Effect of vaginal estrogen on pessary use.

INTRODUCTION AND HYPOTHESIS: Many providers recommend concurrent estrogen therapy with pessary use to limit complications; however, limited data exist to support this practice. We hypothesized that vaginal estrogen supplementation decreases incidence of pessary-related complications and discontinuation. METHODS: We performed a retrospective cohort study of women who underwent a pessary fitting from 1 January 2007 through 1 September 2013 at one institution; participants were identified by billing code and were eligible if they were postmenopausal and had at least 3 months of pessary use and 6 months of follow-up. All tests were two sided, and P values < 0.05 were considered statistically significant. RESULTS: Data from 199 women were included; 134 used vaginal estrogen and 65 did not. Women who used vaginal estrogen had a longer median follow-up time (29.5 months) compared with women who did not (15.4 months) and were more likely to have at least one pessary check (98.5 % vs 86.2 %, P < 0.001). Those in the estrogen group were less likely to discontinue using their pessary (30.6 % vs 58.5 %, P < 0.001) and less likely to develop increased vaginal discharge than women who did not [hazard ratio (HR) 0.31, 95 % confidence interval (CI) 0.17-0.58]. Vaginal estrogen was not protective against erosions (HR 0.93, 95 % CI 0.54-1.6) or vaginal bleeding (HR 0.78, 95 % CI 0.36-1.7). CONCLUSIONS: Women who used vaginal estrogen exhibited a higher incidence of continued pessary use and lower incidence of increased vaginal discharge than women who did not.

Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications?

OBJECTIVE: Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. STUDY DESIGN: We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). RESULTS: Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. CONCLUSION: Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse.

Effect of oral supplementation of the probiotic capsule UB-01BV in the treatment of patients with bacterial vaginosis.

Bacterial vaginosis (BV) is a common condition affecting millions of women annually and is characterised by a reduction in native lactobacilli. Antimicrobial therapy used to cure the disease is often found to be ineffective. We postulate that the potential probiotic capsule UB-01BV might be efficient in the treatment of BV. In the present study, 30 Indian women diagnosed with BV presenting symptoms such as white discharge, pH greater than 4.7, increased discharge, odour, colour of discharge and pruritus were included. All subjects were assigned to receive two potential probiotic capsules UB-01BV a day for 7 days. At the end of the treatment all subjects showed significant (P<0.001) positive response as revealed by a reduction in vaginosis symptoms. Therefore, the results of the present study provide the first preliminary evidence that the potential probiotic capsule UB-01BV can exert a significant reduction in vaginal infection.

Intervención educativa sobre síndrome de flujo vaginal en un grupo de mujeres en edad fértil / Educative labor about vaginal discharge syndrome in a group of fertile women

Se realizó un estudio preexperimental en el marco cuali-cuantitativo, a través de una intervención educativa con diseño antes-después, para incrementar el conocimiento sobre flujo vaginal de 50 mujeres en edad fértil del Consultorio Médico 29-1 del Policlínico Universitario Sur de Placetas, en el período de septiembre a diciembre de 2009. Se realizó un muestreo no probabilístico intencional. Después de la intervención educativa, 45 mujeres (90 por ciento) contestaron correctamente que el lavado vaginal debe ser de delante hacia atrás. Se evidenció en el estudio el desconocimiento sobre el efecto de las duchas vaginales como causantes de esta afección, así como la diferencia que existe entre secreción vaginal normal y síndrome de flujo vaginal; se comprobó el conocimiento de algunos síntomas: sensación de quemazón (86 por ciento), ardor al orinar (80 por ciento) y prurito (60 por ciento). La intervención educativa fue eficaz para aumentar el conocimiento sobre esta enfermedad(AU)

[Genital discharge in women]. / Bakterien, Chlamydien, Trichomonaden, Malignom ... Ausfluss: An welche Ursachen denken Sie?

The most frequent cause of genital discharge in women is an infection or colonization with different microorganisms, including sexually transmitted pathogens. Mechanical or chemical irritations are additional causes. Malignant diseases can also cause increased discharge. For this reason, especially postmenopausal and brown, bloody discharges should be differentiated and if necessary, histologically confirmed. Due to the variety of causes, a symptomatic treatment should not be prescribed without prior diagnosis.

The use of vaginal antimicrobial after large loop excision of transformation zone: a prospective randomised trial.

OBJECTIVE: To investigate whether the use of an antibacterial vaginal pessary containing tetracycline and amphotericin B would reduce complications from large loop excision of the transformation zone (LLETZ). DESIGN: Prospective randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, University of Hong Kong. POPULATION: A total of 321 women who underwent LLETZ. METHODS: Women were randomised to either receiving an antimicrobial vaginal pessary twice a day for 14 days after LLETZ or no medication. Before LLETZ, endocervical and high vaginal swabs were taken for the detection of Chlamydia and other pathogens. All women were given a diary to record the degree of symptoms, such as vaginal discharge, bleeding and pain for 3 weeks. These were then compared between the two groups. MAIN OUTCOME MEASURES: Bleeding, vaginal discharge and pain after LLETZ. RESULTS: There was no significant difference in the total bleeding, vaginal discharge and pain scores between the two groups. However, for women who had positive endocervical or high vaginal swabs, the treatment group had significantly less bleeding in the second week (Z=-2.083, P= 0.037) and less overall vaginal discharge (Z=-2.024, P= 0.043). CONCLUSIONS: An antimicrobial vaginal pessary containing tetracycline and amphotericin B did not provide any significant benefit after LLETZ, except for a subgroup of women with positive vaginal or endocervical swabs. Given that this group of women cannot be identified before the procedure since swabs are not routinely taken, the use of routine prophylactic topical antibiotics cannot be recommended for the general population.

Distinguishing the temporal association between women's intravaginal practices and risk of human immunodeficiency virus infection: a prospective study of South African women.

Cross-sectional studies have suggested that intravaginal practices, such as douching or "dry sex," may increase women's susceptibility to infection with human immunodeficiency virus (HIV). The authors examined the temporal nature of this association in a cohort of South African women. At enrollment (2001-2002), 4,089 women were tested for HIV infection. Participants reported their intravaginal practices at a 6-month follow-up visit and were followed with repeat HIV testing for up to 24 months. Among the 3,570 women who were HIV-negative at enrollment, 26% reported some type of intravaginal practice, mostly washing inside the vagina with water and/or cloth as part of daily hygiene. During follow-up, 85 incident HIV infections were observed. Intravaginal practices were associated with prevalent HIV at enrollment (adjusted odds ratio = 1.50, 95% confidence interval: 1.22, 1.85), but during follow-up there was no association between intravaginal practices and incident HIV (adjusted hazard ratio = 1.04, 95% confidence interval: 0.65, 1.68). These findings may be explained by a reversal of the causal sequence assumed for this association, since intravaginal practices may be undertaken in response to vaginal infections that occur more commonly among HIV-infected women. Intravaginal practices appear unlikely to be a cofactor in the male-to-female transmission of HIV in this setting.

1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention.

These guidelines for the treatment of patients who have sexually transmitted diseases (STDs) were developed by CDC staff members after consultation with a group of invited experts who met in Atlanta on February 10-12, 1997. The information in this report updates the "1993 Sexually Transmitted Diseases Treatment Guidelines" (MMWR 1993;42[no. RR-14]). Included are new recommendations for treatment of primary and recurrent genital herpes and management of pelvic inflammatory disease; a new patient-applied medication for treatment of genital warts; and a revised approach to the management of victims of sexual assault. Revised sections describe the evaluation of urethritis and the diagnostic evaluation of congenital syphilis. These guidelines also include expanded sections concerning STDs among infants, children, and pregnant women and the management of patients who have asymptomatic human immunodeficiency virus infection, genital warts, and genital herpes. Guidelines are provided for vaccine-preventable STDs, including recommendations for the use of hepatitis A and hepatitis B vaccines.