RESUMEN
ABSTRACT: This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life.Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at Pâ<â.05.The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12âmonths of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12âmonths. Starting VD therapy ≤3âmonths after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12âmonths of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12âmonths of dilation.Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3âmonths after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12âmonths. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.
Asunto(s)
Braquiterapia/efectos adversos , Supervivientes de Cáncer/psicología , Dilatación , Conducta Sexual/efectos de la radiación , Neoplasias del Cuello Uterino/radioterapia , Enfermedades Vaginales/etiología , Anciano , Constricción Patológica/etiología , Femenino , Humanos , Persona de Mediana Edad , Calidad de Vida , VaginaRESUMEN
Background: Human papillomavirus (HPV)-DNA testing combined with self-sampling could increase cervical cancer screening effectiveness, utilizing a sensitive screening modality and an easy sampling method with minimal pain or discomfort. Self-sampling acceptability, though, is pivotal. Materials and Methods: This study is a nested cross-sectional survey within GRECOSELF, a cross-sectional study on HPV-based screening with self-sampling, aiming at investigating self-sampling acceptability among Greek women residing in rural areas, and the factors affecting it. Women between 25 and 60 years old were recruited by midwives participating in a nationwide midwifery network. Participants, after self-sampling, filled out a questionnaire with three sections, one regarding demographic characteristics, a second with questions pertaining to the participants' cervical cancer screening history, and a third with questions regarding the self-sampling process per se. Results: The sample included 13,111 women. Most participants (67.9%), including those screened or not in the past, would prefer self-sampling if assured that the results are not inferior to standard testing. Discomfort or pain during self-sampling was absent or minimal in 97.1% and 96.5% of the cases, respectively, and 74.4% of the women felt adequately confident that they followed the instructions correctly. Women mostly preferred self-sampling at home compared with health care facilities. Pain and discomfort during the procedure, although rare, were significant factors against acceptance. Most of the women reporting a negative impression had a negative experience with conventional sampling in the past. Conclusion: Self-sampling is highly acceptable. Acceptance can be further improved with proper communication of the process and its noninferiority compared with conventional screening.
Asunto(s)
Papillomaviridae , Infecciones por Papillomavirus/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Autocuidado/métodos , Manejo de Especímenes , Neoplasias del Cuello Uterino/prevención & control , Adulto , Anciano , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Humanos , Tamizaje Masivo , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Frotis VaginalRESUMEN
Self-sampling for human papillomavirus (HPV) testing is an alternative to physician sampling particularly for cervical cancer screening nonattenders. The GRECOSELF study is a nationwide observational cross-sectional study aiming to suggest a way to implement HPV-DNA testing in conjunction with self-sampling for cervical cancer screening in Greece, utilizing a midwifery network. Women residing in remote areas of Greece were approached by midwives, of a nationwide network, and were provided with a self-collection kit (dry swab) for cervicovaginal sampling and asked to answer a questionnaire about their cervical cancer screening history. Each sample was tested for high-risk (hr) HPV with the Cobas HPV test. HrHPV-Positive women were referred to undergo colposcopy and, if needed, treatment according to colposcopy/biopsy results. Between May 2016 and November 2018, 13,111 women were recruited. Of these, 12,787 women gave valid answers in the study questionnaire and had valid HPV-DNA results; hrHPV prevalence was 8.3%; high-grade cervical/vaginal disease or cancer prevalence was 0.6%. HrHPV positivity rate decreased with age from 20.7% for women aged 25-29 years to 5.1% for women aged 50-60 years. Positive predictive value for hrHPV testing and for HPV16/18 genotyping ranged from 5.0% to 11.6% and from 11.8% to 27.0%, respectively, in different age groups. Compliance to colposcopy referral rate ranged from 68.6% (for women 25-29) to 76.3% (for women 40-49). For women residing in remote areas of Greece, the detection of hrHPV DNA with the Cobas HPV test, on self-collected cervicovaginal samples using dry cotton swabs, which are provided by visiting midwives, is a promising method for cervical cancer secondary prevention.
Asunto(s)
Pruebas de ADN del Papillomavirus Humano , Tamizaje Masivo/organización & administración , Partería/organización & administración , Infecciones por Papillomavirus/diagnóstico , Manejo de Especímenes/métodos , Displasia del Cuello del Útero/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Adolescente , Adulto , Anciano , Colposcopía/estadística & datos numéricos , Redes Comunitarias/organización & administración , Redes Comunitarias/normas , Estudios Transversales , ADN Viral/análisis , ADN Viral/genética , Autoevaluación Diagnóstica , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Grecia/epidemiología , Pruebas de ADN del Papillomavirus Humano/métodos , Pruebas de ADN del Papillomavirus Humano/normas , Pruebas de ADN del Papillomavirus Humano/estadística & datos numéricos , Humanos , Ciencia de la Implementación , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Persona de Mediana Edad , Partería/métodos , Enfermeras Obstetrices/organización & administración , Enfermeras Obstetrices/normas , Enfermeras Obstetrices/estadística & datos numéricos , Rol de la Enfermera , Papillomaviridae/genética , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/patología , Población Rural/estadística & datos numéricos , Manejo de Especímenes/normas , Manejo de Especímenes/estadística & datos numéricos , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/etiología , Frotis Vaginal/métodos , Frotis Vaginal/estadística & datos numéricos , Adulto Joven , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/etiologíaRESUMEN
This study investigated whether the GnRH antagonist ganirelix is able to block the positive-feedback effect of E2 in normal women. Ganirelix was unable to block the positive-feedback effect, suggesting that the clinical efficacy of GnRH antagonists in IVF cycles is determined by the hyperstimulation process.
Asunto(s)
Estradiol/farmacología , Retroalimentación Fisiológica/efectos de los fármacos , Hormona Liberadora de Gonadotropina/análogos & derivados , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Administración Cutánea , Adulto , Estradiol/administración & dosificación , Estradiol/sangre , Femenino , Hormona Liberadora de Gonadotropina/administración & dosificación , Hormona Liberadora de Gonadotropina/farmacología , Hormona Liberadora de Gonadotropina/uso terapéutico , Salud , Antagonistas de Hormonas/administración & dosificación , Antagonistas de Hormonas/farmacología , Antagonistas de Hormonas/uso terapéutico , Humanos , Ciclo Menstrual/sangre , Ciclo Menstrual/efectos de los fármacos , Inducción de la Ovulación , Progesterona/sangre , Insuficiencia del TratamientoRESUMEN
BACKGROUND: A term delivery after concurrent appendectomy and salpingectomy at 6 weeks in an appendicitis coexisting with a heterotopic pregnancy after in vitro fertilization (IVF) treatment is reported. METHODS: Case report. RESULTS: The patient presented with severe low abdominal pain at 6 weeks of pregnancy after IVF and had explorative laparotomy for appendicitis, during which she had appendectomy and salpingectomy for an undiagnosed concurrent heterotopic pregnancy. The patient delivered a 3,960 g healthy infant at 38 weeks. CONCLUSION: In patients with severe abdominal pain after IVF, appendicitis and heterotopic pregnancy should be included in the differential diagnosis. A dual pathology is possible and when treated appropriately it can result in survival of the precious intrauterine pregnancy. This is the second and earliest ever reported case of that resulted in live birth. It shows that explorative surgery must be performed timely in acute abdomen in pregnancy.