Vaginal Disorders Research Articles

Возможности профилактики инфекционных осложнений при выполнении малых хирургических вмешательств в гинекологии

Aim: to evaluate the efficacy of an antiseptic disinfectant containing benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride as an active ingredient in the form of vaginal suppositories as a preoperative management for scheduled surgery in women with vaginal microbiocenosis disorder. Patients and Methods: a prospective open-label study of the prevention of postoperative complications in 58 women admitted to a gynecological short-stay unit was conducted. The initial examination included history taking, comprehensive clinical and laboratory examinations, bacterioscopy of cervical and vaginal discharge with Gram stain, and vaginal discharge pH measurement. Surgery (diagnostic dilation and curettage along with hysteroscopy for endometrial hyperplasia) was scheduled in all women. 8.0±1.0 days before surgery, preoperative treatment to prevent infectious complications was performed using benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride monohydrate in the form of 15-mg vaginal suppositories (1 suppository), once daily for 7 days. 30 days after surgery, re-examination of vaginal microflora and microbiocenosis was performed in all women. Results: an increase in WBC count, mixed microflora, and Candida spores were detected at the first visit. Before preventive treatment, vaginal microbiocenosis was characterized by a decrease in the number of obligate microbes in the vaginal biotope. No infectious postoperative complications were reported, and the early and late postoperative period was uneventful. In 56 women (96.5%), normocenosis was revealed (19 women were previously diagnosed with bacterial vaginosis, 25 with candidiasis, and 12 with nonspecific vaginitis). Two women (3.5%) had intermediate-type vaginal microbiocenosis. In 54 women (93.1%), the preparation was well-tolerated, while 4 women (6.9%) complained of short-term burning. Conclusions: the preparation can be recommended as a preventive antiseptic agent before scheduled minor gynecological surgeries in women with vaginal microbiocenosis disorder. KEYWORDS: minor gynecological surgeries, postoperative infectious inflammatory complications, prevention, vaginal microflora, hysteroscopy, antiseptic agent. FOR CITATION: Khlynova S.A., Dobrokhotova Yu.E., Kerchelaeva S.B., Fisenko A.D., Dimitrova V.I. Prevention of infectious complications in minor gynecological surgeries. Russian Journal of Woman and Child Health. 2023;6(3):270–275 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-9.

Vaginal Bacterial Infection Is Associated With the Occurrence of Spontaneous Abortion during the First Trimester

Background: Recurrent spontaneous abortion (RSA) is a serious disorder that may be detrimental to a woman's health. Bacterial vaginosis (BV) is a vaginal microsystem disorder that seems to be connected to a higher risk of abortion, early birth, and puerperal endometritis. 60 percent of all vaginitis types are caused by BV. The purpose of this research is to explore whether vaginal bacterial infection is connected to spontaneous abortion during the first trimester. Methods: This was a cross sectional study on 120 pregnant women on the first trimester diagnosed with spontaneous abortion during the first trimester. Results: No significant difference in clinical data of included subjects in both groups. Significant high prevalence of symptoms in pregnancy loss group. Significant increase in lactobacilli in all grades in abortion group compared with evolving pregnancy group. Significant increase in pathogenic bacteria in abortion group. No significant difference in enteric bacteria. A high significant association between infection and abortion occurrence. All pathogens were significantly associated with pregnancy loss occurrence. Also B. Streptococci were significantly associated with abortion occurrence. Conclusion: To exclude out chronic infections, all RSA patients should be evaluated according on their personal infection risk, which involves a thorough history as well as physical and laboratory examinations. Despite the fact that many RSA patients are healthy, monogamous, and have a minimal risk of STDs, they should be checked. During the first trimester, vaginal infection may be a risk factor for spontaneous abortion.

Study of vaginal microecological imbalance and endometrial receptivity change in the treatment of female infertility

Objective—To understand the relationship between vaginal microecology and endometrial receptivity, and to explore the clinical effect of adjusting vaginal microecology and improving endometrial receptivity in the treatment of female infertility. Study Design—A total of 60 patients with vaginal microecological disorders and poor endometrial receptivity were selected and randomly divided into two groups. The drug treatment group (n = 30) was treated with lactobacillus preparation for 3 months, and the control group (n = 30) was not treated. Three months later, vaginal microecology and endometrial receptivity were detected again by ultrasound. Results—In the drug treatment group, there were significant differences in pH, density, diversity, vaginal flora, cleanliness, PI, endometrial thickness and endometrial type before and after treatment (P < 0.05).The predominance of Lactobacillus in the vagina can be restored by using Lactobacillus preparations. The application of vaginal Lactobacillus preparation is beneficial to improve endometrial receptivity.

Herbal and Integrative Medicine-Associated Improvement of Viral-Induced Cervical and Vaginal Disorders: Case Report

Objective: Cervical cancer is a serious challenge, and pharmacologic nonsurgical treatment of precursor human papilloma virus (HPV) conditions does not exist. The Centers for Disease Control and Prevention (CDC) estimates 36,500 new cases of (HPV)-associated cancers per year. The purpose of this report is to illustrate a method that could eliminate HPV positivity to control precancerous lesions before they develop carcinoma. Eighty-six percent of cervical cancers contain HPV as a likely causal factor. Design/Setting: Two patients sought private practice integrative medicine: one for chronic HPV-induced cervical dysplasia, the other with lichen sclerosis post squamous cell carcinoma (SCC). Methods: The two patients were included because they asked for help with their conditions, since no previous medical help was either offered or successful. Patients were treated with a systematic integrative approach, designed to normalize leaky gut, and microbiome to reduce systemic antigenic stimulation. Also, berberine and curcumin were given, based on in vitro data on their effectiveness for treating HPV-induced oncogenic changes in cells. Those herbal derivatives were obtained from an organic chemist who maintained strict quality control. Results: A patient with oncogenic HPV-induced chronic severe cervical dysplasia had a dramatic improvement of dysplasia and HPV positivity. The patient with lichen sclerosis and atrophicus had a 75% improvement in the appearance of her condition, and her suspected SCC was in situ. Discussion: From this limited case report, it appears that a combination of integrative methods, plus curcumin and berberine, can clear oncogenic HPV and reverse dysplastic and oncogenic changes in the cervix as well as autoimmune changes in the vaginal area. Conclusion: The combination of integrative methods and curcumin and berberine helped patients with oncogenic HPV-induced cervical dysplasia and autoimmune and cancer-forming lichen sclerosis. Considering the high prevalence of HPV-induced cervical dysplasia, and the lack of treatment, this study should be repeated at a larger level.

Correlation between postpartum pelvic floor dysfunction and vaginal microecological imbalance in late pregnancy.

Pelvic floor dysfunction (PFD) seriously affects women's physical and mental health. Pregnancy and childbirth are recognized as high-risk factors for PFD, and studies have shown that vaginal microenvironmental disorders can promote the development of pelvic organ prolapse. In this study, we intend to investigate whether the changes in vaginal microecology during pregnancy affect the pelvic floor function and participate in the development of postpartum PFD, and provide a basis for the prevention and treatment of PFD. A total of 358 full-term mothers who delivered in Third Xiangya Hospital, Central South University from November 2019 to April 2020 were selected and underwent review 6 to 8 weeks after delivery. The pelvic floor structures were examined using pelvic floor ultrasound, and ultrasound values were measured at rest and at maximum Valsalva maneuver. One hundred and seventy women with PFD were assigned in a PFD group, and 188 women without PFD were assigned in a control group. The clinical data of all mothers were collected, and the clinical data and the results of microecological testing for vaginal secretions after 36 weeks of gestation and before delivery were compared between the 2 groups. The correlation of PFD with leucorrhoea cleanliness, lactobacillus level, bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) was analyzed, and logistic regression analysis was used to screen for independent risk factors for PFD. The incidences of VVC, BV, Lactobacillus vaginalis deficiency, and leucorrhoea cleanliness ≥III° were all higher in the PFD group than those in the control group (P<0.05). Among them, leukocyte cleanliness ≥III°and lack of Lactobacilli in the vagina were independent risk factors for the development of PFD, while VVC and BV were not independent risk factors for the development of PFD. Postpartum PFD is related to vaginal microecological imbalance in late pregnancy, among which Lactobacillus vaginalis deficiency and leucorrhoea cleanliness ≥III° are independent risk factors for the occurrence of PFD. Therefore, pregnant women with Lactobacillus vaginalis deficiency and leucorrhoea cleanliness ≥III° in late pregnancy should pay attention to the occurrence of postpartum PFD, and early diagnosis and effective intervention of postpartum PFD should be enhanced.

HPV and vaginal microecological disorders in infertile women: a cross-sectional study in the Chinese population

BackgroundThe purpose of this study was to evaluate the distributions of vaginal microbiome dysbiosis and human papillomavirus (HPV) subtypes in infertile women and explore the correlations of HPV infection and vaginal microbiome dysbiosis with infertility.MethodsIn total, 1464 women aged 18–50 years were included in this study; 649 participants were included in the infertility group, and 815 participants were included in the normal group. The participants were tested for HPV, and their vaginal microecology was examined. The χ2 test and Spearman regression were used for statistical analysis, and binary logistic regression was performed to identify the risk factors for infertility.ResultsThe patients in the infertility group were younger than those in the normal group, and the proportions of bacterial vaginosis and vaginal imbalance in the infertility group were significantly higher than those in the normal group. The incidence proportions of high-risk HPV types in the infertility group were significantly higher than those in the normal group, and the proportions of high-risk subtytes HPV16, HPV39, HV52, HPV56, and HPV68 were significantly higher in the infertility group than in the normal group. However, there were no significant differences in the incidences of low-risk HPV types. The incidence proportions of vaginal flora imbalance and HPV infection in the infertility group were significantly higher than those in the normal group. HPV16, HPV33, HPV51, HPV52and HPV58 infections were independent risk factors for infertility.ConclusionsVaginal microecological imbalance and HPV infection are directly related to infertility, and precautions should be taken.

The association between vaginal microbiota disorders and early missed abortion: A prospective study.

The objective of this study was to explore the association between disordered vaginal microbiota and missed abortion to ascertain potential causes of missed abortion related to vaginal microbiology. This study was a prospective cohort study with a comparison group (reference group). Vaginal secretions from the posterior fornix of women in the early stages of pregnancy were collected in the Xiangya Third Hospital of Central South University in Changsha, Hunan, China, from November 2018 to November 2019. A total of 54 cases of missed abortion (case group) and 50 cases of normal pregnancy requiring induced abortion (reference group) were analyzed. Bacterial DNA was extracted, hybridized with gene-specific primers, and then detected using a bacterial chip. The composition and relative abundance of vaginal microbiota in the two groups were compared using α-diversity analysis, β-diversity analysis, and the linear discriminant analysis effect size method. The α-diversity analysis showed that the Simpson index of the case group was lower than that of the reference group, whereas the Shannon index in the case group was higher. The relative abundance of Firmicutes in the case group (42.52%) was lower than in the reference group (51.03%, p < 0.05), as was the relative abundance of Lactobacillus (case group 16.51%, reference group 23.00%; p < 0.05). Interestingly, levels of Mycoplasma genitalium and Ureaplasma were lower in the case group (p < 0.05). The relative abundance of Lactobacillus crispatus, Lactobacillus jensenii, and Lactobacillus gasseri was also significantly lower in the case group than in the reference group (p < 0.05). The pathways enriched in the case group were predominantly related to metabolism, whereas the genetics-related pathways were predominantly enriched in the reference group. Bacteria are more diverse and unevenly distributed in patients with missed abortion. Decreases in the proportion of vaginal Lactobacillus and changes in Lactobacillus species in these patients may increase the chance of genital tract pathogenic bacterial infection. To our knowledge, our study was the first to observe that a decrease of Firmicutes levels in the vaginal microbiota might impair energy metabolism and have an association with missed abortion.

Immunometabolic and potential tumor-promoting changes in 3D cervical cell models infected with bacterial vaginosis-associated bacteria

Specific bacteria of the human microbiome influence carcinogenesis at diverse anatomical sites. Bacterial vaginosis (BV) is the most common vaginal disorder in premenopausal women that is associated with gynecologic sequelae, including cervical cancer. BV-associated microorganisms, such as Fusobacterium, Lancefieldella, Peptoniphilus, and Porphyromonas have been associated with gynecologic and other cancers, though the pro-oncogenic mechanisms employed by these bacteria are poorly understood. Here, we integrated a multi-omics approach with our three-dimensional (3-D) cervical epithelial cell culture model to investigate how understudied BV-associated bacteria linked to gynecologic neoplasia influence hallmarks of cancer in vitro. Lancefieldella parvulum and Peptoniphilus lacrimalis elicited robust proinflammatory responses in 3-D cervical cells. Fusobacterium nucleatum and Fusobacterium gonidiaformans modulated metabolic hallmarks of cancer corresponding to accumulation of 2-hydroxyglutarate, pro-inflammatory lipids, and signs of oxidative stress and genotoxic hydrogen sulfide. This study provides mechanistic insights into how gynecologic cancer-associated bacteria might facilitate a tumor-promoting microenvironment in the human cervix.

Molecular Identification of Cervical Microbes in HIV-Negative and HIV-Positive Women in an African Setting Using a Customized Bacterial Vaginosis Microbial DNA Quantitative PCR (qPCR) Array.

ABSTRACTBacterial vaginosis (BV) is a common polymicrobial vaginal disorder that is associated with sexually transmitted infections (STIs), including HIV. Several studies have utilized broad-range 16S rRNA gene PCR assays with sequence analysis to characterize cervicovaginal bacterial communities of women with healthy and diseased conditions. With the high burden of BV and STIs among African women, there is a need for targeted PCR assays that can rapidly determine the true epidemiological profile of key cervical microbes, including BV-associated bacteria, and a need to explore the utility of such assays for microbiological diagnosis of BV. Here, we used a taxon-directed 16S rRNA gene quantitative PCR (qPCR) assay to examine the prevalences and determinants of specific cervical microbes among African women with and without HIV infection. Cervical samples were collected using a cytobrush from 162 women (aged ≥30 years) attending a community-based clinic in Eastern Cape, South Africa. The samples were screened for specific microbes (i.e., STIs, emerging sexually transmitted pathogens [pathobionts], and BV-associated bacteria) using a customized bacterial vaginosis microbial DNA qPCR array. Statistical analyses were performed using GraphPad Prism v6.01. Chi-square/Fisher’s exact tests were used to evaluate the determinants associated with specific cervical microbes. Only 145 women had any detectable microbes and were included in the analysis. Lactobacillus iners (62.8%) and specific BV-associated bacteria, namely, Gardnerella vaginalis (58.6%), Atopobium vaginae (40.7%), and the pathobiont Ureaplasma parvum (37.9%), were the most prevalent microbes. Hierarchical clustering analysis revealed that 42.8% of the women (62/145) had a diverse array of heterogeneously distributed bacteria typically linked to BV. Women with detectable Lactobacillus species, specifically Lactobacillus crispatus and Lactobacillus jensenii, and to a lesser extent L. iners, had very low prevalence of BV-associated bacteria. Although the cumulative burden of STIs/pathobionts was 62.8%, Chlamydia trachomatis (3.4%), Neisseria gonorrhoeae (4.8%), and Trichomonas vaginalis (4.8%) were detected at low rates. HIV infection was associated with the presence of STIs/pathobionts (P = 0.022) and L. iners (P = 0.003). Prevalent STIs/pathobionts were associated with having multiple partners in the past 12 months (n ≥ 2, P = 0.015), high number of lifetime sexual partners (n ≥ 3, P = 0.007), vaginal sex in the past month (P = 0.010), and decreasing age of women (P = 0.005). C. trachomatis was associated with increasing age among HIV-positive women (P = 0.016). The pathobiont Ureaplasma urealyticum was inversely associated with age of women in the whole cohort (P = 0.018). The overall prevalence of STIs/pathobionts was high and was associated with HIV infection and sexual behavior. Our study helps us to understand the epidemiological trend of STIs and pathobionts and highlights the need to understand the impact of sexual networks on STI and pathobiont transmission and prevention among women in an African setting.IMPORTANCE Bacterial vaginosis (BV), whose etiology remains a matter of controversy, is a common vaginal disorder among reproductive-age women and can increase the risk for sexually transmitted infections (STIs). African women bear a disproportionately high burden of STIs and BV. Using a targeted quantitative PCR (qPCR) assay, a customized bacterial vaginosis microbial DNA qPCR array, we examined the prevalences and determinants of key cervical microbes, including BV-associated bacteria and emerging sexually transmitted pathogens (pathobionts) among women of African descent aged between 30 and 75 years. High-risk behaviors were associated with a higher prevalence of STIs/pathobionts, suggesting the need to better understand the influence of sexual networks on STI and pathobiont transmission and prevention among women. Our molecular assay is important in the surveillance of BV-associated bacteria, pathobionts, and STIs as well as diagnostic microbiology of BV. Furthermore, our research contributes to a better understanding of the epidemiology of STIs and pathobionts in Africa.

A Scoping Review of Bacterial Vaginosis – A Silent but Potential Threat to Pregnancies and Gynecological Surgeries and Procedures

Bacterial vaginosis (BV) is a common vaginal disorder in women of the reproductive age group that causes offensive vaginal discharge. BV occurs when Lactobacillus spp., the predominant species in healthy vaginal flora, are replaced by anaerobic bacteria, such as Gardnerella vaginalis. The prevalence is about 15-30% of women of reproductive age group. The reported risk factors include a high number of lifetime sexual partners, engagement in sexual intercourse at a younger age, practicing regular douching, and smoking. When BV occurs in pregnancy, there is an increased risk of preterm delivery and its associated complications. For decades, metronidazole has been the drug of choice for the treatment of BV, however, the rate of recurrence is as high as 50%. Therefore, prevention through lifestyle modifications will help to reduce the prevalence of BV.

Occurrence of vaginal candidiasis among female students of Ignatius Ajuru University of Education, Rumuolumeni, Port Harcourt, Rivers State

Vaginal disorders such as bacterial vaginosis, candidiasis, trichomoniasis, and Chlamydia trachomatis infections are common among women of reproductive age, occurring with high prevalence during pregnancy. This study investigated the incidences of vaginal candidiasis among female students in Ignatius Ajuru University of Education, Port Harcourt between Julys to September, 2021. A total population of 150 female students was used with their full consent. High vaginal swab (HVS) and endocervical swab (ES) samples was collected from each of the participating female students. The swab samples were separately inoculated onto Sabouraud dextrose agar and incubated aerobically at 37 °C for 48 hours. An overall prevalence of 38(25.3%) out of 150 female students that were sampled was observed. Out of 50 females sampled from each of the three Hostels, the highest frequency was recorded in Hostel A with 18(36%), followed by Stella Hostel with 12(24%) and the least was in Salvation Hostel with 8(6%) cases. The results revealed that students between the age range of 21-24 were more infected with the yeast with 18(36%), while those in the age range of 17-20 and 25-28 showed the same level of prevalence of 20%.The outcome of this study indicated involvement of Candida species in vulvo-vaginitis among female students of the institution. Sex-education workshops should be conducted to enlighten the female students on the clinical implications of Candida albicans in the development of vulvo-vaginal candidiasis.

MICROBIOCENOSIS STATE SPECIALTIES OF REPRODUCTIVE SYSTEM ORGANS IN HYPERPLASTIC ENDOMETRIAL PROCESSES

Nowadays, endometrial hyperplastic processes are the most common structural abnormalities of the uterine mucosa among those that are found in unexplained infertility. Epidemiological studies of infertile marriages show that among the causes of generative dysfunction in women pathological changes in the endometrium occur in half of the examined patients.The state of microecological parameters of the vaginal biotope in 60 women with polyps of the uterus (PTU) and 60 women with polyp-like endometrial hyperplasia (PLEH) was examined.In this study, microscopy of vaginal smears was performed, which microbiocenosis state was assessed by the following features: the presence of leukocyte reaction, the nature of the epithelium, qualitative and quantitative composition of the vaginal microfl ora. Patients’ microfl ora was characterized by homogeneity of composition (only lactobacilli were dominant), the number of leukocytes did not exceed 10 in the fi eld of view, and the epithelium was represented by cells of the superfi cial and intermediate layers.In a signifi cant number of women with PTU during the study it was found that vaginal microbiocenosis state was associated with bacterial vaginosis (BV). Defi ciency of lactofl ora with the titer of Lactobacillusspp lower than 106 CFU / ml was observed in the group of women with PLEH signifi cantly more often than in the group of PTU and control group.Deviations from the normative pH values of 3.5-4.5 appeared in every seventh with PTU and in every second patient with PLEH.Thus, in the course of a comprehensive microbiological study it was found that PTU and PLEH – a pathology that exists against the background of vaginal dysbiotic disorders.

Inhibitory effect of Lactobacillus gasseri CCFM1201 on Gardnerella vaginalis in mice with bacterial vaginosis.

Gardnerella vaginalis is the core pathogen of bacterial vaginosis (BV), the most common vaginal infection in women. G. vaginalis exerts pathogenicity through various factors, such as biofilm formation and the local host immune response stimulation. Therefore, this study aimed to evaluate the inhibitory effect of Lactobacillus gasseri CCFM1201 on G. vaginalis using experimental BV models. We evaluated L. gasseri in vitro to inhibit pathogen biofilm formation and adhesion capacity in HeLa cells using crystal violet staining. Further in vivo studies were conducted to assess the inhibitory effects of L. gasseri CCFM1201 on BV induced by G. vaginalis. L. gasseri exhibited strain-specific adhesion and inhibition of pathogen biofilm formation in vitro. L. gasseri CCFM1201 significantly reduced G. vaginalis in mice (p < 0.05), inhibited sialidase activity, modulated tumor necrosis factor-α and interleukin-1β expression, and reduced myeloperoxidase activity (p < 0.05). Histopathological examination indicated that L. gasseri CCFM1201 improved inflammatory cell infiltration of vaginal tissue and restored its structure. Vaginal epithelial cell exfoliation, the main clinical feature of BV, was significantly improved by L. gasseri CCFM1201 intervention (p < 0.05). Thus, L. gasseri CCFM1201 is a potential candidate for treating G. vaginalis-induced vaginal diseases.

Treatment of intravaginal ejaculation disorder using ejaculation aids: A multicenter prospective clinical trial

ABSTRACT Introduction Ejaculation disorders, the second most common sexual dysfunction, are often difficult to treat because of the lack of highly effective treatments. The A10 cyclone SA +PLUS (Fig. 1) is a motorized ejaculation aid with adjustable movement and intensity of stimulation. The A10 cyclone SA +PLUS. We hypothesized that the A10 cyclone SA +PLUS would be effective in the treatment of ejaculation disorders. Objective To evaluate the efficacy of the A10 cyclone SA +PLUS ejaculation aid in the treatment of intravaginal ejaculation disorder. Methods Between August 2020 and May 2021, men from 20 to 60 years of age who visited our hospital with complaints of vaginal ejaculation disorder were included. Patients were treated with masturbation using the A10 cyclone SA +PLUS 1–3 times a week for 8 weeks. A questionnaire was used to assess the ability to achieve vaginal ejaculation before and after the intervention. Sexual function was also assessed using questionnaires such as IIEF, EHS, MSHQ-EjD, CPSIQ-12, and NRS (Numerical Rating Scale) before and after the intervention. The procedures were approved by the Regional Ethics Committee (approval number: 2020-007). All patients provided written informed consent. Results Eight patients were included in this study. The median age was 35 years. Three of Eight (38%) patients achieved vaginal ejaculation. Significant improvement was found in IIEF and EH. Conclusions Ejaculation aids may be an effective treatment for vaginal ejaculation disorder, for which any drug has not been effective. We plan to conduct further studies to increase the number of patients. Disclosure Work supported by industry: no.

Prevalence of and risk factors associated with vaginal lubrication issues in women at 6 months postpartum

ABSTRACT Introduction A woman's sexuality changes during her life and varies according to endogenous and exogenous factors. In this perspective, pregnancy and childbirth create a state of sexual dysfunction. The physiological changes that occur in the postpartum period are unique to each woman, and depend on several factors, including the mode of delivery, and the postpartum period. Postpartum vaginal dryness is a common sexual disorder, caused by modifications in vaginal lubrication mechanisms. Objective Studying women's sexuality after childbirth by evaluating vaginal lubrication disorders in postpartum period. Methods This is a prospective, cross-sectional study between November 2018 and September 2019 at obstetric and gynecologic department of Ben Arous hospital of Tunisia. 150 Women were included and were followed from the third trimester of pregnancy through 6 months after childbirth. we opted for the Female Sexual Function Index (FSFI) to evaluate sexual disorder in postpartum period. Results On the FSFI, the average vaginal lubrication score was 4.58 during pregnancy and 3.79 after delivery. At the time of the study, 6% of women were not sexually active during pregnancy and 2% after delivery. 53% of women who were sexually active during pregnancy reported feeling the sensation of vaginal lubrication during intercourse with varying frequency. 36% of women did not claim difficulty to acquire a satisfying level of vaginal lubrication After delivery, 39 women (26%), noted a sensation of lubrication less frequently. 84 % of women reported varying degrees of difficulty in achieving vaginal moisture during sexual intercourse after delivery (very difficult: 12%, difficult: 28%, somewhat difficult: 44%). The ability to maintain vaginal moisture during sex seems decreased after childbirth. In fact, the ability to maintain an adequate vaginal lubrification during sexual intercourse was reported on postpartum in 21 women (14%) compared to 48% during pregnancy. The factors influencing the different parameters of vaginal moisture found in our series were breastfeeding, mode of delivery and contraception. Conclusion In postpartum period achieving vaginal moisture and maintain of an adequate vaginal lubrification during intercourse seems to be altered. Mode of birth, breastfeeding and contraception was associated with lack of vaginal lubrication. Preparing women and their partners for this during the antenatal period and advising on simple measures, such as use of lubrication could be helpful. Disclosure Work supported by industry: no.

Evaluation of ejaculation function using a simple questionnaire

ABSTRACT Introduction There is a wide range of problems associated with ejaculation, including decreased semen volume, vaginal ejaculation problems, premature ejaculation, delayed ejaculation, hematospermia, and pain associated with ejaculation. However, there is no simple questionnaire that can comprehensively evaluate these ejaculatory functions. Objective In this study, we evaluated the overall ejaculation function of the patients in question using an originally developed ejaculation function score (Kimura and Shoji's Ejaculation Function Score). Methods We examined 20 patients who visited our sexual function outpatient clinic with a chief complaint of ejaculation. As a control group, we also examined 20 patients who had undergone vasectomy using the same score. The questionnaire consisted of the following five items (1) Awareness of sufficient momentum, (2) Pleasant sensation during ejaculation, (3) Presence of pain associated with ejaculation, (4) Presence of blood in semen, and (5) Perception of decreased semen volume. The total score was also evaluated. In addition, satisfaction with the current ejaculation was assessed. Results The mean age of the ejaculation disorder group was 43.5±15.1 years. The main complaints were decreased semen volume in 7 cases (35%), vaginal ejaculation disorder in 6 cases (30%), delayed ejaculation in 2 cases (10%), premature ejaculation in 2 cases (10%), lack of orgasm in 1 case (5%), and pain associated with ejaculation in 1 case (5%). The mean scores for each item were 1.5 for item 1, 1.8 for item 2, 3.0 for item 3, 3.0 for item 4, and 2.0 for item 5, resulting in a mean total score of 11.2. On the other hand, the mean age of the vasectomy group was 42.0±9.4 years, item 1 was 2.8, item 2 was 2.9, item 3 was 3.0, item 4 was 3.0, item 5 was 2.9, and the mean total score was 14.6. When the two groups were compared, significant differences were found except for items 3 and 4. There was also a significant difference in satisfaction of present ejaculation with mean scores of 1.3 and 2.9. As a result of examining the clinical severity and the total score, the total score of 5-6 was considered severe, 7-9 moderate, 10-13 mild ejaculation disorder, and 14-15 within the normal range. Conclusion Although our ejaculation function score is still in the developmental stage, we believe that it can be a screening tool for ejaculation function in practical medical care and self-assessment. Disclosure Work supported by industry: no.

The evidence behind the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus: A state-of-the-art review.

In recent years, LASER has been introduced as a minimally invasive treatment for a broad range of vaginal and vulvar symptoms and diseases. However, the efficacy and safety of vaginal and vulvar LASER has continuously been questioned. The aim of this study is to create an overview of the current literature and discuss the controversies within the use of LASER for genitourinary syndrome of menopause, vulvovaginal atrophy, urinary incontinence and lichen sclerosus. A search string was built in PubMed. The search was commenced on August 25, 2021 and closed on October 27, 2021. Two authors screened the studies in Covidence for inclusion according to the eligibility criteria in the protocol. The data were extracted from the studies and are reported in both text and tables. This review included 114 papers, of which 15 were randomized controlled trials (RCTs). The effect of LASER as a vaginal treatment was investigated for genitourinary syndrome of menopause in 36 studies (six RCTs), vulvovaginal atrophy in 34 studies (four RCTs) and urinary incontinence in 30 studies (two RCTs). Ten studies (three RCTs) investigated the effect of vulvar treatment for lichen sclerosus. Half of the included RCTs, irrespective of indication, did not find a significant difference in improvement in women treated with vaginal CO2 or Er:YAG LASER compared with their respective controls. However, most non-comparative studies reported significant improvement after exposure to vaginal or vulvar LASER across all indications. Included studies generally had a short follow-up period and only a single RCT followed their participants for more than 6 months post treatment. Adverse events were reported as mild and transient and 99 studies including 51 094 patients provided information of no serious adverse events. In conclusion, this review found that the effect of vaginal and vulvar LASER decreases with higher study quality where potential biases have been eliminated. We therefore stress that all patients who are treated with vaginal or vulvar LASER should be carefully monitored and that LASER for those indications as a treatment should be kept on a research level until further high-quality evidence is available.

Effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of genitourinary syndrome and ways of its reduction

The article presents the assessment and analysis of the most important predictors and manifestations of genitourinary disorders in women of reproductive age after radical surgical treatment for uterine fibroids in the remote postoperative period. Ways of reducing the severity of symptoms are offered.&#x0D; The aim of the study – to establish the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on manifestation and progression of genitourinary syndrome and ways of the reduction in its severity.&#x0D; Materials and methods. Comprehensive clinical and laboratory assessment of the impact of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was conducted at the gynecological department of the “Kyiv Perinatal Center”. The study included 160 women: 90 patients underwent vaginal classical and laporoscopic hysterectomy including fallopian tubes removal; and 70 patients underwent abdominal hysterectomy including fallopian tubes removal. Data on the assessment of pelvic floor condition and urogenital dysfunction were provided using a standardized POP-Q system, both at the stage of preoperative observation and for 1, 3 and 5 years after the surgery.&#x0D; Research results and their discussion. The most important risk factors that allow forming groups of patients requiring individualized approach in the choice of surgical techniques and rehabilitation program were pointed out. The obtained results allowed to isolate UCDT markers in fractions above 20%. 19 women (11.86%) underwent ovarian surgeries and used gonadotropin-releasing hormone agonists. Genitourinary and sexual disorders were diagnosed in 27 cases (19.3%) 12 months after surgery. Vaginoscopy, performed 12 months after surgery, revealed atrophic vaginitis in 58 cases (36.25%) without significant difference in groups. Microscopy of urogenital smears was in norm only in 51 patients (31.86%). Complaints of dysuria were most common among patients (59 – 36.85%). The combination of sexual disorders and other manifestations (flatulence and intestinal discomfort, stool problems, vaginal microbiota disorders, pelvic floor descent, etc.) was revealed in a quarter of women (28 – 17.50%), and more often – after vaginal hysterectomy (17 – 18.89%). Clinical symptoms of urinary incontinence were observed against the background of a negative cough test in almost a third of patients (49 – 30.63%). They were combined with pollakiuria, nocturia, and imperative urgency, exacerbated by alcohol and accompanied by cystalgia and genital prolapse. The use of low doses of estradiol in the rehabilitation program improved the clinical and laboratory parameters of the urogenital tract, reducing the incidence of vulvovaginal atrophy by 13%, normalizing the biocenosis and vaginal pH, reducing clinical manifestations of urinary incontinence (pollakiuria and nocturnal pollakiuria) by 14%, feeling of incomplete bladder emptying – by 15%, stress urinary incontinence – by 16%, vaginal prolapse – by 11%, compared to the group with standard postoperative management, as well as reducing the severity of psycho-emotional and vegetative-vascular manifestations.&#x0D; Conclusion. The expected effect of surgical recovery may be insufficient, and clinical symptoms of genitourinary syndrome may manifest in the postoperative period, which requires the development of clear algorithms for diagnosing urinary incontinence and pelvic floor failure in the preoperative stage and application of long-term preventive measures after hysterectomy in the remote postoperative period. There is no statistically significant difference in the development of genitourinary syndrome with different surgical approaches.

Long-term fecal incontinence after lateral internal sphincterotomy for anal fissure.

&lt;b&gt;Introduction:&lt;/b&gt; Anal fissure is a common benign anal condition. The gold standard treatment is lateral internal sphincterotomy (LIS), and this procedure carries a risk of incontinence. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Aim:&lt;/b&gt; The aim of this study is to determine the long-term risk of fecal incontinence after LIS. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Method:&lt;/b&gt; All patients who had LIS for chronic anal fissure between the years 2004-2010 were interviewed by phone and assessed for sphincter function (incontinence) using Wexner fecal incontinence score (WIS). &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Fifty-nine patients (34 females, 57.6%) with a mean follow-up duration of 10.6 years (range 8-15 years) were interviewed. Twelve patients (20.3%) had a WIS score of one or more. The majority of the patients noticed a change in sphincter function years after the operation. There was no association between vaginal delivery and the WIS score. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; The long-term risk of abnormal sphincter function after LIS appears to be higher than expected, especially in the presence of multiple vaginal deliveries or systemic diseases such as diabetes mellitus. A larger prospective study is required to establish a correct risk of incontinence in the long term.

Case Report: Methotrexate and Etoposide as Adjuvant Therapy on Patient with Hydatidiform Moles that Have Growing Rapidly Becomes Gestational Trophoblastic Neoplasia

A hydatidiform mole is a type of placental abnormality that is associated with gestational trophoblastic disease (GTD). It can be complete or partial mole. They are typically considered benign, but they are also premalignant, with the potential to become malignant and invasive to other organs (gestational trophoblastic neoplasia/GTN). Management of the hydatiform moles is curettage therapy and suction, which aims to therapy and diagnostic. Follow-up post evacuation of moles must be tight with serum hCG and clinical examination. When there is evidence of vaginal bleeding and an increase in serum hCG, chemotherapy must be used as an adjuvant. This case report intends to persuade clinicians that adjuvant therapy with chemotherapy combination-based Methotrexate/MTX and etoposide can recover and eliminate vaginal bleeding disorders. On her first pregnancy, a woman of 27 years old develops a complete hydatiform mole. The curettage and suction procedure were then performed twice. She also receives chemotherapy in three series of single MTX and three series of MTX plus Etoposide. Following this therapy, the patient recovers, normal hCG level and has no vaginal bleeding problems.