Menstrual products: culprits or bystanders in endometriosis and adenomyosis pathogenesis?

Products that may reduce menstrual flow from the endometrial cavity to the vagina (i.e. tampons and menstrual cups) could facilitate retrograde menstruation and the spillage of blood into the myometrium, two mechanisms which could be major determinants in endometriosis and adenomyosis pathogenesis. The aim of this narrative review is to summarize the evidence regarding the mechanical role menstrual products may have in the pathogenesis of these two conditions. Evidence in this regard is inconclusive. While Darrow and colleagues observed that 14 or more years of tampon use were associated with endometriosis (OR 3.6; 95% CI, 1.04-13.5); in Meaddough and colleagues' retrospective study, the percentage of women using pads only was significantly higher among those with endometriosis than among those without the condition (31% vs 22%). Three further groups failed to find an association between endometriosis/adenomyosis and any type of menstrual product. The only case that may be considered as a sort of proof-of-concept of the association between products potentially reducing anterograde menstrual flow and endometriosis was reported by Spechler and colleagues, who described the case of a 41 year-old who developed endometriosis after having used a menstrual cup on a regular basis. However, the number of studies on the subject is scarce, study populations are exiguous and a greater attention to temporality of endometriosis onset in relation to when women started habitually using a specific menstrual product is needed. Confounding variables including type and quantity of endocrine disruptors contained in menstrual products should also be addressed. At the present moment, no recommendation can be provided on the safety of one type of menstrual product compared to another.

A multimodality review of gynecologic devices in the pelvis.

There are a wide variety of gynecologic devices encountered on pelvic imaging which may not be the focus or primary reason for imaging. Such devices include pessaries, menstrual products, radiation therapy devices, tubal occlusion devices, and contraceptive devices, including intrauterine devices and intravaginal rings. This manuscript offers a comprehensive review of multimodality imaging appearances of gynecologic devices encountered on pelvic imaging and discusses device indications, positioning, and complications.

Retained Tampon Fragment as an Unusual Cause of Vesicovaginal Fistula.

BACKGROUND: Vesicovaginal fistula (VVF) is an uncommon cause of urinary incontinence (UI). Iatrogenic etiologies, especially abdominal hysterectomy, are most common; however, a minority of VVFs are caused by retained foreign bodies. Objects associated with VVF include intrauterine devices, gauze, pessaries, bottle caps, and sexual aids, but retained tampons or other menstrual products have not been commonly reported. CASE: We present the case of a 53-year-old woman, gravida 0, with no prior pelvic surgery, with 2 months of intermittent UI and hematuria. Although initial diagnostic test results were negative, cystoscopy and vaginoscopy eventually confirmed the diagnosis of VVF associated with a retained foreign body. In the operating room, all debris was removed using vaginoscopy, and the VVF was repaired using a modified Latzko technique. At the patient's 9-week follow-up appointment, she was found to have complete healing of the VVF and resolution of associated symptoms. CONCLUSION: This is a case of VVF secondary to a retained tampon fragment. In addition to this uncommon etiology, our patient's presenting symptoms were atypical, leading to a delay in diagnosis and treatment for which vaginoscopy was critical.

Acceso y prácticas de higiene menstrual en América Latina: revisión de alcance / Menstrual hygiene access and practices in Latin America: scoping review / Acesso e práticas de higiene menstrual na América Latina: revisão de escopo

Objetivo: sintetizar la evidencia disponible relacionada con el acceso y las prácticas de higiene menstrual en América Latina y el Caribe. Método: revisión de alcance de la literatura con protocolo de investigación registrado en el Open Science Framework, realizada en las bases de datos bibliográficas: PubMed, Scopus, Web of Science y Portal Regional da Biblioteca Virtual em Saúde. Los datos fueron analizados mediante estadística descriptiva simple y análisis temático. Resultados: se incluyeron 15 publicaciones, la mayoría de las cuales trataban sobre adolescentes en Brasil: 12 artículos, dos informes técnicos y una monografía de trabajo de conclusión de curso. Como temas recurrentes en las publicaciones se destacan: acceso a condiciones dignas para el manejo de la higiene menstrual; necesidad de acceso a información sobre el manejo de la higiene menstrual; y prácticas para el manejo de la higiene menstrual. Conclusión: adolescentes informan dificultades para acceder a baños, agua y materiales absorbentes, y falta de información sobre la salud menstrual, incluso en las escuelas, lo que lleva al ausentismo escolar. De esta manera, las lagunas en la literatura científica latinoamericana revelan desigualdades y diversidad en las experiencias menstruales interseccionadas por categorías como género, clase social y etnia.

Objective: to synthesize available evidence related to menstrual hygiene access and practices in Latin America and the Caribbean. Method: literature scoping review with research protocol registered in the Open Science Framework, carried out in the bibliographic databases: PubMed, Scopus, Web of Science and Portal Regional da Biblioteca Virtual em Saúde. Data were analyzed using simple descriptive statistics and thematic analysis. Results: 15 publications were included, the majority of which addressed adolescents in Brazil: 12 articles, two technical reports and a course conclusion monograph. As recurring themes in the publications, the following stand out: Access to dignified conditions for managing menstrual hygiene; Need for access to information on menstrual hygiene management; and Practices for managing menstrual hygiene. Conclusion: adolescents report difficulties in accessing toilets, water and absorbent materials, and lack of information about menstrual health, including in schools, leading to school absenteeism. Thus, gaps in the Latin American scientific literature reveal inequalities and diversity in menstrual experiences intersected by categories such as gender, social class and ethnicity

Objetivo: sintetizar evidências disponíveis relacionadas ao acesso e práticas de higiene menstrual na América Latina e Caribe. Método: revisão de escopo da literatura com protocolo de pesquisa registrado no Open Science Framework, realizada nas bases de dados bibliográficas: PubMed, Scopus, Web of Science e Portal Regional da Biblioteca Virtual em Saúde. Os dados foram analisados por estatística descritiva simples e análise temática. Resultados: foram incluídas 15 publicações, cuja maioria abordava adolescentes no Brasil: 12 artigos, dois relatórios técnicos e uma monografia de trabalho de conclusão de curso. Como temas recorrentes nas publicações, destacam-se: acesso a condições dignas para o manejo da higiene menstrual; necessidade de acesso à informação sobre manejo da higiene menstrual; e práticas para manejo da higiene menstrual. Conclusão: adolescentes relatam dificuldades de acesso a sanitários, água e materiais absorventes, e falta de informação sobre saúde menstrual, inclusive nas escolas, levando ao absenteísmo escolar. Assim, lacunas na literatura científica latino-americana revelam desigualdades e diversidade nas experiências menstruais interseccionadas por categorias como gênero, classe social e etnia.

Encarceramento feminino: um debate entre criminologia e perspectivas feministas / Female incarceration: a debate between criminology and feminist perspectives / Encarcelamiento femenino: un debate entre la criminología y las perspectivas feministas

Este ensaio teórico-reflexivo tem como objetivo discutir sobre as contribuições dos estudos da criminologia e sua crítica para as diversas formas de aprisionamento feminino, e mais atualmente para o encarceramento em massa no sistema prisional, além de abrir espaço para o debate sobre as diferentes perspectivas feministas e as relações com os estudos criminológicos, sobretudo com os posicionamentos da chamada criminologia crítica. Reconhecem-se importantes avanços e conquistas feministas no debate sobre a estruturação masculinizada do direito penal e do seu fazer jurídico, mas também a manutenção de diversas formas de violência de gênero que configuram um sistema penal antropocêntrico, seletivo, racista e discriminatório. Indica-se a urgência de estudos interseccionais que considerem as particularidades e reinvindicações das mulheres no cárcere e suas formas de militância, sobretudo diante de população carcerária feminina composta majoritariamente por mulheres negras, pobres e periféricas. Faz-se visível a necessidade de uma análise dos fatores que atravessam o encarceramento feminino por uma ótica feminista plural, adequada às realidades que se estudam e atenta às múltiplas perspectivas que podem existir dentro do feminismo.(AU)

This theoretical-reflexive essay aims to discuss the contributions of criminological studies and their critique of the various forms of imprisonment of women, and more recently of mass incarceration in the prison system, in addition to opening space for the debate on the different feminist perspectives and their relations with criminological studies, especially with the positions of the so-called critical criminology. Important feminist advances and conquests are recognized in the debate about the masculinized structure of penal law and its legal practice, but also the maintenance of diverse forms of gender violence that configure an anthropocentric, selective, racist, and discriminatory penal system. It indicates the urgency of intersectional studies that consider the particularities and claims of women in prison and their forms of militancy, especially in the face of the female prison population composed mostly of black, poor, and peripheral women. The need for an analysis of the factors that cross women's imprisonment from a plural feminist perspective, adequate to the realities under study and attentive to the multiple perspectives that may exist within feminism, becomes visible.(AU)

Este ensayo teórico-reflexivo pretende discutir las aportaciones de los estudios criminológicos y su crítica a las distintas formas de encarcelamiento femenino, y más recientemente de encarcelamiento masivo en el sistema penitenciario, además de generar debate sobre las distintas perspectivas feministas y sus relaciones con los estudios criminológicos, especialmente con las posiciones de la Criminología Crítica. Se reconocen importantes avances y logros feministas en el debate sobre la estructuración masculinizada del derecho penal y su práctica jurídica, además del mantenimiento de diversas formas de violencia de género que configuran un sistema penal antropocéntrico, selectivo, racista y discriminatorio. Se necesitan estudios interseccionales que consideren las particularidades y reivindicaciones de las mujeres en prisión y sus formas de militancia, principalmente ante la población penitenciaria femenina compuesta mayoritariamente por mujeres negras, pobres y periféricas. Se hace evidente la necesidad de analizar los factores que inciden en el encarcelamiento femenino desde una perspectiva feminista plural, adecuada a las realidades que se estudian y atenta a las múltiples perspectivas que pueden existir dentro del feminismo.(AU)

Repercussões da pobreza menstrual para as mulheres e pessoas que menstruam: revisão integrativa / Repercusiones de la pobreza menstrual para las mujeres y las personas que menstruan: revisión integrativa / Repercussions of period poverty for women and people who menstruate: an integrative review

Objetivos: investigar as repercussões da pobreza menstrual para as mulheres e pessoas que menstruam. Método: revisão integrativa da literatura, realizada nas bases de dados MEDLINE, Scopus, Web of Science e CINAHL. Foram incluídos artigos na íntegra, nos idiomas português, inglês e espanhol e com recorte temporal de sete anos (2017-2023) para responder a pergunta norteadora: Quais são as repercussões da pobreza menstrual na vida das mulheres e pessoas que menstruam? A inclusão dos artigos foi feita por dois revisores independentes e com consenso por um terceiro. Resultados: foram incluídos 15 artigos e observou-se três principais repercussões da pobreza menstrual: absenteísmo escolar, aumento do risco de infecções do trato genital e repercussões emocionais. Conclusão: a pobreza menstrual traz repercussões negativas para as mulheres e pessoas que menstruam, comprometendo a saúde física, mental e a esfera social, motivo pelo qual o tema precisa ser amplamente visibilizado e combatido.

Objetivos: investigar las repercusiones de la pobreza menstrual para las mujeres y las personas que menstruan. Método: revisión integrativa de la literatura, realizada en las bases de datos MEDLINE, Scopus, Web of Science y CINAHL. Se incluyeron artículos en su totalidad, en los idiomas portugués, inglés y español y con recorte temporal de siete años (2017-2023) para responder a la pregunta orientadora: ¿Cuáles son las repercusiones de la pobreza menstrual en la vida de las mujeres y personas que menstruan? La inclusión de los artículos fue hecha por dos revisores independientes y con consenso por un tercero. Resultados: se incluyeron 15 artículos y se observaron tres principales repercusiones de la pobreza menstrual: absentismo escolar, aumento del riesgo de infecciones del tracto genital y repercusiones emocionales. Consideraciones finales: la pobreza menstrual trae repercusiones negativas para las mujeres y personas que menstruan, comprometiendo la salud física, mental y la esfera social, por lo que el tema necesita ser ampliamente visibilizado y combatido.

Objective: to investigate the repercussions of period poverty for women and people who menstruate. Method: an integrative review of the literature, performed in MEDLINE, Scopus, Web of Science and CINAHL databases. The sample included complete articles, in Portuguese, English and Spanish, and with a timeframe of seven years (2017-2023) to answer the guiding question: What are the repercussions of period poverty in the lives of women and people who menstruate? The inclusion of the articles was done by two independent reviewers and with consensus by a third party. Results: 15 articles were included and three main repercussions of period poverty were observed: school absenteeism, increased risk of genital tract infections and emotional repercussions. Final considerations: period poverty brings negative repercussions for women and people who menstruate, compromising physical, mental and social health, which is why the theme needs to be widely publicized and combated.

Factors influencing women to participate in cervical cancer screening by providing menstrual pads: A population-based study from rural areas of Maharashtra state, India.

Background: India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods: Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results: The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0-1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0-2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0-14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1-1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4-2.5). Conclusion: Factors including health worker availability, using mobile phones for communication and high education level facilitate women's participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit.

Quantifying procedural pain associated with office gynecologic tract sampling methods.

OBJECTIVE: Emerging technologies may enable detection of endometrial cancer with methods that are less invasive than standard biopsy methods. This study compares patient pain scores among 3 office gynecologic tract sampling methods and explores their potential determinants. METHODS: A prospective study including 3 sampling methods (tampon, Tao brush (TB), endometrial biopsy (EB)) was conducted between December 2015 and August 2017 and included women ≥45 years of age presenting with abnormal uterine bleeding, postmenopausal bleeding, or thickened endometrial stripe. Patients rated pain after each sampling procedure using a 100-point visual analog scale (VAS). RESULTS: Of 428 enrolled, 190 (44.39%) patients underwent all 3 sampling methods and reported a VAS score for each. Nearly half were postmenopausal (n = 93, 48.9%); the majority were parous (172, 90.5%) of which 87.8% had at least one vaginal delivery. Among the 190 patients, the median (IQR) pain score was significantly lower for sampling via tampon (0 [0,2]) compared to TB (28 [12, 52]) or EB (32 [15, 60]) (both p < 0.001, Wilcoxon signed rank test). Among women who underwent tampon sampling, age and pain scores showed a weak positive correlation (Spearman rank correlation, r = 0.14; p = 0.006); EB sampling was associated with a weak inverse correlation between parity and pain scores (r = -0.14; p = 0.016). CONCLUSION: Gynecologic tract sampling using a tampon had significantly lower pain than both EB and TB. Pain with tampon sampling was positively correlated with age and pain with EB sampling was inversely correlated with parity. Pain scores for TB and EB were not significantly related to age, menopausal status, or BMI.

Asymmetric wetting and antibacterial composite membrane obtained by spraying bacterial cellulose grafted with chitosan for sanitary products surface layers.

The asymmetric wetting membranes have attracted intense attention in liquid directional transportation. However, it is a huge challenge to prepare surface layer membrane for sanitary products with antibacterial and asymmetric wettability by a simple method. Herein, the bacterial cellulose grafted with chitosan (BC-CS) was used as the hydrophilic agent to modify polypropylene nonwoven fabric (PPF) substrate via easy and effective one-sided layer-by-layer spraying to prepare the asymmetric wetting and antibacterial composite membrane (BC-CS/PPF). It showed that the BC-CS/PPF had good physical properties, which was attributed to the strong and uniform physical combination between nano-sized BC-CS and PPF. The sanitary products with BC-CS/PPF surface layer, denoted as BC-CS/PPF sanitary products, also had good absorption and anti-return property. The antibacterial test revealed that BC-CS had an excellent performance against S. aureus and E. coli in the simulated application environment. Moreover, the antibacterial performance was better than that of commercial sanitary products.

Avaliação da segurança e conforto no uso do coletor menstrual durante a prática esportiva: um estudo de coorte prospectivo / Evaluation of the safety and comfort of menstrual cup during physical exercise: a prospective cohort study

Objetivos: Avaliar o conforto no uso do coletor menstrual durante o exercício físico. Métodos: Foi realizado um estudo prospectivo com uma coorte de 49 jogadoras de handebol universitário. As participantes foram convidadas a usar o coletor menstrual descartável Softcup® durante três ciclos menstruais. O desfecho primário foi a satisfação geral no uso do coletor. Os desfechos secundários incluíram: facilidade de inserção e remoção do dispositivo, dor, desconforto nas relações sexuais, vazamento de sangue e/ou perda durante o exercício físico. Resultados: A idade média das participantes foi de 22 ± 2 anos. O grau de satisfação geral durante o esporte foi alto (82%). A inserção e a remoção do dispositivo menstrual foram consideradas fáceis pela maioria das usuárias e o grau de satisfação aumentou nos ciclos subsequentes. A queixa de vazamento do fluxo menstrual durante o esporte ocorreu em 63,3% das atletas no primeiro ciclo e caiu para 42,9% no último ciclo (p > 0,05). Houve perda do dispositivo durante o exercício em 36,7% das atletas no primeiro ciclo, 30,6% no segundo e 26,5% no terceiro ciclo (p > 0,05). Das atletas que tiveram relações sexuais com o uso do coletor menstrual, 90,9% não apresentaram desconforto. Conclusão: O conforto no uso do coletor menstrual durante o exercício físico foi elevado. Vazamento menstrual e perda do dispositivo tendem a diminuir com ciclos subsequentes.(AU)

Objective: To evaluate the safety and comfort of menstrual cup during physical exercise. Methods: A prospective cohort study was setting analysing a total of 49 female handball players with a mean age of 22 ± 2 years. The participants were invited to use Softcup® disposable menstrual during three menstrual cycles. The main outcome measures was overall satisfaction. Secondary outcomes included ease of insertion and removal of the device, pain, discomfort in sexual intercourse, blood leakage and/ or loss of the menstrual cup during sport. Results: The degree of overall satisfaction during sport was high (82%). The insertion and removal of the menstrual cup was considered easy by most users, and the degree of satisfaction increased in subsequent cycles. The complaint of menstrual flow leakage during sport occurred in 63.3% of the athletes in the first cycle and fell to 42.9% in the last cycle (p > 0.05).(AU)

Menstruation: science and society.

Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.

Acceptability and safety of the menstrual cup: A systematic review of the literature / Aceptabilidad y seguridad de la copa menstrual: revisión sistemática de la literatura

RESUMEN Objetivo: realizar una búsqueda sistemática de la literatura para evaluar la aceptabilidad y seguridad de la copa menstrual como producto de higiene genital femenina. Materiales y métodos: se realizó búsqueda en las bases de datos PubMed, Cochrane Library, Scopus, PopLine y Google Scholar, desde 1966 hasta julio de 2019. Se utilizaron los términos: "Menstrual" AND "Cup" OR "Copa" AND "Menstrual". Se incluyeron estudios cuantitativos, cualitativos y mixtos, series y reportes de caso publicados en inglés y español que hubieran evaluado la copa menstrual en mujeres en edad reproductiva. Los estudios fueron selecciona- dos y los datos fueron extraídos por dos evaluadores de manera independiente. Como resultado primario se evaluó la aceptabilidad y seguridad. La síntesis de información se presenta de manera narrativa. Resultados: se encontraron 737 títulos para revisión inicial. Finalmente, se incluyeron 38 estudios. La copa menstrual tiene una aceptabilidad que varía entre el 35 y el 90 %. Del 10 al 45 % la encontraron difícil de usar. Fue descrita como más cómoda comparada con el tampón y la toalla higiénica de fabricación industrial. La continuidad de su uso está entre el 48 y el 94 %. En cuanto a la seguridad se presentó un caso de síndrome de choque tóxico, uno de atrapamiento mecánico, uno de alergia al producto y mayor riesgo de expulsión en usuarias del dispositivo intrauterino. Conclusión: la copa menstrual es una alternativa cómoda, segura y eficiente para la higiene mens- trual. Se requieren más estudios controlados alea- torizados y cohortes prospectivas a largo plazo para determinar el riesgo de complicaciones por una exagerada colonización bacteriana o menstruación retrógrada.

ABSTRACT Objective: To conduct a systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product. Materials and methods: A search was conducted in the PubMed, Cochrane Library, Scopus, PopLine and Google Scholar databases for publications be- tween 1966 and July 2019. The terms ("Menstrual" AND "Cup") OR ("Copa" AND "Menstrual") were used. Quantitative, qualitative and mixed studies were included, as well as case series and case reports published in English and Spanish assessing the menstrual cup in women in childbearing age. The studies were selected and the data extracted by two reviewers working independently. Acceptability and safety were assessed as the primary result. The summary of the information is presented in narrative form. Results: Overall, 737 titles were found for initial review and, in the end, 38 studies were included in this work. The acceptability of the menstrual cup ranges between 35 % and 90 %. Between 10 to 45 % of women found it difficult to use. It was described as more comfortable when compared to tampons and pads. Continued use of the cup ranges between 48 and 94 %. In terms of safety, there was one case of toxic shock syndrome, one case of mechanical entrapment, and another case of allergy; and a higher risk of expulsion was found among intrauterine device users. Conclusion: The menstrual cup appears to be a comfortable, safe and efficient option for menstrual hygiene. Further randomized controlled studies and long-term prospective cohort studies are needed in order to determine the risk of complications due to excess bacterial colonization or retrograde menstruation.

Feasibility of endometrial sampling by vaginal tampons in women with Lynch syndrome.

BACKGROUND: Endometrial sampling for the surveillance of women with Lynch syndrome is an invasive and painful procedure. The aim of this study was to evaluate the feasibility of a less invasive procedure of collecting vital cells by vaginal tampons. METHODS: This was a prospective feasibility study of women scheduled to undergo annual gynecological surveillance, including endometrial sampling. We included consecutive asymptomatic women with Lynch syndrome or first-degree relatives and asked them to insert a vaginal tampon 2-4 h before attending their outpatient appointment. Feasibility was evaluated by the following metrics: patient acceptance, pain intensity of each procedure (assessed by visual analog scale; range 0-10), and the presence of vital cells obtained by tampon-based or endometrial sampling methods. Two pathologists independently evaluated all samples. RESULTS: In total, 25 of 32 approached women completed the tampon-based procedure, with 23 of these subsequently undergoing invasive endometrial sampling. The median visual analog scale scores for tampon use and invasive endometrial sampling were 0 (range, 0-10) and 5.5 (range, 1-10) (p < 0.001). None of the tampon samples analyzed by cytology showed endometrial cells, but they did contain vital squamous cells and granulocytes. By contrast, 18 (78%) of the invasive endometrial samples contained enough endometrial tissue for analysis. No endometrial abnormalities were found by endometrial sampling. CONCLUSIONS: Tampon-based endometrial surveillance was a well-accepted and non-painful procedure, and although tampons contained vital cells, they did not provide endometrial cells. However, this study was limited to asymptomatic women with Lynch syndrome (no endometrial pathology), indicating that research is needed to evaluate whether the tampon method has any utility for endometrial surveillance in women with Lynch syndrome.

La copa menstrual, una alternativa de higiene femenina: revisión de la literatura / The menstrual cup, a female hygiene alternative: literature review

INTRODUCCIÓN: La copa menstrual (CM) es un dispositivo diseñado para apoyar a la mujer durante el manejo de su higiene menstrual. OBJETIVO: Caracterizar la literatura existente en torno al uso de la CM, como una alternativa de higiene femenina. METODOLOGÍA: Revisión de la literatura de estudios publicados en los metabuscadores Proquest, Google Scholar, Pubmed y a través del rastreo manual de los artículos divulgados en revistas no indexadas a las bases de datos mencionadas. Los términos MESH fueron combinados con operadores booleanos permitiendo la elaboración de ecuaciones de búsqueda. Posterior a la selección de los estudios catalogados como elegibles, los investigadores procedieron a implementar las listas de verificación propuestas por la Critical Appraisal Skills Programme español (CASPe) y la Iniciativa MINCIR. RESULTADOS: Fueron incluidos 21 estudios que superaron el 75% de los criterios evaluados en las listas de verificación. El proceso de sistematización de los datos expresados en los estudios permitió la constitución de tres ejes temáticos sobre los cuales gira la literatura en esta área, que corresponden a: I. La CM en el desarrollo de la higiene femenina, II. Beneficios y desventajas del uso de la CM, III. Factores socioculturales asociados a la higiene menstrual. CONCLUSIONES: La CM es un dispositivo que puede aportar grandes beneficios a la higiene menstrual como un elemento moderno, discreto, económico y amigable con el medio ambiente.

INTRODUCTION: The menstrual cup is a device designed to support the woman during the management of her menstrual hygiene. OBJECTIVE: To characterize the existing literature about the menstrual cup use, as an alternative of feminine hygiene. METHODOLOGY: Literature review of studies published in the search engines Proquest, Google Scholar, Pubmed and by means of manual tracking of the articles spread in not indexed journals to the databases mentioned above. The MESH terms were mixed with booleanos operators allowing the elaboration of searching equations. Subsequent to the section of studies denominated as eligible, the researchers proceeded to implement the check list proposed by the Critical Appraisal Skills Programme español (CASPe) and MINCIR list. RESULTS: It was included 21 studies that overcame the 75% of the criteria evaluated in the check lists. The systematic data process in the studies allowed the conformation of three thematic axes, which revolve around the literature in this area, that correspond to: I. The CM in the development of feminine hygiene, II. Benefits and disadvantages of the use of CM, III. Sociocultural factors associated with menstrual hygiene. CONCLUSIONS: CM is a device that can bring great benefits to menstrual hygiene as a modern, discreet, economical and environmentally friendly element.

Combining copy number, methylation markers, and mutations as a panel for endometrial cancer detection via intravaginal tampon collection.

OBJECTIVE: We aimed to assess whether endometrial cancer (EC) can be detected in shed DNA collected with vaginal tampon by analyzing copy number, methylation markers, and mutations. METHODS: Tampons were collected prior to hysterectomy from 38 EC patients and 28 women with benign indications. Extracted tampon DNA underwent the following: 1) low-coverage whole genome sequencing (LC-WGS) to assess copy number, 2) pyrosequencing to measure percent promotor methylation of HOXA9, RASSF1, and CDH13 and 3) next generation sequencing (NGS) to identify mutations in 19 genes associated with EC identified through The Cancer Genome Atlas. Sensitivity and specificity for each test and test combinations were calculated. RESULTS: Methylation analysis yielded the highest specificities but lowest sensitivities (37-40% sensitivity; 100% specificity for HOXA9, RASSF1 and HTR1B) while mutation analysis had improved sensitivity (50% sensitivity; 83% specificity). Only one "false positive" result for copy number variants was identified among women with benign surgical indications, which was based on detection of copy number changes, and associated with a leiomyosarcoma that was only recognized at hysterectomy. Considering any of the 3 biomarker classes as a positive, resulted in a sensitivity of 92% and specificity of 86%. Mutation analysis did not add sensitivity to the combination of analysis of copy number and methylation. CONCLUSIONS: This study demonstrates a proof-of-principle for non-invasive yet precise detection of endometrial cancer. We propose that with improved biomarker testing, it may be possible to develop a clinically useful test for detecting EC.

Cervical Human Papillomavirus Testing With Two Home Self-Collection Methods Compared With a Standard Clinically Collected Sampling Method.

BACKGROUND: The purpose of this study was to compare the outcomes of 2 self-collection methods to detect cervical human papillomavirus (HPV) DNA with outcomes from a standard clinical method. The standard method samples were collected by a clinician at a routine pelvic examination. Self-samples were taken at home and mailed to the clinical laboratory. METHODS: The 2 self-collection methods were a tampon-based method and a swab-based method using a commercial device, an Eve Medical HerSwab. All HPV samples were processed by a clinical laboratory using the Food and Drugs Administration approved Roche Cobase HPV method, which specifically identifies HPV 16, HPV 18, and a set of 12 other high-risk subtypes. Patients were recruited from 2 cancer screening clinics 2015 to 2017. All patients signed an informed consent. Screening outcomes, such as prevalence, percent agreement with standard, sensitivity, and specificity, were calculated for each self-collection method. Measures of similarity between self and standard collection outcomes, Cohen's κ, percent concordance, McNemar equivalence, and others were tested statistically. RESULTS: One hundred seventy-four patients were randomized. The prevalence of 1 or more positive HPV high-risk subtypes from the standard clinical specimens was 13.5%. All clinical specimens were sufficient for valid HPV detection. For the tampon method, 15 (27%) of the specimens were insufficient quality. Only 1 (2%) swab specimen was insufficient. Only the swab self-collection method was found to be statistically noninferior to the clinical method. The tampon method had an unacceptably high rate of insufficient quality specimens and also failed the equivalency tests. CONCLUSIONS: The swab home collection samples were equivalent to the clinical samples, but the tampon method had an unacceptably high rate of specimens insufficient for HPV detection.

Maximizing semen extraction from sanitary pads by chemical and shredding treatments.

Evidence of sexual aggression may be obtained from superabsorbent polymer (SAP) sanitary pads, which are used by forensic laboratories for semen evaluation. Semen can be extracted from their upper layers, which are free of SAPs. However, our previous results showed a need to optimize the protocol for semen analysis by considering its extraction from the lower core, often composed of sodium polyacrylate SAPs. SAPs generate a hydrogel, which traps the cellular components, hindering the possibility of obtaining cells and hence their genetic material. Simple filtration has been tried previously, but further maximization by application of a treatment has never been attempted. In this paper, we compare both chemical and physical shredding treatments for maximizing gel-trapped sperm and male cell DNA recaptures from hygienic superabsorbent substrates in sanitary pads, panty-liners or diapers. Our findings suggest that the lower core should be treated to induce a dewaterisation of the SAP hydrogels in order to maximize the extraction of bodily fluids.

Menstrual Blood-Derived Mesenchymal Stem Cells: Women's Attitudes, Willingness, and Barriers to Donation of Menstrual Blood.

Background: Menstrual blood contains mesenchymal stem cells (MenSC), considered a potential "off-the-shelf" treatment for a range of diseases and medical conditions. Samples of menstrual blood can be collected painlessly, inexpensively, and as frequently as every month for cell therapy. While there has been considerable previous research into the clinical advantages of MenSC, there is currently little understanding of potential donors' attitudes regarding menstrual blood donation and MenSC. Methods: One hundred women 18 years of age or over were surveyed to understand attitudes and potential barriers to menstrual blood donation. The questionnaire assessed participant age and brief medical history (giving birth, donating blood, donating stem cells), menstrual experience (period rating, preferred menstrual hygiene products), and whether participants would donate MenSC or accept MenSC therapy. Results: MenSC was met with a generally positive response, with 78% of menstruating women willing to donate menstrual blood. No significant relationship was recognized between willingness to donate menstrual blood with age, history of childbirth or blood donation, menstruation perception, and preferred menstrual hygiene product. Women rated their period experience better after being made aware of the ability to donate menstrual blood, meaning MenSC therapy can be beneficial for donors as well as patients. Conclusions: Considering women's attitudes to MenSC and donation of menstrual blood, the future of MenSC therapy is positive; women are generally willing to donate menstrual blood, independent of age, perception of periods, and history of childbirth and blood donation.

Feasibility and acceptability of the menstrual cup for non-surgical management of vesicovaginal fistula among women at a health facility in Ghana.

OBJECTIVE: To assess the feasibility of the menstrual cup for short-term management of urinary leakage among women with vesicovaginal fistula (VVF). METHODS: A repeated measures design compared volume of leakage with and without the cup via a 2-hr pad test among women with VVF seeking surgical repair at a health facility in Ghana. Subsequently a gynecological exam was administered to assess safety outcomes, followed by a questionnaire to assess acceptability and perceived efficacy. A paired t-test was used to analyze reduction of leakage in ml, and percent reduction was reported. Study limitations include observer bias while evaluating adverse outcomes and the possibility of social desirability bias during questionnaire administration that might overestimate the effect of the cup and women's acceptability. RESULTS: Of the 32 patients screened, 11 were eligible (100% consent rate). At baseline, mean (±SD) leakage in ml was 63.2 (±49.2) (95% CI: 30.2-96.3) over two hours, while the mean leakage over two hours of use of the cup was 16.8 (±16.5) (95% CI: 5.7-27.9). The mean difference of 46.4 (±52.1) ml with use of the cup (95% CI: 11.4-81.4) was statistically significant (p = 0.02). With the cup, women experienced an average 61.0% (±37.4) (95% CI: 35.9-86.2) leakage reduction, a difference 10/11 users (91.0%) perceived in reduced leakage. One participant, reporting four previous surgical attempts, experienced a 78.7% leakage reduction. Acceptability was high-women could easily insert (8/11), remove (8/11), and comfortably wear (11/11) the cup and most (10/11) would recommend it. No adverse effects attributable to the intervention were observed on exam, although some women perceived difficulties with insertion and removal. Data collection tools were appropriate with slight modification advised. CONCLUSION: A larger trial is warranted for a more robust evaluation of the menstrual cup for management of urinary leakage due to VVF among women who have not yet accessed surgery or for whom surgery was not successful.