Prepubertal Vulvovaginitis.

Vulvovaginitis is a common gynecologic complaint in prepubertal girls. It typically presents with complaints of vulvovaginal itching, burning, irritation, discharge, or skin changes. Prepubertal females have anatomic, physiological, and behavioral factors that most often contribute to the development of symptoms. Careful attention to history and associated complaints will direct evaluation, diagnosis, and treatment. Most cases are nonspecific in origin and treatment includes counseling to patients and parents on hygiene and voiding techniques. Antibiotic treatment for specific pathogens may be indicated. Other less common causes include foreign bodies and lichen sclerosus.

Prepubertal and Adolescent Vulvovaginitis: What to Do When a Girl Reports Vaginal Discharge.

Vaginitis presents with vaginal discharge, odor, pruritis, and/or discomfort and affects up to 75% of girls and women over the course of their lifetimes, with most women experiencing their first episode during adolescence. Given the prevalence of this disorder, this article aims to provide an overview of vaginitis for the general pediatrician. We start with prepubertal etiologies of vaginitis, then discuss pubertal and normal physiologic discharge, and then focus on the most common etiologies of adolescent vulvovaginitis. The three most common microbial etiologies of vaginitis (bacterial vaginosis, vulvovaginal candidiasis, and trichomonas) are addressed, as well as their diagnosis and treatment in adolescents. [Pediatr Ann. 2020;49(4):e170-e175.].

Prevention of recurrent lower urinary tract infections in postmenopausal women with genitourinary syndrome: outcome after 6 months of treatment with ospemifene.

Aim of this study was to evaluate the efficacy of ospemifene in the prevention of recurrent lower urinary tract infections in postmenopausal women with vulvovaginal atrophy. The study have a retrospective design. Thirty-nine patients were enrolled. Patients underwent clinical examination and urine culture. The urinary symptoms and the quality of life were evaluated with UTISA score, PUF and SF-36 questionnaires before and after treatment. All 39 patients received ospemifene 60 mg one tablet/daily for 6 months. Adverse effects and complications were assessed. Thirty-nine patients were enrolled in the study. Two patients experienced one new UTI episode and the mean number of positive urine culture decreased significantly after 6 months (3.65 ± 2.12 vs 0.25 ± 0.17, p < .0001). The mean number of urinary infection symptoms decreased significantly after treatment; dysuria reduced (4.76 ± 2.45 vs 0.89 ± 1.12). PUF score and SF-36 showed a statistically significant change (22.43 ± 5.89 vs 12.14 ± 3.21) and (52.86 ± 9.21 vs 83.43 ± 10.76). No adverse effects were reported and the total success rate was the 92.3% after 6 months at PGI-I. Ospemifene is a valid alternative with excellent tolerability for the UTIS prevention in postmenopausal patients.

Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis.

AIM: The study aimed to evaluate whether cytolytic vaginosis (CV) has important clinical implications for recurrent vulvovaginitis and to identify clinical differences between CV and vulvovaginal candidosis (VVC). METHODS: Medical histories, physical examinations and laboratory findings were used to diagnose and assess the prevalence rates of various vulvovaginal infections among 536 women with recurrent vulvovaginitis. Chi-square and Fisher exact tests were used to compare age, menstrual cycle phase at episode onset, symptoms/signs of infection and discharge characteristics between CV and VVC with single infection. RESULTS: Among the 484 women with a single-infection recurrent vulvovaginitis, the prevalence of CV (n = 143; 26.7%) was second only to VVC (n = 196; 36.6%). CV symptoms occurred predominantly during the ovulatory and luteal phases. Meanwhile, VVC episodes were not concentrated premenstrually, but rather occurred throughout the menstrual cycle. Significant differences were found in the vaginal pH, discharge characteristics and frequency of inflammatory symptoms between the 2 groups. CONCLUSIONS: CV is clinically important, because it is a common cause of recurrent vulvovaginitis. To distinguish CV from VVC, gynecologists should consider the patient's medical history, physical and laboratory findings, vaginal pH and vaginal discharge characteristics.

Vaginal cytokines do not correlate with postmenopausal vulvovaginal symptoms.

OBJECTIVES: Exploratory pilot study to determine the correlation between postmenopausal vulvovaginal symptoms and vaginal cytokine levels. METHODS: Postmenopausal women (n = 34) not using menopausal hormone therapy and presenting with or without symptoms of vulvovaginal irritation were screened. Each participant underwent a vaginal examination and screening for vaginitis. A cervicovaginal lavage (CVL) with sterile saline and a peripheral blood sample were obtained. Main outcome measures were assessed by Luminex® X-map method on the Bio-Plex® platform. Main outcome measures were cervicovaginal and serum interleukin (IL)-4, IL-5, IL-10, IL-12, IL-13, TNF-α, GM-CSF, MIP-1-alpha and RANTES level. Cervicovaginal cytokines were adjusted to total protein concentration [pg/mcg protein]. RESULTS: Twenty-six postmenopausal women were enrolled (symptomatic: n = 15; asymptomatic: n = 11). There were no significant differences between groups: age, age at menopause, vaginal pH and all CVL and serum cytokines (IL-4, IL-5, IL-10, IL-12, IL-13, TNF-α, GM-CSF, MIP-1-alpha and RANTES). GM-CSF was the most abundant vaginal cytokine (symptomatic: 146.5 ± 165.6 pg/mcg protein; asymptomatic: 146.0 ± 173.5 pg/mcg protein; p = 0.99). CONCLUSIONS: Postmenopausal vulvovaginal symptoms did not correlate with vaginal inflammatory marker. There was no difference in serum or CVL cytokines between symptomatic and asymptomatic postmenopasual women. Vaginal symptoms after menopause are not related to the vaginal cytokine changes associated with loss of estrogen.

Candida albicans-induced chronic thrombocytopenic purpura.

We present 2 patients with chronic immune thrombocytopenic purpura (ITP) secondary to Candida albicans infection. Neither patient responded to standard ITP therapy including splenectomy. Appropriate antifungal treatment of the C. albicans infection was followed by sustained improvement in platelet count in both patients. To our knowledge, this is the first report of ITP in association with C. albicans infection.

Oral and vulvar changes in pregnancy.

The endocrinologic, immunological, and vascular changes that occur during pregnancy are far-reaching. These systemic factors produce profound local impact on the physiology and pathology of the oral cavity, vagina, and vulva. Physiological changes can be expected and tolerable or of such severity that they are viewed as pathological. Existing disease can be exacerbated and dermatoses specific to pregnancy can erupt. Each of these conditions can pose potentially challenging treatment considerations.

When sex hurts, anxiety and fear orient attention towards pain.

Hypervigilance for pain-relevant stimuli has been associated with anxiety, fear of pain and anxiety sensitivity. This attentional bias has been primarily investigated in heterogeneous pain groups or pain-free controls, but has not been examined in pain conditions where anxiety and fear are likely to play a central role. Due to the intimate and interpersonal nature of genital pain experienced during sexual intercourse, Vulvar Vestibulitis Syndrome (VVS) constitutes an ideal sample in which to investigate the role of cognitive and affective factors in pain perception and maintenance. Seventeen women suffering from VVS and an equal number of age and education matched control women completed an emotional Stroop and memory recall task in addition to a series of questionnaires assessing pain-hypervigilance, state and trait anxiety, fear of pain, and anxiety sensitivity. VVS sufferers reported hypervigilance for coital pain and also exhibited a selective attentional bias towards pain stimuli on the emotional Stroop task as compared with controls. This effect was predicted by state and trait anxiety and fear of pain. According to these data, treament strategies for VVS should target anxiety and fear in addition to sensory systems.

The vulvar skin microenvironment: impact of tight-fitting underwear on microclimate, pH and microflora.

The aim of the present study was to investigate if tight-fitting underwear (string panties) equipped with string panty liners affected the vulvar skin microenvironment differently to regular panties with standard panty liners. Thirty-two healthy women participated in a crossover study where temperature, humidity, surface pH and aerobic microflora were measured on vulvar skin. Vulvar skin temperature was 35.2 +/- 0.19 (mean +/- SEM) and 35.3 +/- 0.17 degrees C, respectively, for the two underwear systems. Mean humidity and mean skin surface pH at vulvar skin did not differ between the two systems. Barely noticeable differences were found for the aerobic microflora both at labium majus and at perineum. The mean total number of microorganisms in the two different panty liners was the same, 6.0 +/- 0.15 and 6.0 +/- 0.16, respectively (log CFU per panty liner). The differences in panty and panty liner design studied seem to have negligible impact on the vulvar skin microclimate, skin surface pH and aerobic microflora. No support was found for the assumption that a string panty system would result in higher contamination of vulvar skin by anorectal microflora.

Personality traits associated with perception of noxious stimuli in women with vulvar vestibulitis syndrome.

Vulvar vestibulitis syndrome (VVS) is associated with enhanced pain sensitivity. The present study explores the role of personality on the perception of noxious stimuli among women with VVS. More specifically, the aim of the study was to explore whether the personality traits assessed by Cloninger's Tridimensional Personality Questionnaire (TPQ) (harm avoidance [HA], novelty seeking [NS], and reward dependence [RD]) are associated with the augmented pain perception in women with VVS. Quantitative sensory tests were applied to the forearm of 98 women with VVS and 135 control subjects, all of whom completed the TPQ. The women with VVS scored higher than the control subjects on HA and RD with no significant differences in NS. Linear regression analyses revealed that in the VVS group, lower pain thresholds and higher magnitude estimations of suprathreshold pain stimuli were associated with higher HA and RD scores. The enhanced pain perception among women with VVS might reflect their tendency to respond intensely to signals of reward and to elevate the perceived risk. This might lead them to avoid hazards by overestimating the level of potential harm, as represented by greater pain sensitivity. The association between personality traits assessed by Cloninger's Tridimensional Personality Questionnaire, ie, harm avoidance, novelty seeking, and reward dependence, and the enhanced perception of noxious stimuli in vulvar vestibulitis syndrome might suggest neurochemical mechanisms of pain experience affected by personality, with possible application for future treatment approaches toward pain disorders.

Sorting out common causes of abnormal vaginal discharge.

A chief complaint of abnormal vaginal discharge requires a broad differential diagnosis of both infectious and noninfectious causes. The patient's history and the physical exam should guide the choice of laboratory studies, and a complete physical exam that includes a thorough examination of both the external and internal genitalia will yield additional important information. Empirical treatment is unacceptable, considering the low cost of pH testing and saline and KOH preps compared to the cost of inappropriate treatment, repeat office visits, and the likelihood that eventually these tests will need to be performed. Some of the infectious causes of abnormal discharge may lead to serious complications with inappropriate treatment.

Citodiagnóstico em gestantes e puérperas atendidas no Hospital Universitário - UFAL / Cytodiagnosis in care pregnancy and puerperium at University Hospital of UFAL

O objetivo deste trabalho foi estabelecer a prevalência de infecções cervicovaginais em gestantes e puérperas atendidas no Hospital Universiário - UFAL, entre 1996 e 1197. Foram analisados os resultados das colpocitologias de 39 gestantes e 67 puérperas. Dentre as gestantes, 87,17 por cento apresentaram citologia inflamatória, sendo 55,88 por cento inespecíficas e 44,12 por cento específicas (26,47 por cento bacteriana e 17,64 por cento monilíase). No puerpério, observamos 80,59 por cento de citologias inflamatórias, destas, 44,44 por cento são inespecíficas e 55,54 por cento específicas (48,14 por cento bacteriana e 7,40 por cento de monilíase). Conclusões: A taxa de exames inconclusivos ainda é bastante elevada, com maior definição etiológica entre puérperas. Prevalecem as infecções bacterianas como causas etiológicas definidas. Os autores propõem a realização do exame colpocitológico de rotina nas gestantes, aproveitando a grande oportunidade eferecida pelo pré-natal

Vulvovaginitis en pediatría: un problema frecuente / Vulvovaginitis in pediatrics: a frequent problem

La vulvovaginitis es un problema frecuente en las niñas. Por lo general, no constituye el motivo principal de consulta sino que es una patología por la que el pediatra debe preguntar. Es importante conocer las situaciones normales como la leucorrea fisiológica de la recién nacida y previo a la menarquia. La recomendación de medidas generales de higiene permiten prevenir la vulvovaginitis. Una vez diagnosticada la descripción de las características de la leucorrea así como el cultivo se podrá indicar el tratamiento específico

Aislamiento de Staphylococcus xylosus, asociado con vulvo-vaginitis pediatrica / Isolation of Staphylococcus xylosus associated with pediatric vulvovaginitis

A traves de procedimientos bacteriologicos sencillos pero conlcuyentes, se aisla el 13-07-1994 estaphylococcus excylosus en un proceso cronico de vulvo-vaginitis (muestra 442/1994) siendo la base de este procedimiento el esquema propuesto por Kloos y Schleifer. El antibiograma (KIRBI-BAUER) demostro sensibilidad a Rifampicina, Cefradina, Ciprofloxacina, Gentamicina, Oxacilina y resistencia a la ampicilina, lincomicina y eritromicina, en concordancia con otros resultados internacionales previos. Es pertinente desarrollar este tipo de pruebas en Bolivia para delimitar el espectro epidemiologicos de este y otros ESTAPHYLOCOCCUS COAGULASA NEGATIVOS (CNS)

Diagnosis and treatment of vulvodynia.

Vulvodynia is a complex multifactorial and multidisciplinary clinical syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. Because of the absence of abnormal physical findings among such patients, vulvodynia was long thought to be solely a psychosomatic syndrome. The incidence or prevalence of vulvodynia has not been well studied. The recognition of specific subtypes of vulvodynia is important in the management of patients with vulvodynia. The most common subtypes are vulvar vestibulitis syndrome, cyclic vulvovaginitis and dysesthetic vulvodynia. Simple practice guidelines can be developed to facilitate the evaluation and management of such patients. Systematic epidemiological, etiological and therapeutic studies of vulvodynia are urgently needed.

Vulvovaginite na criança e adolescente / Vulvovaginite in the child and adolescent

Os autores discorrem sobre os fatores predisponentes das vulvovaginites na infância e adolescência. Informam sobre a grande incidência dessa patologia nesta faixa etária. Relatam sobre a importância dos hábitos de higiene na gênese e no tratamento das infecçöes vaginais e vulvares. Discorrem sobre os meios diagnósticos dessa patologia e indicam os tratamentos mais eficazes.

[Presenile and senile vulvovaginitis. Topical hormonal treatment with estriol]. / Vulvovaginiti presenili e senili. Trattamento topico ormonale con estriolo.

A population of 39 women (average age 64.5 years) suffering from presenile or senile vulvovaginitis was subjected to topical treatment with oestriol-based vaginal cream (daily applications of 0.50 mg of oestriol corresponding to 4 g of cream for 14 days and three times a week in the three following weeks). The results of treatment were assessed on the basis of the clear-cut improvement in symptomatology and the noteworthy increase in the index and volume of maturation of the vaginal epithelium. The effectiveness of topical treatment of postmenopausal vulvovaginitis with oestriol in the absence of unwanted side-effects is confirmed.