Tampon Use Research Articles

Acceptability of self-testing for trichomoniasis increases with experience

ObjectivesSelf-testing and point-of-care (POC) tests could improve the detection of sexually transmitted infections (STIs) in adolescents. This study aimed to (1) validate a scale measuring acceptability of self-testing for trichomoniasis,...

Vulvodynia in Adolescence: Childhood Vulvar Pain Syndromes

Background Children, adolescents and young women represent a unique group of patients with vulvodynia. Study Objective To define and characterize vulvodynia, diagnostic criteria, causes and pathophysiology, propose treatment modalities, emphasizing its prevalence in young children, adolescents and young women less than 25 years of age. Design Medline review of the literature on vulvar pain disorders, using the key word vulvodynia, from the years 1995 to 2010, comparing characteristics in children, adolescents and young women ages 25 years and less to older adult women. Setting MEDLINE review of current literature from 1995 to 2010. Participants None Interventions There were no interventions during this literature review. Main outcome measures A synthesis of cases of vulvodynia in these populations and the specific characteristics and recommendations in these age groups. Results Childhood vulvar pain is usually found to have a cause. Pain characteristics in this group are similar to adults. In adolescents and young reproductive age women, vulvar pain is associated with sexual intercourse or early tampon use. The psychological component of vulvar pain is limited due to small numbers of patients available for review. Treatment modalities and recommendations are based on limited data. Conclusions Women with vulvodynia vary in ages from 16 to 80 years with the majority between the ages of 20 to 50 years. Young women in their teens and early twenties are at the greatest risk of developing vulvodynia. Vulvar pain disorders are important in these groups because early pain syndromes may affect future development of body image, self-esteem, and attitudes toward sexual behavior and functioning.

Toxic Shock Syndrome, a Gynecological Source in an Adolescent: A Case Report

Toxic shock syndrome (TSS) is an acute toxin-mediated infectious syndrome characterized by fever, hypotension, desquamation, and multiorgan involvement. It may be menstrually related (MTSS) or non-menstrual (NMTSS) in association. MTSS has been associated with tampon use. TSS is a rare condition, particularly in the adolescent population (1.52/100,000 age 15 to 19), but the effects can be life threatening. Unfortunately, the diagnosis can be difficult until late in the disease progression. We describe a rare case of TSS with a gynecologic source in a 15-year old female who survived her disease after intensive care treatment.

Tampon use in patients with anorexia nervosa can cause persistent vaginal bleeding: A case series

To describe the phenomenon of persistent vaginal bleeding in two patients with severe anorexia nervosa. We report two cases of young women with severe anorexia nervosa reporting vaginal bleeding that persisted for months despite trials of topical and systemic conjugated estrogen therapy. A speculum exam by a gynecologist ultimately revealed the source of the bleeding to be tampon-induced vaginal ulcers. These resolved, along with the vaginal bleeding, with vaginal estrogen cream and cessation of tampon use. Most patients with anorexia nervosa are amenorrheic due to reversion of the hypothalamic-pituitary-ovarian axis to a prepubertal state. Vaginal bleeding in patients with anorexia nervosa may trigger needless systemic hormonal treatments, radiographic studies, and multiple physician visits. A careful exam is warranted to evaluate for the presence of tampon-induced vaginal ulcer in patients with anorexia nervosa who have persistent vaginal bleeding.

Higiene íntima femenina y vaginosis bacteriana. Encuesta Epidemiológica Latinoamericana 2008

Objetivos: hacer una aproximación a la prevalencia de vaginosis bacteriana (VB) en mujeres en Latinoamérica y explorar la asociación entre el tipo de hábitos higiénicos y prácticas sexuales con la presencia de este diagnóstico.Metodología: estudio de corte transversal en mujeres de 10 países de Latinoamérica entre los 16 y 49 años, vida sexual activa y ciclos menstruales. Se excluyeron las mujeres que presentaban otro tipo de infección vaginal, en gestación o en puerperio, con incapacidad para responder la encuesta o con cambio de pareja sexual en el último trimestre. Igualmente, se realizó muestreo por conveniencia de 1.000 mujeres. Se presenta la prevalencia de punto de VB. Se aplicó una encuesta que contenía información sociodemográfica, información sobre actividad sexual e higiene íntima y se hizo el diagnóstico presuntivo de vaginosis bacteriana basado en criterios clínicos y de laboratorio. Se evalúa la asociación entre VB, los hábitos higiénicos y prácticas sexuales por medio del OR y su intervalos de confianza del 95%.Resultados: la prevalencia de VB fue del 40% en las pacientes encuestadas. Se encontró asociación con el uso de alcohol y tabaco. Como actores protectores se identificaron el lavarse las manos después de orinar o defecar (OR=0,32; IC95%, 0,16-0,63); utilizar una técnica “adecuada” de aseo genital (OR=0,55; IC95%, 0,41-0,74) el uso de jabón en forma líquida (OR=0,62; IC95%, 0,46-0,84) y el uso de un jabón exclusivo para el área genital (OR=0,56; IC95%, 0,42-0,75). Como factores de riesgo se encontraron el uso de tampón (OR=3,00; IC95%,1,88-4,80), tener relaciones sexuales durante el período menstrual (OR=1,46; IC95%, 1,03-2,07) y usar lubricantes durante el coito (OR=1,68; IC 95%, 1,07-2,64).Conclusión: la prevalencia de VB es similar a la previamente informada en Latinoamérica. Su frecuencia esta asociada a los hábitos higiénicos y prácticas sexuales.

Association between tampon use and choosing the contraceptive vaginal ring.

To estimate whether tampon users are more likely to select the contraceptive vaginal ring than combined oral contraceptive pills (OCPs). The Contraceptive Choice Project is a longitudinal study of 10,000 St. Louis area women promoting the use of long-acting, reversible methods of contraception and evaluating user continuation and satisfaction for all reversible methods. We performed univariable and multivariable analyses of the 311 women who were asked about tampon use at the time of enrollment and who chose the contraceptive vaginal ring or OCPs to assess the association of tampon use and choice of combined hormonal method. Among contraceptive vaginal ring and OCP users, 247 (79%) reported using tampons. Contraceptive vaginal ring users were not significantly different from OCP users in terms of age, race or ethnicity, marital status, insurance, body mass index, or parity. Adjusted analysis indicated that tampon users were more likely to choose the contraceptive vaginal ring instead of OCPs (adjusted relative risk 1.34, 95% confidence interval 1.01-1.78). Women with previous contraceptive vaginal ring experience were also more likely to choose the contraceptive vaginal ring (adjusted relative risk 1.96, 95% confidence interval 1.6-2.4). Recent OCP use did not influence method choice. In our baseline analysis of the Contraceptive Choice Project, tampon users were more likely to choose the contraceptive vaginal ring than OCPs. Use of tampons could be considered an indicator for the initial acceptability of the contraceptive vaginal ring, but all women should be offered the contraceptive vaginal ring regardless of experience with tampon use. II.

Microbiological and functional evaluation of an alternative device (OB®) for estrous synchronization in ewes

The use of synthetic progestagens released by vaginal devices is an important tool to overcome the reproductive seasonality in sheep, but cost and/or subsequent vaginitis are limiting factors for their use. To identify economic, simple and innocuous alternative vaginal devices for estrous synchronization/induction protocols in sheep, this study aimed to evaluate the microbiological and functional viability of the human vaginal tampons (OB®) impregnated with medroxyprogesterone acetate (MAP) on reproductive performance of ewes. The study compared them with commercial vaginal inserts (CIDR®) and polyurethane sponges impregnated with MAP. In Experiment 1, the device loss rate, the degree of vaginitis during the device removal, the count and identification of bacterial colonies at the device insertion and removal, and efficiency in estrous synchronization and estrus temporal distribution were evaluated. Pubertal ewes at the beginning of the breeding season were randomly allocated to three experimental groups: CIDR®, PSP (polyurethane sponge) and OB®. No device losses occurred in any group, but the use of OB® caused milder signs of vaginitis than polyurethane sponges, with a similar vaginal bacterial growth and microbiota than the CIDR group. The estrus distribution was more disperse in the CIDR than PSP or OB groups. In Experiment 2, pregnancy rates using CIDR® or OB® devices were compared, with estrus manifestation (85.4% and 89.8%) and pregnancy rates (58.3% and 49.0%) being similar between groups (P>0.05), respectively. In conclusion, the use of human intra-vaginal tampons (OB®) impregnated with MAP was proven highly hygienic, practical and effective as a low-cost alternative for estrous synchronization and AI in sheep.

Risk factors for recurrent vulvovaginal candidiasis

Recurrent vulvovaginal candidiasis is relatively frequent condition, and may have serious health consequences, like chronic vulvovaginal pain syndrome. The aim of our study was to determine possible risk factors for recurrent vulvovaginal candidiasis in non-pregnant females within the reproductive age. The design of our study was of a case-control type. Case and control patients were selected from the gynecological patients at six primary care facilities in Serbia and in Montenegro. The data on the patients' health condition, concomitant therapy and diseases were taken from their records, and the data on habits were obtained by unstructured interview. For potential risk factors crude odds ratios were calculated, and then adjusted by logistic regression. A total of fifty-one patients had four or more episodes of vulvovaginal candidiasis during the last year (cases), and 132 patients with one to three episodes of vulvovaginal candidiasis were sampled as controls, matched by age. The only two significant associations were found between recurrent vulvovaginal candidiasis and continual wearing of panty liners during the last year (Odds ratio - OR adjusted: 3.97; confidence interval--CI: 1.57-10.02;p = 0.004), and between recurrent vulvovaginal candidiasis and predominant use of vaginal tampons during menstruation in the last year (OR adjusted: 4.25; CI: 1.11-16.27;p = 0.035). The synergistic effect was observed for the concurrent continual wearing of panty liners during the last year and self-medication with antimycotics. Local factors, like wearing of panty liners or use of tampons during menstruation, may promote recurrence of vulvovaginal candidiasis, especially in patients who practice self-medication with antimycotics.

Intravaginal and in vitro temperature changes with tampons of differing composition and absorbency

Vaginal tampons are Class II medical devices used by women to manage menstruation. The purpose of this study was to investigate intravaginal temperature changes with simulated and actual menstrual tampon use. Tampons (with varying absorbent compositions) embedded with a thermocouple sensor were used to study temperature effects in vitro in a model of the vagina (condom placed in a hollow glass tube, jacketed in a 37 degrees C water bath, and dosed with human menses to fluid saturation) and clinically during menstrual tampon wear under controlled conditions (up to 8 h in a stationary, supine position). Elevations in the temperature of the tampon core occurred upon menses fluid acquisition both in vitro and clinically. Temperature profile characteristics varied from a transient spike with commercial cotton-rayon blend tampons of two different absorbencies to a small but sustained rise (> or =6 h) with a carboxymethyl cellulose (CMC)-containing prototype. On the basis of the results from this study, fluid absorption by tampons generates an exothermic event whose characteristics vary with tampon design and composition. We speculate the small, sustained increased in tampon temperature noted during this study may enhance the production of a bacterial exotoxin associated with tampons composed of CMC.

In vitro Actinomyces israelii biofilm development on IUD copper surfaces

Background Female pelvic actinomycosis may involve fallopian tubes, ovaries, uterus and bladder. This condition is often associated with the use of intrauterine contraceptive devices (IUDs), vaginal pessaries and/or tampons. The predominant causative agent of human actinomycosis is Actinomyces israelii, which has been found on copper IUDs retrieved from patients. Study Design In this work, a biofilm of A. israelii was developed in vitro on copper surfaces immersed in a simulated uterine fluid under anaerobic conditions. The biofilm was characterized using scanning electron microscopy (SEM), energy dispersive X-ray and atomic force microscopy. Results The capacity of A. israelii to develop a biofilm over copper surfaces in synthetic media was demonstrated. SEM micrographies illustrate the exopolysaccharides production and bacterial distribution. Conclusion A. israelii was able to attach and grow in synthetic intrauterine media and to present on the copper surface is likely due to the production of biofilm.

The Nose Knows: Toxic Shock and Rhinosinusitis

Source: Chan KH, Kraai TL, Richter GT, et al. Toxic shock syndrome and rhinosinusitis in children. Arch Otolaryngology Head Neck Surgery. 2009;135:538–542; doi:10.1001/archoto.2009.55Investigators from The Children’s Hospital, Denver, sought to determine the relationship between toxic shock syndrome (TSS) in children and either acute or chronic rhinosinusitis. To identify potential study patients, the primary and secondary discharge diagnoses of children admitted between 1983 and 2000 were searched using diagnostic codes for TSS and sinusitis. Medical records of the identified children were reviewed.TSS was defined as fever (>38.9°C), a diffuse macular erythroderma (with or without desquamation), hypotension, and dysfunction of three or more body systems.1 Proven TSS included all four criteria, while probable TSS cases fulfilled three of the four criteria. Probable rhinosinusitis was defined as plain or CT films with ≥4 mm of mucosal thickening in the maxillary sinuses, air fluid levels in any of the sinuses, or total opacification of any of the paranasal sinuses. Proven rhinosinusitis required the same abnormal radiographic imaging plus a positive culture or Gram stain for organisms or polymorphonuclear cells.A total of 11 cases of proven TSS and five probable TSS with either proven or probable rhinosinusitis were identified. The average age was 10 years with equal distribution of girls and boys. Ten of these children required critical care while six underwent otolaryngologic surgery. No patients died. The authors conclude that patients with TSS without an identified source of infection should be evaluated for sinus disease.Dr Lemoine has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.TSS is an acute, toxin-mediated illness, and like endotoxic shock, is characterized by fever, rash, hypotension, multi-organ involvement, and desquamation.2 TSS is usually caused by Staphylococcus aureus or Streptococcus pyogenes. The mortality in children is slightly higher with streptococcal TSS (5–10%) compared to staphylococcal TSS (3–5%).3 TSS appears to be a rare complication of sinus disease. The limited number of sinus cultures performed in children with TSS and sinusitis precludes any conclusions regarding the causative organisms. The principal bacterial pathogens of acute bacterial rhinosinusitis are S pneumoniae (30%–40%), Haemophilus influenzae (20%–30%), Moraxella catarrhalis (12%–20%), and S pyogenes (up to 3%).5 Other pathogens include other Streptococcus species, Staphylococcus aureus, and Neisseria species. Rhinosinusitis complicates 5%–10% of pediatric upper respiratory infections and typically is a self-limiting disease.4This case series suggests that sinus disease should be evaluated in children with TSS and no identified source of infection. However, the authors did not reach any conclusions as to the frequency of sinus disease as an infectious source for TSS or the merits of antral lavage, performed in five patients in this report. The utility of surgery to treat rhinosinusitis in children with TSS awaits further investigation.TSS was first described as a unique entity associated with S aureus in 1978 by J. Todd, one of the coauthors of this paper.8 Subsequent interest in the syndrome, generated by its association with tampon use in young women, relegated to virtual obscurity the fact that all seven patients in the original report were children. Unfortunately, estimates of the current frequency and age distribution of TSS are undoubtedly inaccurate as they rely on passive surveillance.9 The disease has been reported in all age groups, but is most common in children and young adults who presumably lack immunity to toxic shock syndrome toxin-1 (TSST-1).Approximately 50% of reported cases are now unrelated to menses. TSS has been associated with surgical wounds, cutaneous and subcutaneous infections, adenitis, bursitis, osteomyelitis, burns, and respiratory and post-partum infections.10 This study reminds us of the previous reports of TSS associated with nasal packing10,11 but unfortunately it lacks bacteriologic confirmation. Nonetheless, it serves as a reminder of the myriad anatomic sites in which the organisms can replicate and release toxins.

SYMPTOMS AND RISK FACTORS ASSOCIATED WITH FIRST UTI IN COLLEGE-AGED WOMEN: A PROSPECTIVE COHORT STUDY

INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) is a significant health care problem in the female population, and the majority of published studies focus on recurrent UTIs in older women. In order to better identify origin, evaluate risk, and recommend intervention, we identify the urinary symptoms and risk factors associated with first time UTI in a cohort of college-aged women compared to controls. METHODS: From July 2001 through April 2005, we prospectively enrolled 181 women with their first UTI episode who presented to the student health care facility at the University of Florida. A control group of 80 females attending the student health care facility for routine health care with no prior history of UTI was also enrolled. A study nurse dedicated to the project obtained informed consent from all participants and administered a validated questionnaire that addressed lifestyle habits and dietary intake to identify contributing factors to UTI. Urinalysis, urine cultures, and vaginal cultures were obtained on all enrollees. All women with UTI were seen two weeks post treatment, and women in both groups were seen for a minimum of one and maximum of three post-infection, healthy visits. Comparisons between the symptomatic and control groups were made using ANOVA and Student t-test. RESULTS: The most common presenting symptoms of first time UTI patients were frequency and urgency, and the majority of patients sought treatment between days 3 and 4 of first symptoms (p<0.01). UTIs were most common in women who had increased sexual activity (p<0.01), who recently used alcohol-containing beverages (p<0.01), and who used sanitary napkins during menstruation (p<0.05). Direction of wiping, hesitating to urinate, and use of tampons did not appear to correlate with increased UTI risk. Co-existing chlamydia, gonorrhea, and yeast infections did not contribute significantly to urinary symptoms. CONCLUSIONS: According to this cohort, urinary frequency and urgency are the predominant presenting urinary symptoms in females affected by their first UTI. Increased sexual activity and the recent use of alcohol-containing beverages were associated with increased incidence of first time urinary tract infection in college-aged women.

Nasal Tampon Packing Using Anesthetic Lidocaine and Chlorhexidine Urinary Lubricant Gel

Since Hippocrates first defined nasal tampon packing in the fifth century BC, nasal tampons have been considered the primary treatment for epistaxis [1]. Nasal tampon use is very common after surgery involving the nasal cavity and paranasal sinuses. Many kinds of materials such as gauzes, expanding sponges, ready-made or inflatable tampons, and Foley catheters can be used for nasal tamponing. However, whatever is used, the primary purposes of nasal tamponing are to provide an adequate pressure over the nasal mucosa to prevent bleeding and hematoma, to support unstable gentle nasal structures after nasal surgery, and to protect against infection. It is important to prepare the nasal tampon in a sterile way to prevent infection [2]. However, both the placement and the removal of nasal tampons can be distressing and painful for patients. Because the tampon adheres to the mucosa over the course of time, patients can become distressed and there can be bleeding, particularly when the tampon is removed. Because of these unwanted circumstances, the gauzes are greased and softened with lubricants or pomades. Antibiotic ointments have advantages against infections. However, additional methods can be required to reduce pain. For providing adequate greasiness and softness to facilitate application, for maintaining analgesia, and for preventing infections, the use of sterile urinary lubricant anesthetic gel that includes lidocaine and chlorhexidine (lidocaine HCl 2%, chlorhexidine 2HCl 0.05%) is a practical, useful, and cheap method for preparing the nasal tampon. Chlorhexidine helps prevent infections, while lidocaine reduces the pain after the application by distributing local anesthesia over the nasal mucosa. Thus, the patient can be more comfortable after the application. Also, the gel keeps the tampon from adhering to the nasal mucosa, so the pain and bleeding seen with removal is reduced. To prepare the nasal tampon, long, slim gauzes are greased with urinary lubricant (Figs. 1 and 2). Being in a sterile container is an additional advantage of the lubricant. Although the use of commercial tampons is easier than making them, they are more difficult to obtain. Also, they are more expensive than classical tampon packing. It is easy to obtain sterile lidocaine and chlorhexidine urinary

Assessment of Vulvodynia Symptoms in a Sample of U.S. Women: A Follow-up National Incidence Survey

To estimate the annual incidence of vulvodynia-like symptoms and evaluate triggers of vulvar pain in a sample of U.S. women. After a 1-year interval, women who previously participated in a national vulvodynia prevalence study were recontacted and administered a telephone questionnaire that assessed self-reported vulvodynia-like symptoms and triggers of symptoms. From the original cohort of 425 women, 285 (67%) participated in this follow-up study. Symptoms consistent with vulvodynia occurring within 1 year of initial contact were reported by 4.7% of previously asymptomatic women. Nearly 50% of the original patients again reported a history of vulvodynia-like symptoms, with 68.6% of these as persistent over the past year. Of significance, pain or discomfort with first-time tampon use was 2.15 times more likely (95% CI 1.0-4.62) in symptomatic women. These women were also 2.4 times more likely (95% CI 1.29-4.53) to use a combination of tampons and pads for sanitary protection rather than one method alone. Over the course of 1 year, as many as 1 in 20 women may experience new-onset chronic genital pain. Despite a higher likelihood of having discomfort or pain with first tampon use, symptomatic women did not exhibit a preference for sanitary napkins. This indicates that lack of tampon use because of pain may not be an effective screening criterion for vulvodynia. We recommend additional studies with symptomatic and diagnosed women to explore in more detail the issues surrounding tampon use history and chronic genital pain.

Vaginal maturation index self-sample collection in mid-life women

During menopause, the ratio of the three vaginal epithelial cell types (parabasal, intermediate, and superficial) changes. The proportion of these vaginal cell types is categorized by the vaginal maturation index (VMI). The VMI provides an objective assessment of vaginal hormone response as well as overall hormonal environment. The aim of this study was to determine the concordance of self- and physician-collected samples for VMI and evaluate participant preference for self-collection. Twenty women aged 42 to 67 years were enrolled. Each woman received instructions and self-collected a sample for VMI analysis from her posterior lateral vaginal walls. Next, she underwent a vaginal speculum examination for physician VMI sampling. Finally, she completed a survey regarding sampling preference, ease of self-sampling, and previous vaginal experience. Correlation between physician- and self-collected samples were calculated using Pearson's correlation coefficient and Cronbach's alpha. Participant characteristics, vaginal experiences, and sampling preferences were summarized using frequencies and measures of central tendencies. The relationships between preference for sampling method and previous vaginal experiences were examined using Fisher's exact test. Average age of the 20 participants was 52.2 years (range, 42-67 y). Women had a variety of previous vaginal experiences ranging from tampon use (100%) to previous vaginal self-swabbing (15%). Average self-collected VMI was 48.4 (range, 13.8-83.5) and physician-collected VMI was 49.9 (range, 20.5-83.5) with a correlation of 0.97 (P < 0. 001), alpha = 0.94. The majority of women preferred self-collection (80%) to physician collection, and there was no difference in preference based on previous vaginal experiences. Nineteen women (95%) found the self-collection to be very easy, and one found it to be somewhat easy. Women can reliably self-collect samples for VMI, and the majority of women in our study preferred self-collection to physician collection. Vaginal self-sampling allows this technique for measuring overall hormonal environment to be used in clinical and epidemiological research.

Symmetrical peripheral gangrene complicating staphylococcal toxic shock syndrome

Sudden onset symmetrical peripheral gangrene (SPG) is a relatively uncommon clinical entity which was initially described in 1981 by Hutchison. It is defined as symmetric distal ischemic damage in two or more sites in the absence of major vascular occlusive disease [1, 2, 3]. It is a manifestation of many systemic disorders and accompanies infectious disease of various etiologies, shock, drugs and malignancy [1, 2, 3]. Toxic shock syndrome (TSS) is an acute life threatening inflammatory response characterized by fever, rash, hypotension, constitutional symptoms and multiorgan involvement [4, 5]. The disease first described in 1978, is typically associated with tampon use in healthy menstruating women. The disease also exists in men, neonates and non-menstruating women. TSS is a toxin mediated disease caused by coagulase - positive staphylococci (S aureus) and group A beta- hemolytic streptococci (S pyogenes) [4, 5]. We report a case of staphylococcal TSS, complicated by rapid onset SPG involving the toes and fingers.

PH‐balanced tampons: do they effectively control vaginal pH?

To determine if tampons lubricated with pH-balanced gel are effective at maintaining normal vaginal pH. Randomised controlled trial. Urban family planning clinic and teaching hospital. Healthy volunteers using the combined oral contraceptive pill. Women were randomised to use an existing lubricating gel (pH 5.1) or a lactic acid-buffered gel (pH 3.8-4.2) with regular size, non-applicator tampons. In the preceding control cycle, women used identical tampons without gel. Vaginal pH < or = 4.5, microbiology (candida and bacterial vaginosis [BV]) and colposcopic appearance within 72 hours of tampon use, subject acceptability and symptoms. Eighty-one out of 98 (83%) women completed the study. No significant difference was observed between tampons with the standard gel formulation, the pH-balanced gel and nonlubricated tampons in terms of vaginal pH, microbiological evidence of candida or BV, or colposcopic appearance. Acceptability scores were significantly higher for lubricated tampons compared with nonlubricated tampons (P < 0.05), although there was no difference in reported symptoms. Tampons lubricated with pH-balanced gel do not control vaginal pH. There was no evidence of measurable health benefits of lubricated tampons, but women preferred tampons with [corrected] lubrication.

Sacral nerve stimulation as an option for the treatment of faecal incontinence in patients suffering from cauda equina syndrome

Retrospective clinical study with 1-year follow-up. Treatment of faecal incontinence by permanent sacral nerve stimulation (SNS) in patients suffering from cauda equina syndrome (CES). Klosterneuburg, Austria. A flaccid paresis of the sphincter ani muscle and the pelvic floor combined with faecal incontinence can occur in patients suffering from CES as a result of a trauma in the region of the lumbar spine. If the incontinence cannot be managed by the use of laxatives or anal tampons, the patient is restricted in his/her quality of life. Thus, it was our aim to improve sphincter function and anal sensitivity to achieve voluntary rectal defaecation. The functional integrity of at least one sacral root (S2-S4) was determined through percutaneous nerve evaluation (PNE). Following this analysis, a period of external temporary SNS was performed to evaluate the functional effect. If there was a decrease in the number of episodes of faecal incontinence during this evaluation period, a neurostimulation device (InterStim; Medtronic) was implanted. A total of 11 patients suffering from flaccid paresis of the anal sphincter muscle and faecal incontinence caused by CES underwent PNE, which was successful in 8 patients. Two of these patients were eliminated from the procedure at the end of the temporary SNS period, one patient refused the permanent implantation. Therefore, five patients proceeded to permanent implantation, which led to an improved continence in all the cases. In the synopsis of the preoperative proctologic and neurological findings, successful electric stimulation of the sacral roots can be expected in incomplete CES. In the case of flaccid paresis of the anal sphincter muscles caused by an incomplete CES, permanent SNS offers a promising option for the treatment of faecal incontinence. .

The contraceptive vaginal ring: female adolescents' knowledge, attitudes and plans for use

Background This study aimed to determine female adolescents' knowledge about the contraceptive vaginal ring and to assess their attitudes toward and consideration of ring use. Study Design We recruited 164 participants, ages 14–21, who completed a 62-item, 15-min interview assessing tampon and vaginal product use history, reproductive health history and ring awareness. Among those who had heard of the ring, knowledge was assessed with a 15-item pretest. All participants received a 2-min description of the ring with a demonstration, after which attitudes, consideration of use and posttest knowledge were assessed. Results Our study population is unique in that 92% had been sexually active and 22% who had been sexually active had also been pregnant. The mean age of coitarche was 15.2 years, and 35% had ever used emergency contraception. More than half (52%) had never heard of the ring. Of those who had heard of it, only 35% had sufficient knowledge. After a brief demonstration with a vaginal model, 98.2% acquired sufficient knowledge to use the ring correctly. More than half (57.9%) liked the idea of the ring, and 45.7% said that they would consider using it. Logistic regression demonstrated that liking the idea of the ring and considering its use were associated with comfort using at least one vaginal product, with those who were comfortable using a vaginal product being 3.1 times more likely to like the idea of the ring compared to those who were not comfortable using a vaginal product. Logistic regression also showed that liking the idea of the ring was associated with having had at least one pelvic exam. Conclusions Most participants had limited or no prior ring knowledge. Once briefly educated, all had sufficient knowledge and a substantial percentage would consider using it. The ring appeals to adolescents and should be routinely offered as a method of contraception. Comfort using at least one vaginal product is associated with liking the idea of the ring and considering its use.

An Exploration of Issues around Menstruation for Women with Down Syndrome and their Carers

Background There is little research on issues related to menstruation for women with Down syndrome, yet they may experience menstruation in a qualitatively different way from normal women, which impacts on their quality of life and that of their families and carers. The aim of this qualitative study was to explore issues with the women and/or their carers.Method Face‐to‐face or telephonic interviews were carried out with six women with Down syndrome, and 53 mothers of women with Down syndrome.Results The range in age and pattern of menses was similar to that of the general population. Around two‐thirds of the women were coping with the self‐care aspects with limited help. Heavy periods were an issue for around one‐third. Use of tampons was rare, yet several women had problems with pads. Some mothers were unaware how much their daughter knew about the menstrual cycle; others deliberately withheld information.Conclusions Lack of information and preparation, heavier periods for some and reluctance to use tampons, all indicated specific issues for these women. Establishing routines was helpful and could have been applied to more of the women. Further research is suggested into heavy periods and other possible interventions.