator internus muscle is carried out with complete removal of multiple mesh components. Conclusion Avoiding transection of the mesh along with meticulous dissection aides in traction and greatest chance of complete removal. Maintenance of hemostasis is critical for adequate visualization, especially within the space of Retzius. Knowledge of pelvic anatomy is paramount, as scarring, fibrosis, and mesh migration can distort normal anatomical planes.

Post-coital bleeding: What is the incidence of significant gynaecological pathology in women referred for colposcopy?

ObjectiveTo evaluate the incidence of underlying serious gynaecological pathology in women referred to colposcopy with post-coital bleeding. Main outcome measures.Incidence of precancer and cancer. MethodsA retrospective cohort study of women referred to colposcopy at a London hospital from January 2008-March 2015. Inclusion criteria are women with post-coital bleeding and the following cervical cytology history: negative; inadequate; never had. Multinomial logistic regression was used to assess for significant risk factors for cervical dysplasia and cancer. ResultsOverall, 635 women with either negative cytology (n = 436/68.7%), no previous cytology (n = 175/27.6%), or inadequate cytology (n = 24/3.8%) were referred to colposcopy for post-coital bleeding. The median age is 35 years (S.D. = 9.7 years). In 256 (40.3%) women, no cause was detected, and 322 (50.7%) women had a benign cause. Overall, 42 (6.6%) women had low-grade dysplasia, and eleven women had high-grade dysplasia (1.7%). Four women (0.6%) had cervical cancer; clinically evident cancer on speculum examination (n = 3); micro-invasive cancer (n = 1). Current smokers were significantly more likely to have HPV atypia (p = 0.015) or cervical intraepithelial neoplasm grade 1 (CIN1) p = 0.003. Advancing age was a significant risk factor for cervical cancer (p = 0.037). ConclusionAll women with post-coital bleeding need an urgent speculum examination to rule out frank cervical cancer. Although most women had a benign cause for post-coital bleeding, around 2% had a colposcopy-aided diagnosis of either cervical precancer or cancer; therefore, referral of symptomatic women deserves consideration. HPV testing may reduce referrals to colposcopy for post-coital bleeding due to non-significant pathology in the future.

Endocervical Adenocarcinoma With Skip Lesion in a Fundal Endometrial Polyp Mimicking Endometrioid Adenocarcinoma Arising From Endometrial Polyp

Abstract Human papillomavirus–related adenocarcinomas account for approximately 20% of all cervical cancers. Most of them arise in the transformation zone but may be found exclusively in endocervical canal. Contiguous spread into the lower uterine segment is known to occur, but finding a “skip” lesion in a fundal endometrial polyp poses an interesting pathologic conundrum. We present a case of a 57-year-old woman with a history of postcoital bleeding and abnormal cervical smear. Cervical exam showed a 2-cm exophytic mass on anterior cervix. Biopsy revealed invasive endocervical adenocarcinoma. Patient underwent radical hysterectomy. Gross examination revealed large cervical mass without involvement of low uterine segment and a benign-appearing small uterine fundal polyp. Microscopic examination confirmed the deeply invasive endocervical adenocarcinoma, and the benign-appearing endometrial polyp had similar atypical glands on the polyp surface and admixed with benign endometrial glands. Both cervical tumor and the carcinoma involving endometrial polyp demonstrated identical immunohistochemistry showing diffuse positive p16 and CEA(m) and negative for ER and vimentin. The authors report a rare case of endocervical adenocarcinoma with skip lesion in the endometrial fundal polyp, and rare cases with skip lesion in the fallopian tubes from endocervical adenocarcinoma have been reported in the literature. High clinical suspicion and ancillary immunohistochemistry are necessary to differentiate the lesion from endometrioid or papillary carcinoma arising from endometrial polyp.

Laparoendoscopic Single-site Radical Hysterectomy: Sufficient Exposure via Effective Suspension

Study ObjectiveTo perform a radical hysterectomy for early-stage cervical cancer through laparoendoscopic single-site (LESS) approach and demonstrate if the effective suspension could achieve different exposed purposes and space extension. DesignPresentation of the surgery through this technical video. SettingHospital. InterventionsA 52-year-old menopausal woman who presented with postcoital bleeding for 3 months was diagnosed with poorly differentiated (G3) cervical squamous cell carcinoma with International Federation of Gynecology and Obstetrics stage IB1. The patient was carefully consulted about the oncologic risks of the different surgical approaches; thereafter, the LESS approach was decided with informed consent. The LESS procedures for staging surgery were completed. The estimated blood loss was 60 mL, and operation time was 250 minutes. Results of the pathology report showed G3 squamous cell carcinoma and no pelvic lymph nodes metastases. The Foley catheter was removed on the 21st day, and the bladder function recovered completely after removal. She was followed up for a year without any evidence of recurrence or complications. ConclusionBecause of technical difficulties with a limited number of hands, complex surgeries, such as radical hysterectomy, have rarely been performed using the LESS approach [1]. The dissection of vesicocervical and parametrial space is critical to radical hysterectomy, and inadequate exposure to these spaces during the procedure presents major difficulties [2]. In the video, surgery for cervical cancer was performed successfully and met the International Federation of Gynecology and Obstetrics’ standards for type C radical hysterectomy. Our video demonstrated that the varied and flexible suspension played a significant role in providing clear vision and sufficient exposure; furthermore, it was feasible, effective, and safe in the LESS approach [3,4].

Cryotherapy as a Method for Relieving Symptoms of Cervical Ectopy: A Randomized Clinical Trial.

ObjectivesBenign cervical ectopy (CE) may cause chronic or recurrent symptoms leading to women repeatedly being referred to gynecology clinics. We aimed to present a safe and effective method for relieving symptoms of CE.MethodsThis double-blind clinical trial was conducted among 164 women with CE who complained of persistent or recurrent symptoms of cervicitis in the last six months. Patient’s demographic data, medical history, symptoms, and vaginal examination results were recorded. Normal co-test or Pap smear was required to enter the study. Participants were divided into two groups; the intervention group received cryotherapy and the control group underwent cryo-placebo (inserted the probe without true cryotherapy). The outcomes including improvement of symptoms and CE were monitored one, three, and six months later.ResultsThe prevalence of symptoms in the two groups were not significantly different (p > 0.050). Symptom improvement was significantly higher with cryotherapy: vaginal discharge (p = 0.006), itching (p < 0.001), dyspareunia (p = 0.005), post-coital bleeding (p = 0.023), and pelvic pain (p = 0.009). If the symptoms did not disappear, their severity was lower after cryotherapy, comparatively (p < 0.050). Examination showed more improvement of CE following cryotherapy (p < 0.001). Cryotherapy showed no remarkable side effects and was associated with more satisfaction (p < 0.001).ConclusionsCryotherapy is a safe, effective, fast-acting, and cost-benefit therapy that can be considered for the treatment of symptomatic CE.

Acute pelvic inflammatory disease: a narrative review

Background and objective: Pelvic inflammatory disease (PID) is an upper genital tract infection in females that is typically acquired via sexual activity. It usually is initiated by the presence of Chlamydia trachomatis and/or Neisseria gonorrhoeae and escalates into a polymicrobial infection from local genital tract flora. Research identifies various known risk factors including young age, immunopathology and others. This article reviews the epidemiology, differential diagnosis, management, and concepts of prevention for PID. Methods: An electronic search was performed on MEDLINE to identify relevant articles from 2010 to 2018. Key Content and Findings: PID continues to be a major sexually transmitted disease among adolescent and young adult females. Among the 1 million cases that are found in the United States (U.S.) each year, about one-third are in adolescent females. It is typically a polymicrobial infection that can lead to acute salpingitis, perihepatitis, endometritis, oophoritis, pelvic peritonitis and/or tubo-ovarian abscess. Diagnostic criteria and recommended treatment have been developed by the U.S. Centers for Disease Control and Prevention (CDC). Complication of PID include chronic pelvic pain, ectopic pregnancy and infertility. Conclusions: PID is a common sexually transmitted disease that is found in many adolescents and young women. The possibility of PID should be seriously considered by clinicians when evaluating a sexually active teenage or young adult female with lower abdominal pain, vaginal discharge, vaginal bleeding, urinary symptoms, post-coital bleeding and/or dyspareunia. It may be a silent infection as well. Various risk factors for PID are noted including the adolescent age group, ectropion of young adolescent females, immature immune system, multiple coital partners and others. Clinicians should follow treatment protocols established by the CDC and the World Health Organization (WHO). The problem of PID should stimulate clinicians and society to provide comprehensive sexuality education to our youth.

Postcoital bleeding is a predictor for cervical dysplasia.

BackgroundPostcoital bleeding (PCB) is a common gynecological symptom that may cause concern among both patients and physicians. Current literature is inconclusive regarding management recommendations.ObjectiveTo identify risk-factors for dysplasia/cancer among patients presenting post-coital bleeding (PCB).MethodsUsing large health maintenance organization (HMO) database, all women reporting PCB in 2012–2015 were identified. PCB patient records in a single colposcopy center were reviewed. Age, marital status, ethnicity, gravidity, parity, BMI, smoking, PAP smear result (within 1 year of PCB presentation), colposcopy and biopsy results were recorded. Cases were matched by age and socio-economic enumeration area to controls accessing primary care clinics for routine care.ResultsYearly incidence of PCB ranged from 400 to 900 per 100,000 women; highest among patients aged 26–30 years. Among the sample of 411 PCB cases with colposcopy, 201 (48.9%) had directed biopsy. Biopsy results included 68 cervicitis (33.8%), 61 koilocytosis/CIN 1/condyloma (30.3%), 44 normal tissue (21.9%), 25 cervical polyp (12.4%), 2 CIN 2/3 (1%) and 1 carcinoma (0.5%). Positive predictive value for koilocytosis/CIN 1 or higher pathology was 15.6% (64/411) and 0.7% for CIN 2 or higher grade pathology (3/411). In conditional logistic regression, multiparty was a protective factor: OR 0.39 (95% CI 0.22–0.88, P = 0.02), while pathological PAP smear was a related risk-factor: OR 3.3 (95% CI 1.31–8.35, P = 0.01). When compared to controls, PCB patients were significantly (P = 0.04) more likely to present CIN 1 or higher grade pathology (OR 1.82, 95% CI 1.02–3.33).ConclusionsStudy results indicate that PCB may require colposcopy, especially for nulliparous women with an abnormal PAP smear.

Histopathological Patterns and Characteristics of Abnormal Cervical Smear in Madinah Region of Saudi Arabia

Cervical cancer is a major public health problem that continues to be one of the leading female genital cancers worldwide. In the kingdom of Saudi Arabia (KSA), cervical cancer ranks the fifteenth most frequent cancer among females. This study is the first published research study addressing the screening of cervical cancer in Madinah region of KSA.Aim:To evaluate the abnormal cytological entities detected by cervical Pap smear in Madinah region of KSA and to compare the results with other national and international studies.Methods:This retrospective case-control study was conducted in the Departments of Obstetrics and Gynecology, and Histopathology at the Maternity and Children Hospital (MCH), Madinah, KSA from January 2013 to December 2015.Results:Of the 1594 cases reviewed, only 38 cases (2.4%) had epithelial cell abnormalities. High grade squamous intraepithelial lesions (HSIL) and low grade squamous intraepithelial lesions (LSIL) were the most common diagnosis categories, and cervical cancer accounted for 36.8% of the total cases for each, followed by atypical squamous cells of uncertain significance (ASCUS) found in (15.9%). Squamous cell carcinoma (SCC ) was found in (5.3%) of the cases. Patients with abnormal epithelial changes had higher parity (P=0.021) and presented more with a complaint of postcoital bleeding (P<0.0001), tend to have abnormal cervical appearance (P=0.004), more likely bleeding on touch (P=0.001) and associated with cervical erosion (P=0.014).Conclusion:The study showed a relatively low prevalence of epithelial cell lesions. These lesions were mainly squamous cell lesions harbored by females who have an abnormal cervical appearance, and those with high parity who were lacking cervical screening program.

An Audit on the Outcomes of the Assessment of Post-Coital Bleeding at Colposcopy at Wellington Hospital in 2012-2013

An Audit on the Outcomes of the Assessment of Post-Coital Bleeding at Colposcopy at Wellington Hospital in 2012-2013

Association of Sexually Transmitted Diseases With Cervical Ectopy: A Systematic Review.

The aim of this study was to review the available literature to explore evidence indicating an association between cervical ectopy and sexually transmitted diseases, which could help in the decision to treat or not to treat this condition. A review of the literature was conducted using the PubMed, EMBASE and clinicaltrials.gov databases on ectopy of the cervix using the terms "ectopy OR ectropium AND cervix" filtered only by language, without limit of date. A total of 71 studies were found in the initial selection, of which 56 were deleted by title, abstract, or full text. The remaining 15 articles were analyzed in this study. Cervical ectopy showed a positive association with human papillomavirus, human immunodeficiency virus, bacterial vaginosis, cervical epithelial atypia, postcoital bleeding, and desquamative inflammatory vaginitis. High-quality studies reported no association between ectopy and chlamydia infection. It was also not associated with gonococcal infection and herpes simplex. Cervical ectopy shows a probable association with increased acquisition of some sexually transmitted diseases. Additional studies are required to confirm the possible beneficial effects of treatment and to evaluate the possible complications of these treatments.

Cytological and colposcopic evaluation of abnormal cervix

The second most common cancer among women worldwide is cancer of the cervix commonly develop due to abnormal cervix. To evaluate abnormal cervix by cytology and colposcopy, a prospective study was undertaken among 100 women attending at the colposcopy clinic in Mymensingh Medical College Hospital (MMCH) from January 2008 to July 2008. Cytological and colposcopic evaluation were done in all the patients attending the colposcopy clinic with various complaints like per vaginal discharge, post-coital bleeding, dyspareunia, irregular per vaginal bleeding, backache and abnormal cervix on examination. A biopsy was taken from 53 cases of colposcopically abnormal or clinically doubtful cervices. Cytology and colposcopy findings were compared with the histological results. Study results revealed that 26 apparently healthy cervices in naked eye examination showed abnormal cytology in 8 cases and premalignant and malignant changes was seen in 9 among colposcopically abnormal 11 cases. Among the 40 cases of ectropion, abnormal cytology found in 11 and premalignant and malignant changes in 13 cases. In 11 cases of nabothion cyst, 4 had abnormal cytology and premalignant changes in 2 cases. Among 10 erythema cases, 3 showed abnormal cytology and 6 showed premalignant and malignant changes. One ulcer case revealed malignancy on cytology, colposcopy and histopathology. The other 12 cases, abnormal cytology found in 7, premalignant and malignant changes found in 8. On cytological examination, abnormal cytology found in 34 cases, among these 26 revealed premalignant and malignant on biopsy report. Out of 66 negative cytological smear cases, 23 colposcopically positive and biopsy showed 13 cases as premalignant and malignant. So, 13% cases of premalignant and malignant lesion may be overlooked if cytology alone was used for screening. This study revealed that colposcopy examination significantly reduces false negative cytology. Results of this study concluded that combined procedures enhance diagnostic accuracy.&#x0D; CBMJ 2019 January: vol. 08 no. 01 P: 3-11