Effect of prunes on gastrointestinal function after benign gynecological surgery: a randomized control trial.

OBJECTIVE: To investigate the effect of postoperative prune consumption on time to first bowel movement after benign gynecologic surgery. MATERIALS AND METHODS: In this randomized, open label, controlled trial, 77 adult women who had benign gynecologic surgery that required at least one night in the hospital were enrolled from July 2018 to April 2019. Participants were randomized in a 1:1 ratio to one of two groups using a randomization assignment: 4 oz prunes daily plus docusate sodium 100 g twice daily versus docusate alone. The study's primary objective was time to first bowel movement (BM). Secondary outcomes were pain associated with first BM, stool consistency using Bristol stool scale, and patient satisfaction with bowel regimen and surgery experience. RESULTS: Postoperative survey data was available for 68.4% of participants (n = 52). There was no difference in time to first BM between the two groups (p = 0.29); however, consumption of > 12 prunes was associated with an increased likelihood of having a BM in the study period. Among women who consumed at least 12 prunes, hospital discharge was earlier, and there was a not statistically significant greater satisfaction with postoperative bowel regimen. CONCLUSIONS: The addition of prunes to postoperative bowel regimen of docusate sodium may be a beneficial adjunct to postoperative bowel regimen. CLINICAL TRIAL: The Institutional Review Board at the University of Southern California approved the study, and the study was registered at clinicaltrials.gov (ID: NCT03523715).

Translation and linguistic validation of the Female Genitourinary Pain Index in Spanish.

INTRODUCTION AND HYPOTHESIS: We sought to develop a Spanish translation of the Female Genitourinary Pain Index (GUPI) and to validate this instrument in US Latina women. METHODS: Translation back-translation was performed to create the initial Spanish version. Bilingual women with pelvic and/or genitourinary pain were recruited from clinical sites and social media. Participants reported demographics and completed the Female GUPI in both English and Spanish. Agreement was assessed for each item, subscale and total score. Additionally, we performed cognitive debriefing interviews to further test face validity. A consensus group of bilingual physicians and healthcare personnel utilized comments from the interviews to create a final Spanish version. RESULTS: Thirty-four participants completed the questionnaire. Their average age was 33 years, 80% reported attending some college, and 20% reported an undergraduate degree or higher. Most were born in mainland USA (57%) or Mexico (27%). Agreement for the pain, urinary and quality of life subscales between the English and Spanish versions of the measure were excellent (0.91, 0.89 and 0.92, respectively) with 0.96 agreement for the measure as a whole. Despite favorable psychometrics, preferences for alternate wording were reported over 50 times. Based on that feedback, a consensus group was formed, which recommended changes to 13 of the 15 items, 3 of which required complete rewriting. CONCLUSIONS: The Spanish Female GUPI is strongly correlated with the English original; however, participants reported the language was overly complex. Translation and validation should include review of the measure and feedback by the target audience for optimal clarity and readability.

Progestin therapy for obese women with complex atypical hyperplasia: levonorgestrel-releasing intrauterine device vs systemic therapy.

BACKGROUND: Though hysterectomy remains the standard treatment for complex atypical hyperplasia, patients who desire fertility or who are poor surgical candidates may opt for progestin therapy. However, the effectiveness of the levonorgestrel-releasing intrauterine device compared to systemic therapy in the treatment of complex atypical hyperplasia has not been well studied. OBJECTIVE: We sought to examine differences in treatment response between local progestin therapy with the levonorgestrel-releasing intrauterine device and systemic progestin therapy in women with complex atypical hyperplasia. METHODS: This single-institution retrospective study examined women with complex atypical hyperplasia who received progestin therapy between 2003 and 2018. Treatment response was assessed by histopathology on subsequent biopsies. Time-dependent analyses of complete response and progression to cancer were performed comparing the levonorgestrel-releasing intrauterine device and systemic therapy. A propensity score inverse probability of treatment weighting model was used to create a weighted cohort that differed based on treatment type but was similar with respect to other characteristics. An interaction-term analysis was performed to examine the impact of body habitus on treatment response, and an interrupted time-series analysis was employed to assess if changes in treatment patterns correlated with outcomes over time. RESULTS: A total of 245 women with complex atypical hyperplasia received progestin therapy (levonorgestrel-releasing intrauterine device n = 69 and systemic therapy n = 176). The mean age and body mass index were 36.9 years and 40.0 kg/m2, respectively. In the patient-level analysis, women who received the levonorgestrel-releasing intrauterine device had higher rates of complete response (78.7% vs 46.7%; adjusted hazard ratio, 3.32; 95% confidence interval, 2.39-4.62) and a lower likelihood of progression to cancer (4.5% vs 15.7%; adjusted hazard ratio, 0.28; 95% confidence interval, 0.11-0.73) compared to those who received systemic therapy. In particular, women with class III obesity derived a higher relative benefit from levonorgestrel-releasing intrauterine device therapy in achieving complete response compared to systemic therapy: class III obesity, adjusted hazard ratio 4.72, 95% confidence interval 2.83-7.89; class I-II obesity, adjusted hazard ratio 1.83, 95% confidence interval 1.09-3.09; and nonobese, adjusted hazard ratio 1.26, 95% confidence interval 0.40-3.95. In the cohort-level analysis, the obesity rate increased during the study period (77.8% to 88.2%, 13.4% relative increase, P = .033) and levonorgestrel-releasing intrauterine device use significantly increased after 2007 (6.3% to 82.7%, 13.2-fold increase, P < .001), both concomitant with a higher proportion of women achieving complete response (32.9% to 81.4%, 2.5-fold increase, P = .005). CONCLUSION: Our study suggests that local therapy with the levonorgestrel-releasing intrauterine device may be more effective than systemic therapy for women with complex atypical hyperplasia who opt for nonsurgical treatment, particularly in morbidly obese women. Shifts in treatment paradigm during the study period toward increased levonorgestrel-releasing intrauterine device use also led to improved complete response rates despite increasing rates of obesity.

Route-specific association of progestin therapy and concurrent metformin use in obese women with complex atypical hyperplasia.

INTRODUCTION: Previous studies have suggested that metformin use may enhance the therapeutic effect of progestin therapy for endometrial hyperplasia or malignancy. However, it is not known how the impact of concurrent metformin may be altered by route of progestin therapy, either locally via an intrauterine device or systemically. This study examined the effectiveness of concurrent metformin use and progestin therapy for women with complex atypical hyperplasia stratified by progestin route (systemic vs local). METHODS: This single-institution retrospective study examined consecutive women with complex atypical hyperplasia who received progestin therapy from 2003 to 2018. Time-dependent analyses for complete response rate were performed comparing concurrent metformin users versus non-users in the oral progestin group and in the levonorgestrel-releasing intrauterine device group. RESULTS: Across the study cohort (n=245), there were 137 (55.9%) women who responded to progestin therapy. In the oral progestin group (n=176), the median age and body mass index were 36 years and 37.7 kg/m2, respectively. 36 (20.5%) of women on oral progestins also took metformin. After controlling for diabetes status, women taking both oral progestins and metformin had a complete response rate similar to those not taking metformin (6 month cumulative rates, 23.1% vs 27.8%, adjusted hazard ratio (aHR) 0.71, 95% confidence interval (95% CI) 0.36 to 1.41). In the levonorgestrel-releasing intrauterine device group (n=69), the median age and body mass index were 35 years and 39.9 kg/m2, respectively. There were 15 (21.7%) women who took metformin in addition to the levonorgestrel-releasing intrauterine device. After controlling for diabetes status, women who had the levonorgestrel-releasing intrauterine device and took metformin had a significantly higher complete response rate compared with those not taking metformin (6 month cumulative rates, 86.7% vs 58.9%, aHR 2.31, 95% CI 1.09 to 4.89). CONCLUSION: In a predominantly obese population, concurrent metformin may possibly offer treatment benefit when used with the levonorgestrel-releasing intrauterine device.

Effectiveness of progestin-based therapy for morbidly obese women with complex atypical hyperplasia.

OBJECTIVE: While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes. METHODS: We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed. RESULTS: Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30-39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30-39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obese patients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09). CONCLUSION: In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.

Randomized controlled trial of 2% lidocaine gel versus water-based lubricant for multi-channel urodynamics.

INTRODUCTION AND HYPOTHESIS: The purpose of the study was to determine if there is a difference in pain during and after multichannel urodynamic testing in women when using 2% lidocaine gel versus water-based lubricant. METHODS: This was a randomized, controlled, double-blinded study. Women scheduled to undergo urodynamic testing were invited to participate. Participants were randomized to lidocaine 2% gel or water-based lubricant for use during testing. Both participant and examiner were blinded to the type of gel. Pain was assessed by the Wong-Baker pain scale from 0 to 10 at four points during the examination. After testing, participants completed a questionnaire to assess their expectations of pain and embarrassment with urodynamic testing. The examiner also completed a questionnaire to assess his/her impression of the participant's pain during the procedure. RESULTS: The women in the lidocaine group had lower pain scores after the cotton tipped swab test (1.3 vs 3.6, lidocaine vs lubricant respectively, p < 0.001) and after placement of urodynamic catheters (1.4 vs 3.9, lidocaine vs lubricant, respectively, p < 0.001). Mean pain scores 30 min post-completion of the study were similar between groups (0.7 vs 1.2, 1.4 vs 3.9, lidocaine vs lubricant respectively, p = 0.19). Participants reported that pain during the study was better than expected in both groups. Physician perception of the participant's pain during testing was lower in the lidocaine group (2 vs 3, lidocaine vs lubricant respectively p = 0.008). CONCLUSION: Use of 2% lidocaine gel during in and out catheterization, cotton-tipped swab test, and urodynamic testing decreases pain during these procedures.

Effect of pessary use on hydronephrosis in women with advanced pelvic organ prolapse: a self-selected interventional trial.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to determine the proportion of women who demonstrate improvement in hydronephrosis after pessary placement for advanced pelvic organ prolapse (POP). METHODS: This was a planned subset analysis of a prospective study on the prevalence of hydronephrosis in women with advanced POP. Women with anterior or apical POP ≥1 cm past the hymenal remnant were enrolled and screened for hydronephrosis. All were offered expectant management, pessary placement or surgery. Participants self-selecting pessary placement were compared with those with expectant management during the study period. A follow-up ultrasound scan was performed after >3 weeks of treatment. The proportions of participants demonstrating cure/improvement were compared using Fisher's exact test. RESULTS: Of 180 participants enrolled, 55 had hydronephrosis for a prevalence of 30.6% (95% CI 24.3-37.6%). Of those with hydronephrosis, 39 (70.8%) chose pessary placement while 16 (30.2%) declined. A follow-up ultrasound scan was performed in 89% of participants at a median of 77 days (interquartile range 49-99 days). Intention-to-treat analysis showed no difference in improvement or resolution of hydronephrosis between women who accepted and those who declined pessary placement (p = 0.43). However, of 22 women successfully using a pessary, 77.3% showed improvement or cure, compared with 29.6% of 27 women not using a pessary (p = 0.003). CONCLUSIONS: Successful pessary use improved hydronephrosis in over 75% of women with advanced POP. Approximately 39% of women with prolapse did not comply with pessary use and did not demonstrate hydronephrosis improvement.

The relationship between uterine leiomyomata and pelvic floor symptoms.

INTRODUCTION AND HYPOTHESIS: To compare pelvic floor symptoms in women with a leiomyomatous uterus ≤12 weeks and those >12 weeks in size and to evaluate the resolution of these symptoms after surgical intervention. METHODS: The PFDI-20, PFIQ-7 and 3-day voiding diaries were administered prospectively to all subjects. Demographics and questionnaire responses were compared using a t test, Chi-squared test or Mann-Whitney U test as indicated. RESULTS: One hundred and forty-five women completed the questionnaires and were included for analysis. There were 58 women with uterine size ≤12 weeks (group I) and 87 women with size >12 weeks (group II). Participants in group I reported more straining to defecate (p = 0.042), while group II reported increased feeling of incomplete bladder emptying (p = 0.007) and difficulty emptying their bladder (p = 0.008). Review of ultrasound images revealed no difference in pelvic floor symptoms when stratified by leiomyoma location. At 1-year follow-up, 69 women (48 %) responded, and 40 (58 %) had undergone surgical intervention. Surgery was shown to improve symptoms for all questions reviewed at 1-year follow-up. CONCLUSIONS: A leiomyomatous uterus >12 weeks is associated with the symptom of incomplete bladder emptying, but does not appear to have an effect on other pelvic floor symptoms compared with women with a smaller leiomyomatous uterus. Surgical intervention for leiomyomata improves pelvic floor symptoms.

Comparison of the POP-Q examination, transvaginal ultrasound, and direct anatomic measurement of cervical length.

INTRODUCTION AND HYPOTHESIS: Our objective was to determine the relationship between the Pelvic Organ Prolapse Quantification (POP-Q) examination for determining cervical length (CL) and CL at hysterectomy. Secondary objectives were to define cervical elongation using both measures in a urogynecologic population, determine the relationship between POP-Q estimate and CL on ultrasound (US) and examine the interobserver reliability of each mode of measurement. METHODS: This was a prospective cohort study of women scheduled for hysterectomy at the Los Angeles County + University of Southern California (LAC + USC) medical center. CLs were measured by POP-Q and at the time of hysterectomy. Transvaginal US CLs were determined when available. Exam CL (eCL) was compared with anatomic (aCL) and US (uCL) CL. Repeat measures of eCL, uCL, and aCL were all compared for interobserver reliability. RESULTS: The study enrolled 151 women. Median eCL was 3.0 cm (0.5-9.0) (n = 149); average uCL was 2.3 cm ± 0.7 (n = 108), average aCL 2.8 cm ± 1.1 (n = 87); eCL correlated fairly with aCL (r = 0.3, p = 0.005, n = 88) but poorly with uCL (r = -0.13, p = 0.18, n = 105); uCL correlated poorly with aCL (r = 0.19, p = 0.14, n = 64). Interobserver reliability for eCL and aCL were good to excellent (eCL α=0.881; aCL α=0.889) but for uCL adequate (α=0.699). The 97.5 percentile cutoff for aCL was 5.0 cm and for eCL 8.0 cm. CONCLUSIONS: The POP-Q examination estimate of CL correlates fairly with aCL at the time of hysterectomy; uCL does not appear to correlate with aCL or eCL. Cervical elongation may be defined as an anatomic length of 5.0 cm or a POP-Q estimate of 8.0 cm.

Is there a pelvic organ prolapse threshold that predicts bladder outflow obstruction?

INTRODUCTION AND HYPOTHESIS: To determine if there is a cutpoint of anterior vaginal wall prolapse which predicts bladder outflow obstruction. METHODS: Subjects with and without bladder outflow obstruction (BOO) were identified. Baseline characteristics, urodynamics, and exam findings were compared. RESULTS: Forty-seven women with BOO were compared to 115 women without BOO. Those with obstruction were significantly older (53.9 vs. 50.0 years, p = 0.015) had higher parity (p = 0.03), significantly smaller maximum bladder capacity (359.0 vs. 426.0 ml, p < 0.0001), and were less likely to leak at smaller volumes (213.0 vs. 109.0 ml, p = 0.006) than those without obstruction. Those with obstruction also had higher measurements on Aa (p = 0.004) and Ba (p = 0.001), though receiver operator curve analysis did not reveal a clear point of anterior prolapse at which bladder outflow obstruction occurs. CONCLUSIONS: Bladder outflow obstruction is associated with anterior vaginal wall prolapse, though there is no clear cutpoint of anterior prolapse which predicts obstruction.

Lavender Aromatherapy for Anxiety and Pain During Multichannel Urodynamics: A Randomized Controlled Pilot Trial.

OBJECTIVE: Our objective was to determine if there is a difference in anxiety during urodynamics in women given lavender aromatherapy (lavender) versus placebo. METHODS: This was a randomized, controlled trial of women scheduled for urodynamic testing with baseline anxiety. Participants rated their anxiety and pain immediately before the examination and then were randomized to lavender or placebo. Anxiety and pain were assessed immediately after catheter placement and 15 minutes after termination of the study. RESULTS: Data for 40 women who received lavender and 38 women who received placebo were available for analysis. Decrease in anxiety from baseline to catheter placement (-2 vs -0.5, P = 0.01) and 15 minutes post procedure was significantly greater in the lavender group. Postprocedure anxiety was lower in the lavender group compared with controls (0 vs 0.5, P = 0.001). No differences were seen in pain. CONCLUSIONS: Lavender aromatherapy reduces anxiety during urodynamics.

Does Obtaining a Diagnosis of Interstitial Cystitis/Bladder Pain Syndrome Improve Symptoms or Quality of Life? A Cross-sectional Questionnaire-Based Study.

OBJECTIVES: The aim of this study was to investigate whether receiving a clinical diagnosis of interstitial cystitis (IC) or bladder pain syndrome (BPS) improves patients' symptoms, health-related quality of life (HRQOL), or ability to cope with their symptoms. METHODS: In this cross-sectional study, participants with self-reported IC/BPS completed an online questionnaire recalling their perceived change in symptoms after diagnosis and treatment. The questionnaire included demographic information, overall HRQOL measured on a visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Problem Index, the Urinary Impact Questionnaire, and questions regarding patient beliefs about diagnosis. HRQOL and symptom impact scales were compared before and after diagnosis and treatment. Demographic data, symptom data, and beliefs were examined for correlation with improvement in quality of life after diagnosis. RESULTS: A total of 1052 participants initiated the survey and were included in the analysis; most of them identified as female, non-Hispanic, and white (90%). Before symptom onset, median VAS HRQOL score was 87 (interquartile range [IQR], 77-95). Median scores nadired at 34 (IQR, 20-59) after symptom onset before diagnosis, but improved to 61 after diagnosis and treatment (IQR, 38-74; all P < 0.001). Scores remained stable after diagnosis and initiation of treatment with a median score of 65 at the time of survey (IQR, 37-80; P > 0.05). Age, insurance type, and improvement in scores on the symptom impact scale predicted improvement in HRQOL after diagnosis and treatment in the multivariable model. CONCLUSIONS: Participants reported improvements on global and symptom-specific quality of life measures after diagnosis and treatment for IC/BPS.

Actinomyces infection associated with the transobturator sling.

We present a case of Actinomyces infection associated with the transobturator sling. The patient had a transobturator sling complicated only by a left vaginal sulcal perforation. She subsequently developed mesh erosion that led to two partial mesh resections performed in the operating room at 6 weeks and again at 6 months after the initial surgery. She subsequently required a groin dissection and removal of the entire left side of the sling due to persistent infection. The presence of a foreign body is believed to create an environment that makes growth of the bacteria more likely. With increased use of artificial mesh in incontinence and prolapse surgery, we may see increasing numbers of these types of infections.

Colorectal and anal symptoms in women with urinary incontinence and pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Our aim was to determine the prevalence of colorectal and anal (CRA) symptoms in women with urinary incontinence and pelvic organ prolapse (UI/POP) in a predominantly Latina population. METHODS: We reviewed charts of women seen in the urogynecology clinic for UI/POP for those who completed the colorectal anal distress inventory-8 (CRADI-8) on their first visit. A detailed history was taken independent of the questionnaire. RESULTS: Two hundred sixty-five women completed the questionnaire; 94% were Latina; 89% completed the questionnaire in Spanish. Of the women, 88% indicated at least one CRA symptom: 60% reported needing to strain hard to have a bowel movement; 59% reported sensation of incomplete bowel emptying; 21% indicated incontinence of solid or liquid stool, and an additional 30% of women reported flatal incontinence only, for a total anal incontinence rate of 58%. CONCLUSION: CRA symptoms are highly prevalent among women with UI/POP who completed the CRADI-8 in a predominantly Latina patient population.

Does mental imagery prior to cystoscopy make a difference? A randomized controlled trial.

OBJECTIVE: We sought to determine whether mental imagery improves surgical performance of residents novice to cystoscopy. STUDY DESIGN: We performed a multicenter randomized controlled trial. Residents who had performed < or = 3 cystoscopies were randomized to preoperative mental imagery sessions or reading a book chapter describing cystoscopy. The primary outcome was comparison of groups' surgical performance scores. Secondary outcomes were measurements of operative times and resident ratings of helpfulness of their preparation. Scores were compared using 2-factor analysis of variance. RESULTS: In all, 68 residents were randomized; 33 to imagery and 35 to control groups. Groups did not differ in age, cystoscopic experience, residency level, or sex. The imagery group's surgical assessment scores were 15.9% higher than controls (P = .03). Operative times did not differ between groups. Imagery residents rated imagery preparation as more helpful than controls (P < .0001). CONCLUSION: Residents considered mental imagery to be a more useful preoperative preparation. The mental imagery group's surgical performance was superior to controls.

Effectiveness of transobturator tape in women with decreased urethral mobility.

OBJECTIVE: To determine whether preoperative urethral mobility is associated with success of the transobturator insertion of suburethral polypropylene slings. STUDY DESIGN: A cohort of women who underwent a transobturator insertion of a suburethral polypropylene sling for urodynamic stress incontinence between October 2003 and January 2005 was prospectively assessed. RESULTS: Of the 134 women in the study cohort, 107 (80%) provided postoperative data at a median followup interval of 10 months. Postoperatively, 92 (86%) reported complete resolution of stress urinary incontinence on the Urogenital Distress Inventory-6 questionnaire, and 15 (14%) reported persistent incontinence. The median preoperative urethral mobility was significantly decreased among women who were incontinent postoperatively compared to those who were continent (40 degrees [10-60] vs. 50 degrees [10-90], p=0.0049). Women with preoperative urethral mobility < 45 degrees were at least 4 times more likely to report postoperative incontinence compared with women with preoperative urethral mobility > or = 45 degrees (29.4% vs. 6.9%, RR 4.29, 95% CI 1.59-11.60, p = 0.005). In addition, women with preoperative urethral straining angles < 45 degrees from the horizontal were at least 5 times more likely to report postoperative incontinence compared with women with preoperative urethral straining angles > or = 45 degrees (41.7% vs. 8.7%, RR 5.21, 95% CI 1.88-14.42, p = 0.006). Neither patient age nor the concomitant performance of an anterior colporrhaphy affected these results. CONCLUSION: Women with preoperative urethral mobility or preoperative urethral straining angles < 45 degrees appear to be at higher risk for failure following a transobturator insertion of a suburethral polypropylene sling.

The effect of transdermal and vaginal estrogen therapy on markers of postmenopausal estrogen status.

OBJECTIVE: To compare serum 17beta-estradiol (E2), estrone (E1), estrone sulfate, follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin, vaginal pH, and the vaginal maturation indices in women using a low-dose transdermal patch releasing 14 microg of E2 per day and a vaginal ring releasing 7.5 microg of E2 per day. DESIGN: Twenty-four postmenopausal women were randomly assigned to either the patch (n = 12) or the ring (n = 12) for a 12-week study period. Serum E2, E1, estrone sulfate, follicle-stimulating hormone, luteinizing hormone, and sex hormone-binding globulin were measured by immunoassay at baseline and 6 and 12 weeks. Vaginal pH was determined at baseline and 6 and 12 weeks. Vaginal cytologic examinations for vaginal maturation index were done at baseline and 12 weeks. RESULTS: Twenty women completed the study. The patch significantly increased serum E1 and E2 levels at 6 and 12 weeks (P < 0.01); there was no significant increase in serum E1 and E2 levels with the ring. Both the patch and the ring significantly reduced vaginal pH at 6 (P < 0.001) and 12 (P < 0.001) weeks and significantly reduced the percentage of vaginal parabasal cells at 12 weeks with no significant difference between the two groups. Both preparations increased the proportion of superficial cells; the increase was significant only with the patch (P = 0.04). CONCLUSIONS: A transdermal E2 skin patch releasing 14 microg of E2 per day had an effect on vaginal pH and vaginal maturation indices similar to that of a vaginal E2 ring releasing 7.5 microg of E2 per day. Therefore, this patch is likely to relieve symptoms of vulvovaginal atrophy.

Vaginal Angiomyofibroblastoma: A Case Report and Review of Diagnostic Imaging.

BACKGROUND: Angiomyofibroblastoma (AMFB) is a benign mesenchymal tumor most commonly found in the female genital tract of premenopausal women. Although rare, AMFB is an important consideration in the differential diagnosis of vulvar and vaginal masses, as it must be distinguished from aggressive angiomyxoma (AA), a locally recurrent, invasive, and damaging tumor with similar clinical and pathologic findings. CASE: We describe a patient with a 4 cm vaginal AMFB and the relevant preoperative radiographic imaging findings. CONCLUSION: Preoperative diagnosis of AMFB remains difficult. Common findings on magnetic resonance imaging and transvaginal sonography are described. We conclude that both transvaginal ultrasound and MRI are potentially useful imaging modalities in the preoperative assessment of vulvar and vaginal AMFB, with more data needed to determine superiority of one modality over the other.

Sexual function in women with urodynamic stress incontinence, detrusor overactivity, and mixed urinary incontinence.

OBJECTIVE: This study was undertaken to compare sexual function in sexually active women with urodynamic stress incontinence (USI), detrusor overactivity (DO), and mixed urinary incontinence (MUI). STUDY DESIGN: We reviewed the medical records of all women evaluated for urinary incontinence (UI) at our institution between March 2003 and August 2004. At the time of initial evaluation, all women completed the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). PISQ-12 scores of age-matched women with urodynamic diagnoses of USI, DO, and MUI were compared. Statistical analysis was performed with 1-way analysis of variance and chi2 contingency table analysis. RESULTS: Fifty women with USI, 50 with DO, and 48 with MUI were included in this study. Subject demographics were similar among the 3 groups. Mean PISQ-12 scores did not differ significantly among the 3 groups. CONCLUSION: Among sexually active women with urinary incontinence, sexual function as assessed by the PISQ-12 does not differ according to type of incontinence.

Effects of transdermal and oral contraceptives on estrogen-sensitive hepatic proteins.

OBJECTIVE: The purpose of this study was to evaluate the effects of the contraceptive patch and an oral contraceptive (OC) on serum concentrations of estrogen-sensitive hepatic proteins, ethinyl estradiol (EE) and levonorgestrel (LNG). METHODS: Twenty-four women were randomized to receive three cycles of a contraceptive patch that delivers EE 20 microg/day and norelgestromin 150 microg/day or an OC that contains EE 35 microg and norgestimate 250 microg. Blood samples were taken at baseline and at the end of Cycle 3. Serum levels of sex-hormone-binding globulin (SHBG), thyroxine-binding globulin (TBG), corticosteroid-binding globulin (CBG) and C-reactive protein (CRP) were quantified by immunoassay methods. EE and LNG levels in patch users were measured by radioimmunoassay (RIA) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. The paired t test and Student's t test were used for statistical analysis. RESULTS: Nineteen women completed the study (patch, n=10; OC, n=9). Treatment with both the patch and OC resulted in significant increases from baseline in SHBG, TBG and CBG. The increase in CRP was significant in the patch group and approached significance in the OC group. The increases in SHBG and TBG observed with the patch were significantly greater than those associated with the OC. By way of RIA and LC-MS/MS assay methods, the patch was associated with mean EE levels of 114 and 111 pg/mL, respectively. CONCLUSIONS: The serum concentrations of estrogen-sensitive hepatic proteins and EE associated with the patch suggest that this new contraceptive system may have relatively large net estrogen effects.