Vaginal Conditions Research Articles

Effect of Foeniculum vulgare (fennel) vaginal cream on vaginal atrophy in postmenopausal women: A double-blind randomized placebo-controlled trial

ObjectiveVaginal atrophy is one of the main concerns of postmenopausal women. The aim of the present study was to investigate the effect of fennel vaginal cream on vaginal atrophy in postmenopausal women in Ahvaz, Iran. Materials and methodsThis double-blind randomized controlled trial was conducted on 60 postmenopausal women (45–65 years of age) in Ahvaz, Iran. The study participants were randomly divided into one of two groups, receiving either a placebo (n=30) or fennel 5% vaginal cream (n=30) administered as one application per day (5g/day) for 8 weeks. Main outcomeThe vaginal pH and maturation vaginal index (MVI) were measured at baseline and 8 weeks after the intervention, while the vaginal atrophy symptoms was measured at baseline and at 2, 4, and 8 weeks after the intervention. The data were analyzed using the independent t-test, chi-square test, paired sample t-test, and the generalized estimating equation. ResultsThe number of superficial cells increased significantly in the fennel group after 8 weeks compared to the control group (76.1±15.3 vs. 11.8±8, p<0.001). The number of intermediate and parabasal cells decreased significantly in the fennel group compared to the control group (p<0.001). The vaginal pH decreased significantly at the 8-week follow-up in the fennel group compared to the control group (100% vs. 7.4%, p<0.001). All women in the fennel group had an MVI of 65–100 at the 8-week follow-up, whereas almost half (40.7%) of the women in the control group had an MVI of 50–64 (p<0.001). ConclusionAccording to results of this study, fennel is an effective means to manage the symptoms of vaginal atrophy in postmenopausal women and is devoid of side effects. Larger studies are necessary to confirm the positive impact of fennel for vaginal conditions occurring among postmenopausal women.

Psychological treatment for vaginal pain: does etiology matter? A systematic review and meta-analysis.

Classification of vaginal pain within medical or psychiatric diagnostic systems draws mainly on the presumed presence or absence (respectively) of underlying medical etiology. A focus on the experience of pain, rather than etiology, emphasizes common ground in the aims of treatment to improve pain and sexual, emotional, and cognitive experience. Thus, exploring how vaginal pain conditions with varying etiology respond to psychological treatment could cast light on the extent to which they are the same or distinct. To examine the combined and relative efficacy of psychological treatments for vaginal pain conditions. A systematic search of EMBASE, MEDLINE, PsycINFO, and CINAHL was undertaken. Eleven randomized controlled trials were entered into a meta-analysis, and standardized mean differences and odds ratios were calculated. Effect sizes for individual psychological trial arms were also calculated. Main outcome measures were pain and sexual function. Equivalent effects were found for psychological and medical treatments. Effect sizes for psychological treatment arms were comparable across vaginal pain conditions. Effectiveness was equivalent regardless of presumed medical or psychiatric etiology, indicating that presumed etiology may not be helpful in selecting treatment. Research recommendations and clinical implications are discussed.

Antimicrobial Properties of Microparticles Based on Carmellose Cross-Linked by Cu(2+) Ions.

Carmellose (CMC) is frequently used due to its high biocompatibility, biodegradability, and low immunogenicity for development of site-specific or controlled release drug delivery systems. In this experimental work, CMC dispersions in two different concentrations (1% and 2%) cross-linked by copper (II) ions (0.5, 1, 1.5, or 2.0 M CuCl2) were used to prepare microspheres with antimicrobial activity against Escherichia coli and Candida albicans, both frequently occurring pathogens which cause vaginal infections. The microparticles were prepared by an ionotropic gelation technique which offers the unique possibility to entrap divalent copper ions in a CMC structure and thus ensure their antibacterial activity. Prepared CMC microspheres exhibited sufficient sphericity. Both equivalent diameter and copper content were influenced by CMC concentration, and the molarity of copper (II) solution affected only the copper content results. Selected samples exhibited stable but pH-responsive behaviour in environments which corresponded with natural (pH 4.5) and inflamed (pH 6.0) vaginal conditions. All the tested samples exhibited proven substantial antimicrobial activity against both Gram-negative bacteria Escherichia coli and yeast Candida albicans. Unexpectedly, a crucial parameter for microsphere antimicrobial activity was not found in the copper content but in the swelling capacity of the microparticles and in the degree of CMC surface shrinking.

Formulation and evaluation of clindamycin HCL in situ gel for vaginal application.

Objective:The vagina has been studied as a favorable site for the local and systemic delivery of drugs, for female associated conditions. Vaginal preparations, although generally perceived as safer most still associated with number of problems including multiple days of dosing, dripping, leakage and messiness, causing discomfort to users and expulsion due to the self-cleansing action of the vaginal tract. These limitations lead to poor patient compliance and failure of the desired therapeutic effects. For efficient vaginal delivery of drugs, the delivery system should reside at the site of infection for a prolonged period of time. In situ gel formulation which combines advantages of both gels and solution so that an accurate dose can be administered with ease. These formulations remain in solution state before administration and transforms to gel after administration in to vaginal cavity.Material and Methods:In these formulations we prepared clindamycin loaded hydroxypropyl methycellulose (0.1%) (bioadhesive) and gellan gum (ion activated gelling polymer) based in situ gel system for vaginal application. NaCl (0.9%) was added as an isotonic agent. The developed formulation was characterized for various in vitro parameters such as clarity, refractive index, pH, viscosity, drug release profile, statistical release kinetics, bioadhesive force, and microbial efficacy along with stability studies. To simulate vaginal conditions, synthetic membrane (cellophane hydrated with modified simulated vaginal fluid) was used as model membranes.Results and Discussion:The developed formulation was found to be nonirritant, bioadhesive with good retention properties. Formulations have satisfactory appearance, clarity and drug content in the range 98.1-101%. Refractive index of the gel is ranging from 1.335 to 1.337, proofing the transparency of gel. Furthermore, formulation displayed 33.3% cumulative drug release after 2 h. 67.4% after 6 h and 98.9% after 12 h.Conclusion:Developed formulation should be stable. Hence, formulation is thus a viable alternative to conventional vaginal dosage forms.

Feasibility and acceptance of cervicovaginal self-sampling within the German National Cohort (Pretest 2).

Background and objectivesWithin the German National Cohort (GNC) 100,000 adult women in Germany will be comprehensively interviewed and examined. While women’s health is addressed in the basic interview, direct detection of cervicovaginal microbial colonisation or infection is not part of the examination protocol. In a pilot project the feasibility of female study participants of the GNC collecting a cervicovaginal lavage at home without having to involve a gynecologist or other medical personnel was thus investigated. The ability of the procedure to detect vaginal microbes and conditions including human papillomavirus (HPV), Chlamydia trachomatis and bacterial vaginosis (BV) were also explored.MethodsThis cross-sectional study was conducted in two study centers (Hamburg and Hanover) of the GNC during Pretest 2 in 2012 as an add-on module to the main program of the National Cohort. Participants were randomly selected through the population registration office. After providing written informed consent at the study center, participants self-collected a cervicovaginal lavage (Delphi Screener™) at home following written instructions. Participants mailed samples and acceptability questionnaires to the laboratory and the study center, respectively. Acceptability of self-sampling was categorized as consent, partial consent and rejection. The samples were analyzed by multiplex HPV genotyping for the presence of 27 mucosal HPV subtypes. To detect other pathogens “Sexually Transmitted Infection Profiling” (STIP) was used, a novel multiplex polymerase chain reaction (PCR) for various vaginally occurring pathogens/conditions coupled with subsequent bead-based Luminex® hybridization. Human beta-globin and DNA polymerase alpha (PolA) sequences were used as positive controls for the detection of human DNA during HPV detection and STIP, respectively.ResultsThe participation based on the proportion of all women in Pretest 2 who could take part in the add-on Pretest 2 was 67.3 % (109 out of 162). The age of participants ranged from 20 to 69 years. The self-reported median duration of the collection of the lavage was 5 min. Analysis of the questionnaires (n = 108) revealed that the self-sampling of a cervicovaginal lavage was acceptable to 98 % of women (106 out of 108), and considered to be easy by 89 % (96 out of 108) as well as user-friendly by 96 % of the women (104 out of 108). Human beta-globin and PolA as markers for human DNA and sample quality were detected in all samples analyzed while HPV as a marker for pathogen detectability was identified in 18 out of 109 samples. Of the 107 samples tested with STIP as a second marker for pathogen detectability, 5 samples were excluded from statistical analyses on bacterial colonization because of signs in the laboratory results of the use of antibiotics. For the computation of the possible occurrence of bacterial vaginosis and candidiasis 7 and 8 samples, respectively, were excluded because of low signal intensities resulting in an evaluation of 95 or 94 samples, respectively. Ureaplasma parvum was detected in 22 out of 102 samples, BV in 14 out of 95 samples and candidiasis in 13 out of 94 samples. Chlamydia trachomatis was not detected in any sample.ConclusionThe feasibility study on cervicovaginal self-sampling indicates that this form of biosampling was very well accepted within the framework of the GNC and feasible in terms of pathogen detection. Its further application in the GNC would allow investigation of transience and persistence, or long-term effects of vaginal (co)infections and colonization.

The Use of E-learning Modules to Improve Student Knowledge in Obstetrics and Gynecology

OPEN ACCESSSeptember 23, 2014The Use of E-learning Modules to Improve Student Knowledge in Obstetrics and Gynecology Carmen Obando, PhD, Joel Maurer, MD, Geraud Plantegenest, Christina Dokter, PhD Carmen Obando, PhD Michigan State University College of Human Medicine Google Scholar More articles by this author , Joel Maurer, MD Michigan State University College of Human Medicine Google Scholar More articles by this author , Geraud Plantegenest Michigan State University College of Human Medicine Google Scholar More articles by this author , Christina Dokter, PhD Michigan State University College of Human Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9920 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: The Obstetrics and Gynecology e-learning modules included in this resource are a set of three interactive self-directed learning instruments that offer alternative explanations of three different clinical case scenarios: amenorrhea, vaginitis, and third-trimester bleeding. These three topics were found to be rare in some clinical settings, thus making it difficult for students to observe them during their rotations. Methods: These modules allow students to observe patient-physician interactions and to identify symptoms and alternative diagnoses by using photos, videos, graphics, animations, text, and notes. The time needed to review each module varies by student. A student can take as much time as needed for each of the components and view them in the order desired. Results: Students' feedback suggests that they liked the availability of the modules as an online resource they could access at any time to review as many times as they needed. The interaction and self-directed characteristics of the modules also allowed the students to learn at their own pace. Discussion: The use of these modules reduces learning disparities by creating standardized simulated cases regardless of the number of cases encountered during the clerkship. The modules are accessible 24/7 to all students going through the OB-GYN clerkship and to faculty and staff through our departmental website, and students are required to review them before their hands-on experience. One of the limitations imposed by the use of online teaching materials is the lack of live interaction with an instructor. This can be easily compensated for by complementing use of the modules with a face-to-face interaction with the preceptor to review concepts not well understood by the student and to obtain feedback on any of the clinical cases presented. Educational Objectives By the end of the vulvar disease/vaginitis module, learners will be able to: Recognize vaginal conditions and consequences.Review differential diagnoses.Interpret a wet mount and microscopic examination.Complete all the steps of the evaluation and management of symptoms. By the end of the abnormal obstetrics/third-trimester bleeding module, learners will be able to: Practice the evaluation and management for reducing maternal and fetal morbidity and mortality.Review of the causes, initial evaluation, differentiation of signs and symptoms, and evaluation of acute blood loss and complications. By the end of the reproductive endocrinology/amenorrhea module, learners will be able to evaluate amenorrhea including the definition, pathophysiology, etiology, associated symptoms, evaluation and management, and consequences of an untreated condition. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Obstetrics and Gynecology E-learning Modules folder To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2014 Obando et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsBleedingVaginitisGynecologyThird TrimesterObstetricsInteractiveModulesHemorrhageAmenorrhea Disclosures None to report. Funding/Support None to report. Loading ...

Relative prevalence of STI pathogens, vaginal conditions and HIV co-infection among STI patients attending Alexandra Health Centre, Gauteng Province, South Africa (2011-2013)

Relative prevalence of STI pathogens, vaginal conditions and HIV co-infection among STI patients attending Alexandra Health Centre, Gauteng Province, South Africa (2011-2013)

Preactivated thiomers for vaginal drug delivery vehicles

It was the purpose of this study to design and evaluate a chitosan derivative as mucoadhesive excipient for vaginal drug delivery systems. The chemical modification of chitosan was achieved by conjugation of thioglycolic acid (TGA) resulting in 1594 μmol thiol groups per gram of polymer followed by the linkage of mercaptonicotinic acid (MNA) to the immobilized thiol groups via disulfide bonding leading to 702 μmol ligand per gram of preactivated polymer. The mucoadhesive properties of these polymers within newly designed vaginal formulations (Chitosan–TGA and Chitosan–TGA–MNA) and commercially available vaginal formulations (Candibene®, Daktarin®, Dalacin®, GynoPevaryl®) were tested over a time period of 24 h via a mucoadhesion test system simulating vaginal conditions, tensile studies and mucus polymer interaction studies via viscosity measurements. Within the vaginal test system simulating vaginal in situ conditions, a 1.5-fold increase in mucoadhesion could be observed for preactivated thiomer formulations after 24 h in comparison to commercially available formulations. Similar results were achieved for tensile studies, as the chitosan–TGA–MNA containing formulation resulted in a 4.9-fold increase in total work of adhesion (TWA) in comparison to Candibene which showed the highest TWA value of all tested commercial formulations. Also in terms of rheology investigations of mucus/formulation mixtures, a 5.8-fold increase in dynamic viscosity for chitosan–TGA–MNA containing mixtures could be observed in comparison to the mucus-free control. In contrast, commercially available formulations achieved a maximum enhancement of 1.9-fold. These outcomes confirm that the newly developed polymer is a promising tool for vaginal drug delivery likely providing a prolonged vaginal residence time due to its comparatively high mucoadhesive properties.

Quantification of Normal Vaginal Constituents Using a New Wet Preparation Technique

This study aimed to evaluate a new method for preparing vaginal wet preparations to enable quantification of cells and lactobacilli. The current nonstandardized technique allows for a variable amount of vaginal fluid collected, diluted by a variable amount of saline/KOH, and no quantification of constituents. The vaginal fluids from 100 randomly selected women without vulvovaginitis symptoms presenting to the author's practice at Mayo Clinic underwent analysis by the quantification technique. Women were excluded if they were younger than 18 years, had antibiotics within the past 2 months, currently on their period, had placed anything in the vagina for the past 24 hours, used Depo-Provera, or were lactating. All the wet preparations were made by mixing the natural vaginal fluids with 3 mL of sterile normal saline. Spinal diluting fluid was added to the saline preparation. The saline and KOH mixtures were injected into separate wells of KOVA Glasstic Grid Slide and analyzed with a phase-contrast microscope at 40× and 60×. The concentration of leukocytes, lactobacilli, and squamous cells and the degree of maturation of the majority (>50%) of squamous cells were assessed, and it was determined whether there was excessive non-lactobacilli bacteria (EB) as evident by clumps of bacteria in the background fluid and speckling on the squamous cells. The 3 most common patterns to occur were as follows: First, 51% (95% confidence interval [CI] = 41%-60%) of the total specimens had abundant lactobacilli, no leukocytes, more than 50% fully maturated squamous cells, and no EB. Second, 22% (95% CI = 14%-32%) of the total specimens had low lactobacilli counts, no leukocytes, more than 50% undermaturated squamous cells, and no EB. Third, 12% (95% CI = 6%-20%) of the total specimens had abundant lactobacilli, leukocytes, more than 50% fully maturated squamous cells, and no EB. It is imperative to be able to objectively quantify normal vaginal secretion constituents so that (1) the abnormal patterns can be demarcated and (2) treatment targets of what constitutes healthy vaginal conditions can be provided.

PH and temperature dual-sensitive liposome gel based on novel cleavable mPEG-Hz-CHEMS polymeric vaginal delivery system

BackgroundIn this study, a pH and temperature dual-sensitive liposome gel based on a novel cleavable hydrazone-based pH-sensitive methoxy polyethylene glycol 2000-hydrazone-cholesteryl hemisuccinate (mPEG-Hz-CHEMS) polymer was used for vaginal administration.MethodsThe pH-sensitive, cleavable mPEG-Hz-CHEMS was designed as a modified pH-sensitive liposome that would selectively degrade under locally acidic vaginal conditions. The novel pH-sensitive liposome was engineered to form a thermogel at body temperature and to degrade in an acidic environment.ResultsA dual-sensitive liposome gel with a high encapsulation efficiency of arctigenin was formed and improved the solubility of arctigenin characterized by Fourier transform infrared spectroscopy and differential scanning calorimetry. The dual-sensitive liposome gel with a sol-gel transition at body temperature was degraded in a pH-dependent manner, and was stable for a long period of time at neutral and basic pH, but cleavable under acidic conditions (pH 5.0). Arctigenin encapsulated in a dual-sensitive liposome gel was more stable and less toxic than arctigenin loaded into pH-sensitive liposomes. In vitro drug release results indicated that dual-sensitive liposome gels showed constant release of arctigenin over 3 days, but showed sustained release of arctigenin in buffers at pH 7.4 and pH 9.0.ConclusionThis research has shed some light on a pH and temperature dual-sensitive liposome gel using a cleavable mPEG-Hz-CHEMS polymer for vaginal delivery.

Lymphoma in Pregnancy Initially Diagnosed as Vaginal Intraepithelial Neoplasia and Lichen Planus

Non-Hodgkin's lymphoma presenting as a vaginal mass in pregnancy is uncommon. A 38-year-old primigravid woman presented at 27 weeks of gestation with vaginal lesions, bleeding, and discharge. Previous vaginal biopsies had been consistent with vaginal intraepithelial neoplasia 1 and lichen planus. After admission for this enlarging vaginal mass and bleeding, she was noted to have a newly palpable breast mass. Biopsy of the breast mass and subsequent re-evaluation of original vaginal biopsies were consistent with diffuse large B-cell lymphoma. She was treated with chemoimmunotherapy during pregnancy and delivered a viable neonate at term. Although benign vaginal conditions are common, non-Hodgkin's lymphoma should be considered in the differential diagnosis of persistent or enlarging vaginal lesions in pregnancy.

Engineering a degradable polyurethane intravaginal ring for sustained delivery of dapivirine.

We describe the engineering of a degradable intravaginal ring (IVR) for the delivery of the potent HIV-1 reverse transcriptase inhibitor dapivirine. The degradable polymer used in fabricating the device incorporated poly(caprolactone) ester blocks in a poly(tetramethylene ether) glycol ABA type polyurethane backbone. The polymer was designed to maintain its structure for 1month during usage and then degrade in the environment post-disposal. In vitro release of dapivirine showed zero-order kinetics for up to 1month and significant levels of drug release into engineered vaginal tissue. The mechanical properties of the degradable IVR were comparable to those of a widely used contraceptive intravaginal ring upon exposure to simulated vaginal conditions. Incubation under simulated vaginal conditions for a month caused minimal degradation with minimal effect on the mechanical properties of the ring and polymer. The cytotoxicity evaluation of the drug-loaded IVRs against Vk2/E6E7 human vaginal epithelial cells, Lactobacillus jensenii, and engineered vaginal tissue constructs showed the degradable polyurethane to be non-toxic. In vitro evaluation of inflammatory potential monitored through the levels of inflammatory cytokines IL-8, IL-1α, IL-6, IL-1β, and MIP-3α when engineered EpiVaginal™ tissue was incubated with the polyurethanes suggested that the degradable polyurethane was comparable to commercial medical grade polyurethane. These results are encouraging for further development of this degradable IVR for topical vaginal delivery of microbicides.

Lactobacillus acidophilus contributes to a healthy environment for vaginal epithelial cells.

Lactobacillus species in the female genital tract are thought to act as a barrier to infection. Several studies have demonstrated that lactobacilli can adhere to vaginal epithelial cells. However, little is known about how the adherence of lactobacilli to vaginal epithelial cells affects the acidity, cell viability, or proliferation of the lactobacilli themselves or those of vaginal epithelial cells. Lactobacillus acidophilus was co-cultured with immortalized human vaginal epithelial cells (MS74 cell line), and the growth of L. acidophilus and the acidity of the culture medium were measured. MS74 cell density and viability were also assessed by counting cell numbers and observing the cell attachment state. L. acidophilus showed exponential growth for the first 6 hr until 9 hr, and the pH was maintained close to 4.0-5.0 at 24 hr after culture, consistent with previous studies. The growth curve of L. acidophilus or the pH values were relatively unaffected by co-culture with MS74 cells, confirming that L. acidophilus maintains a low pH in the presence of MS74 cells. This co-culture model could therefore potentially be used to mimic vaginal conditions for future in vitro studies. On the other hand, MS74 cells co-cultured with L. acidophilus more firmly attached to the culture plate, and a higher number of cells were present compared to cells cultured in the absence of L. acidophilus. These results indicate that L. acidophilus increases MS74 cell proliferation and viability, suggesting that lactobacilli may contribute to the healthy environment for vaginal epithelial cells.

PH-sensitive Eudragit nanoparticles for mucosal drug delivery

Drug delivery via vaginal epithelium has suffered from lack of stability due to acidic and enzymatic environments. The biocompatible pH-sensitive nanoparticles composed of Eudragit S-100 (ES) were developed to protect loaded compounds from being degraded under the rigorous vaginal conditions and achieve their therapeutically effective concentrations in the mucosal epithelium. ES nanoparticles containing a model compound (sodium fluorescein (FNa) or nile red (NR)) were prepared by the modified quasi-emulsion solvent diffusion method. Loading efficiencies were found to be 26% and 71% for a hydrophilic and a hydrophobic compound, respectively. Both hydrophilic and hydrophobic model drugs remained stable in nanoparticles at acidic pH, whereas they are quickly released from nanoparticles upon exposure at physiological pH. The confocal study revealed that ES nanoparticles were taken up by vaginal cells, followed by pH-responsive drug release, with no cytotoxic activities. The pH-sensitive nanoparticles would be a promising carrier for the vaginal-specific delivery of various therapeutic drugs including microbicides and peptides/proteins.

Ion activated bioadhesive in situ gel of clindamycin for vaginal application.

Vaginal preparations, although generally perceived as safer most , still they are associated with a number of problems, including multiple days of dosing, dripping, leakage and messiness, causing discomfort to users and expulsion due to the self-cleansing action of the vaginal tract. These limitations lead to poor patient compliance and failure of the desired therapeutic effects. For effective vaginal delivery of antimicrobial agents, the drug delivery system should reside at the site of infection for a prolonged period of time. In our present work, we have developed and optimized a chitosan (bioadhesive and permeation enhancer) and gellan gum (ion activated gelling polymer) based in situ gel system of clindamycin for vaginal application. The developed formulation was characterized for various in-vitro parameters e.g. clarity, refractive index, pH, isotonicity, sterility, viscosity, drug release profile, statistical release kinetics, bioadhesive force, retention time, microbial efficacy, irritation test and stability studies. To simulate vaginal conditions, a synthetic membrane (cellophane hydrated with modified simulated vaginal fluid) and sheep vaginal mucosa were used as model membranes. The developed formulation was found to be non irritant, bioadhesive with good retention properties. Developed formulation shows matrix model release kinetic by PCP disso software. The developed formulation is thus a viable alternative to conventional vaginal dosage forms. Keywords: sol-to-gel system; chitosan; gellan gum; vaginal; clindamycin

Proteomic Analysis of Human Cervical-Vaginal Fluids

The pathophysiology of vaginal conditions is still ill-defined at a molecular level. Because the proteome of the human cervical-vaginal fluid (CVF) has not been reported to date, we undertook the identification of proteins present in the cell-free fraction of these fluids. Proteins were separated bidimensionally (2-D) by isoelectrofocusing (pH 3-11) followed by SDS-polyacrylamide electrophoresis. The proteins of 147 spots were identified by matrix-assisted laser desorption/ ionization-time-of-flight-mass spectrometry (MALDI-TOF/TOF). This approach was supplemented by immunoassays for markers of neutrophils (myeloperoxidase, MPO; neutrophil gelatinase-associated lipocalin, NGAL/HNL) and eosinophils (eosinophil cationic protein: ECP) and by immunoblotting (lactoferrin, calgranulins A and B and annexins A1 and A3. Nearly half of the proteins (69/147) and protein fragments detected were found to be plasma components, on the basis of which the human CVF can be broadly considered a plasma transudate. Although the pattern of protein spots was very similar for all fluids analyzed, a relative overabundance of major plasma proteins such as albumin, transferrin, immunoglobulins, apolipoproteins, alpha-1-acid glycoprotein 1, and calgranulins was associated with the presence of a high number of polymorphonuclear leukocytes in the lavages from which those cell-free fluids had been obtained. Instead, fluids from women experiencing vulvovaginal candidiasis did not show differences in the protein maps compared with asymptomatic individuals. Neutrophil and eosinophil granule secretion proteins were also detected in variable amounts in the lavage fluids by both immunoassay and immunoblotting, indicating polymorphonuclear cell activation.

Lactobacillus species isolated from the vagina: identification, hydrogen peroxide production and nonoxynol-9 resistance

Background Lactic acid production is considered to be the major protection mechanism of lactobacilli against vaginal infections due to genital pathogens. Some species of Lactobacillus are also hydrogen peroxide (H 2O 2) producers. Nonoxynol-9 (N-9) is a nonionic detergent and is the active component of many spermicidal preparations. It immobilizes sperm by disrupting the cell membrane and is believed to act similarly on a number of bacteria and viruses. It is known that N-9 inhibits Lactobacilli in vitro at concentrations of 0.1% to 1%. Purpose The present study was conducted to identify the species of Lactobacillus isolated from vaginal fluids of reproductive-age women and to characterize the H 2O 2-producing and N-9-resistant strains in an Argentine population. Results We identified Lactobacillus acidophilus, L. fermentum, L. gasseri, L. jensenii, L. casei subsp. casei, L. brevis and L. delbrueckii subsp. delbrueckii as the most frequent species. In this Argentine, South American population, 62% of women had H 2O 2-producing vaginal lactobacilli. We found a high number of sensitive strains. Sixty-two H 2O 2-producer strains were detected, 50 (80.6%) strains were sensitive to N-9 and 12 (19.4%) strains were resistant to the inhibitory effect of N-9. Discussion The vaginal microecologic findings are comparable to those found in other populations and suggest that (1) vaginal microecologic conditions are likely to be similar among Argentine women as in other countries, and (2) N-9 may have deleterious effects as in other populations.

MRI of vaginal conditions—pictorial review

Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, and transverse vaginal septum), benign (Bartholin's cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, and postsurgical appearances with the formation of a neovagina and adhesions), or malignant, usually due to the extension or recurrence from another pelvic malignancy.

Characterisation and in vitro evaluation of bioadhesive liposome gels for local therapy of vaginitis

The purpose of this study was to design and evaluate a new vaginal delivery system for the local treatment of vaginitis. Liposomes containing two commonly applied drugs in the treatment of vaginal infections, namely clotrimazole and metronidazole, were prepared by the proliposome and the polyol dilution methods. Both types of liposomes were characterised and compared for particle size, polydispersity, entrapment efficiency, and tested for in vitro stability in media that mimic human vaginal conditions (buffer, pH 4.5, and vaginal fluid simulant). To achieve application viscosity and to further improve their stability, liposomes containing drugs were incorporated in a bioadhesive gel made of Carbopol ® 974P NF resin. In vitro release studies have demonstrated that even after 24 h of incubation in vaginal fluid simulant (at 37 °C) more than 30% of the originally entrapped clotrimazole (or 50% of metronidazole) was still retained in the gel. Storage stability studies have proved the ability of Carbopol ® 974P NF gel to preserve original size distributions of incorporated liposomes. All the performed experiments confirm the applicability of bioadhesive liposome gels as a novel delivery system for local therapy of vaginal infections.

An easier ureteral tunnel approach during laparoscopic-assisted radical vaginal hysterectomy

Identification and mobilization of the ureters is the most difficult part of the Schauta operation and is the most risky and time-consuming step in laparoscopic radical hysterectomy. Since February 2003 we have used a modified technique of laparoscopic radical hysterectomy for managing seven cases of stage IB1 cervical cancer. This technique is based on that described by Querleu–Dargent, but it includes a modified step to treat the parametria and the ureteral tunnel. Both ureters are identified and isolated by placing vessel loops. The ends of the vessel loop are placed into the vagina through the anterior colpotomy previously performed. Once in the vaginal route, gentle traction of the vessel loops allows easy identification and dissection of the ureter. Caudal parametrial management is the most time-consuming of the laparoscopic approaches, and a high risk of ureteral damage is always present. Depending on vaginal conditions, managing the proximal parametrium and ureters is difficult, and Schuchardt’s incision may be necessary. Laparoscopic vessel loop isolation of the ureters allows easier and safer vaginal management of the ureteral tunnel during laparoscopic vaginal radical hysterectomy.