Intravaginal Research Articles

(123) Evaluation of a Vaginal Insert for Self-assessment of Endometriosis-associated Deep Dyspareunia

Abstract Introduction Among individuals with endometriosis, approximately 50% experience deep dyspareunia. There is a validated test to evaluate superficial dyspareunia (tampon test); however, no such test exists for deep dyspareunia. Thus, we conducted a pilot study to evaluate the use of a vaginal insert for self-assessment of deep dyspareunia. Objective To report test-retest reliability and validity of using a vaginal insert for self-assessment of deep dyspareunia in individuals with endometriosis. Methods This was a prospective cohort study embedded within a pilot RCT. Individuals with a surgical diagnosis of endometriosis aged 19-49, who had a clinic visit between January 2018 and December 2020 were recruited from a prospective data registry at a tertiary endometriosis and pelvic pain centre. Inclusion criteria were assigned female at birth, sexually active or not sexually active due to pain, monogamous partner who consents to participate, and deep dyspareunia score ≥ 4/10. Exclusion criteria were superficial dyspareunia ≥ 4/10, prior use of the intervention under investigation in the RCT, intense fear or anxiety around sexual activity, and severe levels of anxiety or depression on validated screening measures. Participants used the vaginal insert to self-assess tenderness at two time points, one week apart, using a numeric rating scale (0-10) at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac. Participants also used a daily diary to record deep dyspareunia severity (0-10) during intercourse over a four-week period. Test-retest reliability was evaluated by correlating tenderness scores between the two time points. Validity was assessed by correlating the vaginal insert tenderness scores with deep dyspareunia scores. Results Nineteen participants completed the study. The average age was 34 ± 7 years, and the majority of participants identified as female (n=18; 94.7%), heterosexual (n=17; 89.5%) and white (n=17;89.5%). Intraclass correlation coefficients for each site showed good test-retest reliability: left pelvic floor 0.79 (p = 0.001), right pelvic floor 0.82 (p < 0.001), bladder 0.54 (p = 0.07), cervix-uterus was 0.89 (p < 0.001), and the cul-de-sac 0.77 (p = 0.003). The strongest correlation between tenderness using the vaginal insert and deep dyspareunia scores was at the cervix-uterus (r=0.35); however, no statistically significant correlations were identified at any of the pelvic sites. Conclusions We found a strong correlation of tenderness scores between assessment dates (test-retest reliability), indicating that the vaginal insert may be a reliable method of assessing deep dyspareunia. A future study with larger sample size will be needed to study the correlations between tenderness assessed with the vaginal insert and prospective deep dyspareunia scores for evaluation of validity. Self-assessment of deep dyspareunia using a vaginal insert shows promise, and may support trauma-informed practice and the collection of ecologically valid data. Disclosure Yes, this is sponsored by industry/sponsor: OhNut Wearable - provided a discount on the silicon buffer used in the trial; ISSWSH Grant. Clarification: No industry support in study design or execution.

(117) Postpartum Vulvovaginal Dryness: Disparities in Adequate Treatment for Postpartum Patients’ Sexual Health

Abstract Introduction Vaginal estrogen therapy (VET) use and efficacy is well established for genitourinary symptoms commonly seen in menopause. Despite the similar symptom profile and dramatic hormonal shifts in postpartum (PP) patients, they are not routinely offered the same therapies. The pathophysiology of these symptoms PP is multifactorial and frequently dismissed as “normal,” even with the subsequent negative effect on their quality of life. Concerns regarding potential harm on lactation and infant development further decreases utilization. However, these apprehensions may be outdated due to evolution of VET, warranting review of available literature. Objective To review the efficacy, concerns, and barriers of utilization of VET for vulvovaginal symptoms in PP patients. Methods A systematic review in the PubMed database spanning from January 1990 – June 2022 was performed to assess the relevant medical literature on the utilization of VET for vulvovaginal symptoms in PP patients. MeSH terms used to narrow the search include: [“dyspareunia” OR “vulvovaginal atrophy” OR “genitourinary”] AND [“hypoestrogenic state” OR “estrogenic endocrine disrupting compounds” OR “estrogen responsive tissues”] AND [“postpartum” OR “menopausal” OR “infant”] AND [“estrogen preparations” OR “vaginal estrogen”]. Results The published literature (n=33) was analyzed by relevant key terms. FDA has approved a number of estrogen-based formulations for vulvovaginal atrophy and dysparenuia in menopausal patients, including: 7.5ug/day (vaginal ring), ultra low dose 10ug (vaginal tablet), 0.01% estradiol creams, premarin (conjugated estrogen) cream, and vaginal DHEA. Data for PP patients is limited with varying results. Nonetheless, drastic improvement in tissue thickening, lubrication, and baseline elasticity within a few weeks of minimal applied dosage of VET has been shown. Addressing primary worries, while higher doses (>50mcg) of estrogen in the early PP period may negatively affect lactation, initiating VET after supply is well established (at 6-8 weeks) or using lower dose estrogen (≤50mcg) has no changes in lactation. In fact, the ultra-low-dose combined oral contraceptive pill (20mcg of ethinyl estradiol with progestins) is approved PP for contraception after 30 days with no adverse impact on breastfeeding. VET concentrations are smaller, and locally applied, implying even less risk of systemic effects. Tolerability is further enhanced with a personalized approach, prescribing the smallest effective dose for the shortest duration of time. Additionally, data suggests that if lactation is affected, there is no significant alteration to the infant’s growth, no to minimal increase of estradiol or estriol in breastfed infants, nor significant evidence of long-term prolongation of physiologic estrogenization. PP patients face numerous barriers, further limiting access to effective treatment, such as: varied clinical presentations, relatively high cost of therapies, minimal time and access to providers resulting in poor communication and hesitation, and limited research focused on therapeutic options for health concerns. Conclusions This review outlines the proven therapeutic uses, indications, and safety of VET, along with the scarcity of current literature for the PP population. The concurrent sexual dysfunction and discomfort can be devastating, supporting the need for focused research on the efficacy of VET connected to the specific needs and concerns of PP patients. Disclosure No

(195) Postpartum Vulvovaginal Dryness: Disparities in Adequate Treatment for Postpartum Patients’ Sexual Health

Abstract Introduction Vaginal estrogen therapy (VET) use and efficacy is well established for genitourinary symptoms commonly seen in menopause. Despite the similar symptom profile and dramatic hormonal shifts in postpartum (PP) patients, they are not routinely offered the same therapies. The pathophysiology of these symptoms PP is multifactorial and frequently dismissed as “normal,” even with the subsequent negative effect on their quality of life. Concerns regarding potential harm on lactation and infant development further decreases utilization. However, these apprehensions may be outdated due to evolution of VET, warranting review of available literature. Objective To review the efficacy, concerns, and barriers of utilization of VET for vulvovaginal symptoms in PP patients. Methods A systematic review in the PubMed database spanning from January 1990 – June 2022 was performed to assess the relevant medical literature on the utilization of VET for vulvovaginal symptoms in PP patients. MeSH terms used to narrow the search include: [“dyspareunia” OR “vulvovaginal atrophy” OR “genitourinary”] AND [“hypoestrogenic state” OR “estrogenic endocrine disrupting compounds” OR “estrogen responsive tissues”] AND [“postpartum” OR “menopausal” OR “infant”] AND [“estrogen preparations” OR “vaginal estrogen”]. Results The published literature (n=33) was analyzed by relevant key terms. FDA has approved a number of estrogen-based formulations for vulvovaginal atrophy and dysparenuia in menopausal patients, including: 7.5ug/day (vaginal ring), ultra low dose 10ug (vaginal tablet), 0.01% estradiol creams, premarin (conjugated estrogen) cream, and vaginal DHEA. Data for PP patients is limited with varying results. Nonetheless, drastic improvement in tissue thickening, lubrication, and baseline elasticity within a few weeks of minimal applied dosage of VET has been shown. Addressing primary worries, while higher doses (>50mcg) of estrogen in the early PP period may negatively affect lactation, initiating VET after supply is well established (at 6-8 weeks) or using lower dose estrogen (≤50mcg) has no changes in lactation. In fact, the ultra-low-dose combined oral contraceptive pill (20mcg of ethinyl estradiol with progestins) is approved PP for contraception after 30 days with no adverse impact on breastfeeding. VET concentrations are smaller, and locally applied, implying even less risk of systemic effects. Tolerability is further enhanced with a personalized approach, prescribing the smallest effective dose for the shortest duration of time. Additionally, data suggests that if lactation is affected, there is no significant alteration to the infant’s growth, no to minimal increase of estradiol or estriol in breastfed infants, nor significant evidence of long-term prolongation of physiologic estrogenization. PP patients face numerous barriers, further limiting access to effective treatment, such as: varied clinical presentations, relatively high cost of therapies, minimal time and access to providers resulting in poor communication and hesitation, and limited research focused on therapeutic options for health concerns. Conclusions This review outlines the proven therapeutic uses, indications, and safety of VET, along with the scarcity of current literature for the PP population. The concurrent sexual dysfunction and discomfort can be devastating, supporting the need for focused research on the efficacy of VET connected to the specific needs and concerns of PP patients. Disclosure No

SUI in postmenopausal women: advantages of an intraurethral + intravaginal Er:YAG laser

Objective This study aimed to compare the efficacy of concomitant application of an intraurethral (IU) + intravaginal (IV) non-ablative Erbium (Er):YAG laser with IV application in improving the symptoms of stress urinary incontinence (SUI) in women. Methods This observational retrospective cohort study included 122 patients with SUI, 60 women in the IU + IV laser arm and 62 in the IV laser arm. The primary outcome was the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form score at entry and at 3, 6 and 12 months from baseline. Results Demographic characteristics were comparable in both arms. Significant improvement in SUI symptoms was seen 3 months after the intervention and was sustained until the end of month 12 in both arms. The women who had severe SUI symptoms initially showed greater improvement. A higher number of women who initially had mild to moderate SUI symptoms were dry after treatment. Patients treated with IU + IV Er:YAG laser showed significant improvement in SUI symptoms compared to IV laser only, especially at postmenopausal state (p = 0.003). Conclusions The Er:YAG laser appears to be an efficient treatment method for SUI. Concomitant application of an IU + IV Er:YAG laser is more effective in relieving SUI symptoms at postmenopausal state.

Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository.

The vaginal microbiota can be altered by uropathogenic bacteria associated with recurrent cystitis (RC), and the vaginal administration of Lactobacillus have suggested certain effects to prevent RC. The relationship between vaginal microbiota and the development of RC has not been elucidated. We aimed to clarify the etiology of RC from vaginal microbiota and importance of vaginal Lactobacillus. Vaginal samples obtained from 39 postmenopausal women were classified into four groups: healthy controls; uncomplicated cystitis; RC; and prevention (prevented RC by Lactobacillus crispatus-containing vaginal suppositories). Principal coordinate analysis and beta-diversity analysis was used to assess 16S rRNA gene sequencing data from the vaginal microbiome. Cluster analysis divided the vaginal bacterial communities among 129 vaginal samples into three clusters (A, B, and C). Fourteen of 14 (100%) samples from the RC group and 51 of 53 (96%) samples from the prevention group were in clusters B and C, while 29 of 38 (76%) samples from the healthy group and 14 of 24 (58%) samples from the uncomplicated cystitis group were in cluster A. The principal coordinate analysis showed that plots in the uncomplicated cystitis group were similar to the healthy group, indicating a large separation between the RC group and the uncomplicated cystitis group. On beta-diversity analysis, there were significant differences between the healthy group and the uncomplicated cystitis group (p = 0.045), and between the RC group and the uncomplicated cystitis group or the healthy group (p = 0.001, p = 0.001, respectively). There were no significant differences between the RC group and the prevention group (p = 0.446). The top six taxa were as follows: Prevotella, Lactobacillus, Streptococcus, Enterobacteriaceae, Anaerococcus, and Bifidobacterium. Among patients with RC, Lactobacillus was undetectable before administration of suppositories, while the median relative abundance of Lactobacillus was 19% during administration of suppositories (p = 0.0211), reducing the average cystitis episodes per year (6.3 vs. 2.4, p = 0.0015). The vaginal microbiota of postmenopausal women with RC is differed from healthy controls and uncomplicated cystitis in terms of lack of Lactobacillus and relatively dominant of Enterobacteriaceae. Vaginal administration of Lactobacillus-containing suppositories can prevent RC by stabilizing vaginal dysbiosis and causing a loss of pathogenic bacteria virulence.

Role of mode of induction and delivery and women’s satisfaction after induction of labour at term: An observational study

This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman’ satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible for the study. The questionnaire investigated women’s opinion regarding information about induction, pain control, length of induction, their experience about induction, labour and delivery and their attitude towards induction in a subsequent pregnancy. Women were also asked to fill in the Italian version of the Birth Satisfaction Scale-Revised (BSS-R).A total of 300 women entered the study. The answer to the question about a “positive attitude towards induction in a subsequent pregnancy was “absolutely yes” or “yes” respectively in the 77.8%, 52.8% and 48.6% of women who were induced with oral drugs, vaginal drugs and Cook balloon (heterogeneity chi-square p = 0.05). The corresponding values for women who delivered vaginally or by caesarean section (CS) were 63.3% and 36.4% (chi-square p = 0.0009). The mean BSS-R total score was higher among women who underwent IOL with oral drugs than with vaginal drugs (p < 0.0001) or Cook Balloon (p < 0.0001), and among women who delivered vaginally than in those who delivered by CS (p < 0.0001). Women were asked “What do you think is important for a method of induction?”: 47.3% (95% CI 41.7%-53.0%) of women answered that “should make the induction as painless as possible”, 47.0% (95% CI 41.4%-52.7%) “should induce labour quickly”, 44.3% (95% CI 38.8%-50.0%) “should be safe for baby”.This study showed that vaginal delivery was associated with a higher rate of satisfaction among induced women. Considering mode of induction, oral drugs were associated with a higher level of satisfaction. Control of pain and quick induction were the most appreciated characteristics.

Nanoemulsion Loaded with Clotrimazole Based on Rapeseed Oil for Potential Vaginal Application-Development, Initial Assessment, and Pilot Release Studies.

Vaginal candidiasis (VC) is an emerging global hardly treated health issue affecting millions of women worldwide. In this study, the nanoemulsion consisting of clotrimazole (CLT), rapeseed oil, Pluronic F-68, Span 80, PEG 200, and lactic acid was prepared using high-speed and high-pressure homogenization. Yielded formulations were characterized by an average droplet size of 52-56 nm, homogenous size distribution by volume, and a polydispersity index (PDI) < 0.2. The osmolality of nanoemulsions (NEs) fulfilled the recommendations of the WHO advisory note. NEs were stable throughout 28 weeks of storage. The stationary and dynamic (USP apparatus IV) pilot study of the changes of free CLT over time for NEs, as well as market cream and CLT suspension as references, were conducted. Test results of the changes in the amount of free CLT released from the encapsulated form were not coherent; in the stationary method, NEs yielded up to 27% of the released CLT dose within 5 h, while in the USP apparatus IV method, NEs released up to 10% of the CLT dose. NEs are promising carriers for vaginal drug delivery in the treatment of VC; however, further development of the final dosage form and harmonized release or dissolution testing protocols are needed.

19 Relationship Between pH in Vagina and a Successful Pregnancy in Small Ruminant Recipients

Abstract Reproductive efficiency and efficacy are key components of economic return in small ruminant production, therefore utilization of assisted reproductive technologies has increased. Despite advances in assisted reproductive technologies, pregnancy rates per embryo culture and transfer still remain low. The physio-chemical parameter of pH within the female reproductive tract and its potential implications in pregnancy success in caprine remains to be elucidated. The objective of this study was to evaluate vaginal pH and compare pregnancy rate for embryos produced in-vivo and in-vitro in goats. Spanish and Spanish Boer Cross females (n = 78) were estrous synchronized using a progesterone vaginal insert protocol and gonadotropin was administered at time of removal. Embryo grade and stage for conventional fresh embryo transfer and in-vitro fertilization were recorded. Vaginal pH was measured post transfer. At d 45 pregnancy status was determined via trans-abdominal ultrasonography. Successful embryo transfer (ET) was determined by kidding percentages. Data were analyzed using an ANOVA with a multiple linear regression model in GraphPad Prism 9.4. It was found that vaginal pH of females receiving cultured embryos did significantly predict pregnancy detection at d 45 and kidding (P = 0.02). However, the vaginal pH in females receiving fresh embryos had no effect of pregnancy and kidding rates (P = 0.451). While vaginal pH had a correlation with successful kidding of cultured embryos, further research is warranted to determine the relationship between physio-chemical parameters, environmental factors and pregnancy rates in goats.

Outpatient Cervical Ripening: A Multicentered Retrospective Cohort Study [ID: 1377444

INTRODUCTION: This study aims to compare safety and effectiveness between different outpatient cervical ripening (CR) methods. METHODS: Seven community and academic hospitals in the Greater Toronto Area that performed outpatient CR participated. We reviewed eligible charts over 12–24 months based on predetermined criteria. Multivariable analyses were performed; covariates included nulliparity, cervical unfavourability, and maternal and gestational age. Binary outcomes were modeled using logistic regression, presented as adjusted odds ratio (OR) with 95% CI. Time-to-event outcomes were described using unadjusted Kaplan-Meier curves. Multivariable time-to-event analyses were performed using accelerated failure time models with effects presented as time ratios (TRs) with 95% CI. RESULTS: We identified 1,910 pregnancies that underwent outpatient CR using balloon catheters in 881 (46%), dinoprostone vaginal inserts (DVIs) in 553 (29%), and dinoprostone vaginal gel/tablets (DG/T) in 476 (25%) pregnancies. The choice of agent varied considerably per site; one site used balloon catheters in 95%, another used DG/T in 95%, and three sites used DVI in more than 74% of cases. There were no differences in cesarean deliveries or adverse events related to CR. Compared to balloon catheters, patients with pharmacological ripening more often needed a subsequent ripening agent (DVI adjusted odds ratio 2.32 [1.62, 2.81], DG/T 3.26 [2.44, 4.36]). CR-to-delivery time did not differ, but compared to balloon catheters, DG/T had a shorter admission-to-delivery (aTR 0.71 [0.59, 0.86]) interval. CONCLUSION: Balloon catheters, DVI, and DG/T for outpatient CR are comparable in terms of safety and effectiveness. When choosing between agents, consideration should be given to clinical findings, patient preference, and resource availability.

The effect of vaginal administration of isosorbide mononitrate on cervical ripening and induction of labour in term and post term pregnancy

The effect of vaginal administration of isosorbide mononitrate on cervical ripening and induction of labour in term and post term pregnancy

КОМПЛЕКСНЫЙ ПОДХОД К ЛЕЧЕНИЮ БАКТЕРИАЛЬНОГО ВАГИНОЗА У ПАЦИЕНТОК С СИНДРОМОМ ПОЛИКИСТОЗНЫХ ЯИЧНИКОВ

A two-stage complex method of therapy of bacterial vaginosis (BV) in 29 patients with polycystic ovary syndrome (PCOS) is proposed, consisting in the use of standard metronidazole therapy (vaginal suppositories of 500 mg 2 times a day for 7 days) at the first stage and therapy with Acylact DUO at the second stage (1 candle in the vagina per night of 10 days), effective in relieving clinical manifestations and preventing recurrence of vaginal dysbiosis. Intravaginal administration of metronidazole to patients with polycystic ovary syndrome (PCOS) and bacterial vaginosis (BV) significantly reduced the concentration of anaerobic microorganisms. The appointment with Acylact DUO stimulated the growth of its own lactobacilli and helped to reduce the number of relapses of the disease by increasing the protective properties in the vagina. Normalization of the vaginal microflora was noted in all patients included in the study. After three months, normal vaginal biocenosis was detected in 26 patients (89.6% of women) according to a control smear study to detect key cells as markers of bacterial vaginosis. Clinical manifestations of bacterial vaginosis (itching, burning, pathological discharge) were not detected in any patient. Thus, the conducted study showed high efficiency of complex two-stage treatment of bacterial vaginosis, consisting in the use of vaginal candles containing metronidazole at the first stage, followed by the drug Acylact DUO in patients with polycystic ovary syndrome, provided timely correction of hormonal and metabolic disorders in them.

Effectiveness of dinoprostone gel, misoprostol vaginal insert and dinoprostone vaginal insert for induction of labour in twin pregnancies

ObjectivesTo compare the effectiveness and safety of Dinoprostone Gel (DG), Misoprostol Vaginal Insert (MVI) and Dinoprostone Vaginal Insert (DVI) for induction of labour (IOL) in twin pregnancies. Study DesignRetrospective cohort study of twin pregnancies > 34 + 0 weeks gestation that underwent induction of labour (IOL) with DG, MVI or DVI between December 2016 and November 2019 in a Tertiary NHS hospital, North West England, UK. Delivery characteristics, maternal complications and neonatal outcomes were compared between the three groups. ResultsA total of 87 twin pregnancies were included for analysis. 27 women received DG, 34 received MVI and 26 DVI. The MVI cohort had a higher proportion of nulliparous women (55.9%) compared to the DG and DVI cohorts, 29.6% and 38.5% respectively. No other differences amongst demographic characteristics were considered clinically significant.DG demonstrated a significantly quicker time to delivery (minutes) compared to DVI (1021 ± 556 versus 1649 ± 852; P = 0.0026). Significantly fewer women required terbutaline for hyperstimulation/tachysystole in the DG group compared to MVI (0% vs 32%; RR 0.05; 95% CI 0.003–0.88). Both DG and MVI groups required significantly less oxytocin following artificial rupture of membranes compared to DVI (33% vs 65%; RR 0.51; 95% CI 0.28–0.93) and (29% vs 65%; RR 0.45; 95% CI 0.25–0.81). There were no significant differences in mode of delivery, maternal complications and neonatal outcomes. ConclusionOur data suggests that for women with a twin pregnancy considering a planned labour that induction with DG, MVI and DVI appear to be equally safe and effective IOL methods. These results should be interpreted with caution due to the study being underpowered to detect significant adverse outcomes. In order to determine the optimal method of IOL in twins, direct randomised comparison is needed.

Optical Coherence Tomography as a novel tool for non-invasive membrane thickness monitoring of co-extruded drug-delivery systems

Co-extruded core-membrane formulations have been extensively explored as long-acting subcutaneous implants or vaginal inserts, guaranteeing zero-order release. Although the membrane thickness and homogeneity determine the final drug release, these parameters are still evaluated offline via destructive testing. The present study aims at tackling this shortcoming by introducing an in-line, non-invasive, fast and reproducible methodology based on optical coherence tomography (OCT) to evaluate the membrane characteristics of ethylene vinyl acetate (EVA) based co-extrudates. The novel setup enables a membrane representation and thickness analysis in real time during the manufacturing process, while the characterized membrane thicknesses are in good agreement with those obtained by optical microscopy. In addition, OCT offers novel insights into essential membrane characteristics that have not been visualized before. A case in point is the visualization of potential membrane defects, e.g. delaminated membranes, rough surfaces or viscosity mismatches in the core-membrane interface. Due to the obtained wealth of information combined with the instantaneous and destruction-free measurement, OCT has the potential to become the process analytical technology of choice for co-extruded dosage forms.

Intravaginal injection of Lactobacillus johnsonii may modulates oviductal microbiota and mucosal barrier function of laying hens

The avian oviduct connects to the gastrointestinal tract through cloaca, where it is exposed to pathogenic bacteria from intestinal contents. Therefore, improvement of mucosal barrier function in the oviduct is important for safe poultry production. Lactic acid bacteria are known to contribute to strengthening the mucosal barrier function in the intestinal tract, and a similar effect is expected in the oviduct mucosa of chickens. This study aimed to clarify the effects of vaginal administration of lactic acid bacteria on the mucosal barrier function of the oviduct. White Leghorn laying hens (500-days old) were intravaginally administered 1 mL of Lactobacillus johnsonii suspension (1 × 105 and 1 × 108 cfu/mL: low concentration of Lactobacillus (LL) and high concentration of Lactobacillus (HL) groups, respectively) or without bacteria (control: C group) for 7 d (n = 6). The oviductal magnum, uterus, and vagina were collected for histological observations and mucosal barrier function-related gene expression analysis. Amplicon sequence analysis of oviductal mucus bacteria was also performed. Eggs were collected during the experimental period and their weight was measured. Vaginally administering L. johnsonii for 7 d caused 1) an increase in α-diversity of vaginal mucosa microbiota with an increase in the abundance ratio of beneficial bacteria and a decrease in pathogenic bacteria, 2) enhanced claudin (CLA) 1 and 3 gene expression in the magnum and vaginal mucosa, and 3) a decrease in avian β-defensin (AvBD) 10, 11, and 12 gene expression in the magnum, uterus, and vaginal mucosa. These results suggest that transvaginal administration of L. johnsonii contributes to protection against infection in the oviduct by improving the microflora of the oviductal mucosa and strengthening the mechanical barrier function of the tight junctions. In contrast, transvaginal administration of lactic acid bacteria does not enhance the production of AvBD10, 11, and 12 in the oviduct.

Mode of delivery after labor induction with vaginal dinoprostone versus oral misoprostol for women with unfavorable cervix at term

ObjectiveTo compare the delivery mode after labor induction with 10 mg vaginal dinoprostone insert versus oral misoprostol 50 µg/4 h for women with an unfavorable cervix. Material and methodsThis is a retrospective observational study comparing the before/after introduction of oral misoprostol for labor induction, conducted at the Saint-Étienne University Hospital on a cohort of 396 women with a Bishop score <6. One hundred and twelve women (28.3%) were treated with a 10 mg vaginal dinoprostone insert versus 284 (71.7%) with oral misoprostol 50 µg/4 h. The primary outcome was the cesarean section rate. ResultsLabor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol (aOR = 2.44; CI95% from 1.35 to 4.40; p = 0.003). The use of vaginal dinoprostone increased the induction rate during more than 48 h (18.8% versus 9.9%; p = 0.02), and the occurrence of fetal heart rate changes (34.8% versus 21.1%; p = 0.005). The maternofetal morbidity was similar. ConclusionLabor induction with vaginal dinoprostone was independently associated with an increased rate of cesarean sections compared to oral misoprostol in women with an unfavorable cervix.

Luteal phase support in assisted reproductive technology centers: Italian survey.

In assisted reproductive cycles (ART), the fine balance of controlling corpus luteum function is severely disrupted. To challenge this iatrogenic deficiency, clinicians aim to provide exogenous support. Several reviews have investigated progesterone route of administration, dosage and timing. A survey about luteal phase support (LPS) after ovarian stimulation was conducted among doctors in charge in Italian II-III level ART centers. With regards to the general approach to LPS, 87.9% doctors declare to diversify the approach; the reasons for diversifying (69.7%) were based on the type of cycle. For all the most important administration routes (vaginal, intramuscular, subcutaneous) it appears that in frozen cycles there is a shift towards higher dosages. The 90.9% of the centers use vaginal progesterone, and when a combined approach is required, in 72.7% of cases vaginal administration is combined with injective route of administration. When Italian doctors were asked about the beginning and duration of LPS, 96% of the centers start the day of the pickup or the day after, while 80% of the centers continue LPS until week 8-12. The rate of participation of the centers confirms the low perceived importance of LPS among Italian ART centers, while may be considered quite surprising the relatively higher percentage of centers that measures P level. Tailorization to women's needs is the new objective of LPS: self-administration, good tolerability are the main aspects for Italian centers. In conclusion, results of Italian survey are consistent to results of main international surveys about LPS.

MP34-08 ETIOLOGY OF RECURRENT CYSTITIS BASED ON VAGINAL MICROBIOME: THINKING BEYOND THE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP34-08 ETIOLOGY OF RECURRENT CYSTITIS BASED ON VAGINAL MICROBIOME: THINKING BEYOND THE BLADDER Takuya Sadahira, Takanori Sekito, Takehiro Iwata, Yuki Maruyama, and Motoo Araki Takuya SadahiraTakuya Sadahira More articles by this author , Takanori SekitoTakanori Sekito More articles by this author , Takehiro IwataTakehiro Iwata More articles by this author , Yuki MaruyamaYuki Maruyama More articles by this author , and Motoo ArakiMotoo Araki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to determine the etiology of recurrent cystitis from vaginal microbiome and to evaluate the importance of the presence of Lactobacillus in the vagina. METHODS: Vaginal samples were obtained from postmenopausal women classified into four groups: healthy controls (“Healthy”) group, patients with uncomplicated cystitis (“Uncomplicated Cystitis”) group, patients with recurrent cystitis (“RC”) group, and patients with recurrent cystitis prevented by administration of Lactobacillus crispatus-containing vaginal suppositories (“Prevention”) group. 16S rRNA gene sequencing data from vaginal microbiome was analyzed among four groups by principal coordinate analysis. RESULTS: A total of 129 vaginal samples from 39 women were studied. The vaginal bacterial communities could be divided into three clusters (A, B, C), based on differences in relative abundances of bacterial taxa among samples (Figure 1A). Among the four groups of postmenopausal women, 39/39 (100%) samples from "Healthy" group were in Cluster A and B, 24/24 (100%) samples from "Uncomplicated Cystitis" group were in Cluster A and B, 3/4 (75%%) samples from "RC" group were in Cluster C, and 61/63 (97%) samples from "Prevention" group were in Cluster B and C. In principal coordinate analysis, the plots in the “Uncomplicated cystitis” group was similar to those of "Healthy" group (Figure 1A). In addition, principal coordinate analysis indicated a large separation between the plots in the “RC” group and "Uncomplicated cystitis" group. Among four patients in "RC" group, the median (range) relative abundance of Lactobacillus was not detected before administration of Lactobacillus crispatus-containing vaginal suppositories, while Lactobacillus was 18% (12%-25%) during administration on average reducing the onset of cystitis per year (7.8 vs 2.5, p=0.0061) (Figure 1B). CONCLUSIONS: The vaginal microbiome of recurrent cystitis is essentially different from that of uncomplicated cystitis. Moreover, lack of Lactobacillus in postmenopausal vaginal microbiome is associated with the development of recurrent cystitis. Vaginal administration of Lactobacillus prevents recurrent cystitis by improving vaginal dysbiosis. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e462 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takuya Sadahira More articles by this author Takanori Sekito More articles by this author Takehiro Iwata More articles by this author Yuki Maruyama More articles by this author Motoo Araki More articles by this author Expand All Advertisement PDF downloadLoading ...

The problem of recurrent bacterial vaginosis: modern strategies

Objective: to evaluate the clinical tolerability, effectiveness and stability of the therapeutic result when using different regimens for the treatment of recurrent bacterial vaginosis (BV) in women of reproductive age.Materials and methods. 105 women of reproductive age with diagnosed recurrent symptomatic BV participated in the study. The participants were randomized into three comparable groups of 35 women each. A ten-day primary decontamination of the vaginal tract was carried out in all groups: intravaginal administration of the drug Tergynan for group 1 and Femiril suppositories in groups 2 and 3. After the initial treatment patients of group 3 received the vaginal probiotic suppositories Alactel Femi for 15 days, after that they used it twice a week No. 10.The effectiveness of BV therapy was evaluated immediately after the antibacterial course and after a 6-month follow-up period based on the results of clinical examination and determination of vaginal pH.Results. Subjective and objective signs of bacterial infection were not detected in all participants after the course of vaginal decontamination. The pH of vaginal secretion was within the normal range and did not differ statistically between the groups. After 6 month, according to the results of a gynecological examination and pH test, one recurrence of BV was confirmed in group 1 and 2. The patients of group 3 had no complaints about manifestations of reinfection, which, in combination with the data of pH-metry, allowed confirming the absence of BV recurrences in them. Additional use of a probiotic in a complex with lactic acid in group 3 was associated with a stable normalization of the acid-alkaline balance of the vaginal secretion: 4.43 ± 0.12 and 4.39 ± 0.14 in groups 1 and 2, respectively, against 4.02 ± 0 ,12 in the 3rd group (p &lt; 0.05).Conclusions. Obtained results indicate a more stable anti-relapse effectiveness and safety of the local use of Femiril, followed by the restoration of the physiological parameters of the vaginal biotope with a complex of probiotics and lactic acid in the Alactel femi. The effectiveness of this approach consists in combining the antibacterial effect of phytoextracts with the successive restoration of vaginal immunity and metabolism through persistent colonization of the mucous membrane with living lactobacilli of eubiotic origin.

Combined method of the cervical insufficiency correction: Dr. Arabin vaginal perforated obstetric pessary and various forms of tableted micronized progesterone

Objectives: a comparative assessment of the effectiveness of a combined therapeutic and prophylactic method for cervical insufficiency (CI) correcting by using Dr. Arabin vaginal perforated obstetric pessary and various forms of tableted micronized progesterone – vaginal and sublingual.Material and methods. 215 pregnant women with CI were under observation. The main group included 129 pregnant women with CI, in whom therapeutic and preventive measures included a combination of obstetric perforated pessary by Dr. Arabin and sublingual form of micronized progesterone 100 mg three times a day up to 36 weeks of pregnancy. The compression group included 86 pregnant women with CI treated with Dr. Arabin vaginal perforated obstetric pessary and micronized progesterone vaginal tablets 200 mg twice daily up to 36 weeks’ gestation. All women during the gestational period also received vitamin-mineral complexes for pregnant women, ω3-polyunsaturated fatty acids and magnesium preparations.Course of pregnancy, obstetric and perinatal consequences were assessed.Results. The study of combined methods in the CI correction led to similar results in pregnancy outcomes and childbirth: there was no statistically significant difference between the main group and comparison group in the frequency of premature rupture of membranes (χ2 = 6.65% vs. 0.47), labor before 32 weeks (1.55 versus 4.65%, χ2 = 1.83, p = 0.18) labor in 33–36 weeks (4.65 versus 6.98%, χ2 = 0.53, p = 0.47), emergency labor (93.80 versus 88.37%, χ2 = 1.98, p = 0.16), operative delivery by cesarean section (13.95 vs. 2.33% versus 6.98%, χ2 = 2.78, p = 0.10), bleeding in the postpartum period (2.33 vs. 6.98%, χ2 = 2.78, p = 0.10), neonatal morbidity (4.65 versus 10.47%, χ2 = 2.69, p = 0.10), low birth weight – less than 1,500 g (1.55 vs. 5.81%, χ2 = 2.98, р = 0.08), middleweight babies (3,420.24 ± 48.98 vs. 3,360.23 ± 66.38 g, p = 0.47). Comparing the compliance of treatment and preventive measures was established that women in labor in the obstetric pessary + sublingual progesterone group rated them at 9.19 ± 0.11 points, in the obstetric pessary + vaginal progesterone group – at 7.83 ± 0.0.01 points).Conclusions. Combined methods of CI correction using Dr. Arabin vaginal perforated obstetric pessary in combination with tableted micronized progesterone are effective and safe when using both vaginal and sublingual forms of progesterone. But the method of using a pessary and sublingual progesterone is more optimal, convenient and compliant. Both techniques can be widely used in clinical practice.

Cervicovaginal mucus barrier properties during pregnancy are impacted by the vaginal microbiome.

Mucus in the female reproductive tract acts as a barrier that traps and eliminates pathogens and foreign particles via steric and adhesive interactions. During pregnancy, mucus protects the uterine environment from ascension of pathogens and bacteria from the vagina into the uterus, a potential contributor to intrauterine inflammation and preterm birth. As recent work has demonstrated the benefit of vaginal drug delivery in treating women's health indications, we sought to define the barrier properties of human cervicovaginal mucus (CVM) during pregnancy to inform the design of vaginally delivered therapeutics during pregnancy. CVM samples were self-collected by pregnant participants over the course of pregnancy, and barrier properties were quantified using multiple particle tracking. 16S rRNA gene sequencing was performed to analyze the composition of the vaginal microbiome. Participant demographics differed between term delivery and preterm delivery cohorts, with Black or African American participants being significantly more likely to delivery prematurely. We observed that vaginal microbiota is most predictive of CVM barrier properties and of timing of parturition. Lactobacillus crispatus dominated CVM samples showed increased barrier properties compared to polymicrobial CVM samples. This work informs our understanding of how infections occur during pregnancy, and directs the engineering of targeted drug treatments for indications during pregnancy.