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1.
Medicine (Baltimore) ; 101(17): e29225, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35512082

RESUMO

RATIONALE: Transvaginal evisceration of the small bowel is an extremely rare condition after hysterectomy, which requires urgent surgical intervention to prevent serious bowel morbidity and mortality. PATIENT CONCERNS: A 65-year-old woman presented with sudden-onset severe abdominal pain and a mass protruding through the vagina. The past surgical history was significant, with an abdominal hysterectomy for cervical cancer performed 11 weeks prior to presentation. DIAGNOSIS: Pelvic examination revealed prolapsed small-bowel loops (18-20 cm in length). Pelvic computed tomography scan confirmed the presence of transvaginal evisceration of the small bowel. INTERVENTIONS: Bowel reduction and urgent laparotomy were the selected treatment approaches for a detailed inspection and thorough washing of the intrα-abdominal cavity. A Foley catheter was inserted in the emergency room, with the subject in the lithotomy position. The prolapsed bowel loops spontaneously reduced without manual reduction, and the vault defect was repaired transvaginally. OUTCOMES: The patient experienced no postoperative complications and remained disease-free for 9months postoperatively. LESSONS: Transvaginal evisceration of the small bowel should be considered a surgical emergency. A multidisciplinary approach to prompt case management involving clinicians in gynecology, general surgery, and emergency medicine is vital for preventing serious consequences. Hysterectomy is the most frequently performed gynecological surgical procedure, and evisceration occurs most often after hysterectomy. Therefore, patients should be informed about this rare but possible hysterectomy complication.


Assuntos
Neoplasias do Colo do Útero , Dor Abdominal/cirurgia , Idoso , Feminino , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Intestino Delgado/cirurgia , Laparotomia/métodos , Prolapso , Neoplasias do Colo do Útero/cirurgia , Vagina/cirurgia
2.
BMC Surg ; 22(1): 157, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35509095

RESUMO

BACKGROUND: Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral. CASE PRESENTATION: We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness. CONCLUSIONS: Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.


Assuntos
Prolapso Uterino , Dor Abdominal/cirurgia , Idoso de 80 Anos ou mais , Feminino , Humanos , Histerectomia , Intestino Delgado/cirurgia , Laparotomia , Prolapso Uterino/complicações , Prolapso Uterino/patologia , Prolapso Uterino/cirurgia , Vagina/cirurgia
3.
BMJ Case Rep ; 15(5)2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534044

RESUMO

Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late 70s, bed bound with progressive multiple sclerosis (MS), who was referred to urology for consideration of suprapubic catheter due to difficulty in managing her indwelling urethral catheter. The ultrasonogram (USG) identified a 4.7 cm bladder stone with right-sided hydronephrosis (HN) and left atrophic kidney. A CT scan later showed that a 5 cm bladder stone has migrated through a VVF into her vagina. She had a cystoscopy and transvaginal retrieval of the stone. Given her performance status and intraoperative finding of a small contracted bladder, it was agreed to manage her VVF conservatively.To the best of our knowledge, this is the first case of a primary bladder stone migrating into the vagina through a VVF.


Assuntos
Cálculos da Bexiga Urinária , Fístula Vesicovaginal , Cistoscopia/efeitos adversos , Feminino , Humanos , Masculino , Bexiga Urinária/cirurgia , Cálculos da Bexiga Urinária/complicações , Cálculos da Bexiga Urinária/diagnóstico por imagem , Vagina , Fístula Vesicovaginal/diagnóstico por imagem , Fístula Vesicovaginal/etiologia
4.
NPJ Biofilms Microbiomes ; 8(1): 34, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501321

RESUMO

Bacterial vaginosis (BV) is a condition in which the vaginal microbiome presents an overgrowth of obligate and facultative anaerobes, which disturbs the vaginal microbiome balance. BV is a common and recurring vaginal infection among women of reproductive age and is associated with adverse health outcomes and a decreased quality of life. The current recommended first-line treatment for BV is antibiotics, despite the high recurrence rate. Live biopharmaceutical products/probiotics and vaginal microbiome transplantation (VMT) have also been tested in clinical trials for BV. In this review, we discuss the advantages and challenges of current BV treatments and interventions. Furthermore, we provide our understanding of why current clinical trials with probiotics have had mixed results, which is mainly due to not administering the correct bacteria to the correct body site. Here, we propose a great opportunity for large clinical trials with probiotic strains isolated from the vaginal tract (e.g., Lactobacillus crispatus) and administered directly into the vagina after pretreatment.


Assuntos
Microbiota , Probióticos , Vaginose Bacteriana , Bactérias , Feminino , Humanos , Masculino , Probióticos/uso terapêutico , Qualidade de Vida , Vagina/microbiologia , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/microbiologia
5.
BMC Microbiol ; 22(1): 121, 2022 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-35513786

RESUMO

OBJECTIVE: To explore the impact of pre-pregnancy vaginal Mycoplasma hominis (M. hominis) colonization of low abundance on female fecundability. METHODS: In total, 89 females participating in a pre-pregnancy health examination program were included, and their pregnancy outcomes were followed up for 1 year. Vaginal swabs were collected, 16S rRNA genes were sequenced, and M. hominis colonization was confirmed by qPCR. Cox models were used to estimate the fecundability odds ratio (FOR) for women with M. hominis. RESULTS: The prevalence of M. hominis was 22.47% (20/89), and the abundance was relatively low (the cycle thresholds of the qPCR were all more than 25). In terms of the vaginal microbiome, the Simpson index of the positive group was significantly lower than that of the negative group (P = 0.003), which means that the microbiome diversity appeared to increase with M. hominis positivity. The relative abundance of M. hominis was negatively correlated with Lactobacillus crispatus (rho = - 0.24, P = 0.024), but positively correlated with Gardnerella vaginalis, Atopobium vaginae and Prevotella bivia (P all < 0.05). The cumulative one-year pregnancy rate for the M. hominis positive group was lower than that in the negative group (58.96% vs 66.76%, log-rank test: P = 0.029). After controlling for potential confounders, the risk of pregnancy in the M. hominis positive group was reduced by 38% when compared with the positive group (FOR = 0.62, 95% CI: 0.42-0.93). CONCLUSION: The vaginal colonization of M. hominis at a low level in pre-pregnant women is negatively correlated with female fecundability.


Assuntos
Mycoplasma hominis , Vaginose Bacteriana , Estudos de Coortes , Feminino , Fertilidade , Gardnerella vaginalis/genética , Humanos , Masculino , Mycoplasma hominis/genética , Gravidez , RNA Ribossômico 16S/genética , Vagina , Vaginose Bacteriana/epidemiologia
6.
J Biomech Eng ; 144(6)2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35425969

RESUMO

Higher reproductive age is associated with an increased risk of gestational diabetes, pre-eclampsia, and severe vaginal tearing during delivery. Further, menopause is associated with vaginal stiffening. However, the mechanical properties of the vagina during reproductive aging before the onset of menopause are unknown. Therefore, the first objective of this study was to quantify the biaxial mechanical properties of the nulliparous murine vagina with reproductive aging. Menopause is further associated with a decrease in elastic fiber content, which may contribute to vaginal stiffening. Hence, our second objective was to determine the effect of elastic fiber disruption on the biaxial vaginal mechanical properties. To accomplish this, vaginal samples from CD-1 mice aged 2-14 months underwent extension-inflation testing protocols (n = 64 total; n = 16/age group). Then, half of the samples were randomly allocated to undergo elastic fiber fragmentation via elastase digestion (n = 32 total; 8/age group) to evaluate the role of elastic fibers. The material stiffness increased with reproductive age in both the circumferential and axial directions within the control and elastase-treated vaginas. The vagina demonstrated anisotropic mechanical behavior, and anisotropy increased with age. In summary, vaginal remodeling with reproductive age included increased direction-dependent material stiffness, which further increased following elastic fiber disruption. Further work is needed to quantify vaginal remodeling during pregnancy and postpartum with reproductive aging to better understand how age-related vaginal remodeling may contribute to an increased risk of vaginal tearing.


Assuntos
Pelve , Vagina , Envelhecimento , Animais , Anisotropia , Feminino , Camundongos , Elastase Pancreática , Gravidez , Estresse Mecânico
7.
Front Immunol ; 13: 841723, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35401577

RESUMO

Background: The female reproductive tract (FRT) mucosa is the first line of defense against sexually transmitted infection (STI). FRT environmental factors, including immune-cell composition and the vaginal microbiota, interact with each other to modulate susceptibility to STIs. Moreover, the menstrual cycle induces important modifications within the FRT mucosa. Cynomolgus macaques are used as a model for the pathogenesis and prophylaxis of STIs. In addition, their menstrual cycle and FRT morphology are similar to women. The cynomolgus macaque vaginal microbiota is highly diverse and similar to dysbiotic vaginal microbiota observed in women. However, the impact of the menstrual cycle on immune markers and the vaginal microbiota in female cynomolgus macaques is unknown. We conducted a longitudinal study covering three menstrual cycles in cynomolgus macaques. The evolution of the composition of the vaginal microbiota and inflammation (cytokine/chemokine profile and neutrophil phenotype) in the FRT and blood was determined throughout the menstrual cycle. Results: Cervicovaginal cytokine/chemokine concentrations were affected by the menstrual cycle, with a peak of production during menstruation. We observed three main cervicovaginal neutrophil subpopulations: CD11bhigh CD101+ CD10+ CD32a+, CD11bhigh CD101+ CD10- CD32a+, and CD11blow CD101low CD10- CD32a-, of which the proportion varied during the menstrual cycle. During menstruation, there was an increase in the CD11bhigh CD101+ CD10+ CD32a+ subset of neutrophils, which expressed higher levels of CD62L. Various bacterial taxa in the vaginal microbiota showed differential abundance depending on the phase of the menstrual cycle. Compilation of the factors that vary according to hormonal phase showed the clustering of samples collected during menstruation, characterized by a high concentration of cytokines and an elevated abundance of the CD11bhigh CD101+ CD10+ CD32a+ CD62L+ neutrophil subpopulation. Conclusions: We show a significant impact of menstruation on the local environment (cytokine production, neutrophil phenotype, and vaginal microbiota composition) in female cynomolgus macaques. Menstruation triggers increased production of cytokines, shift of the vaginal microbiota composition and the recruitment of mature/activated neutrophils from the blood to the FRT. These results support the need to monitor the menstrual cycle and a longitudinal sampling schedule for further studies in female animals and/or women focusing on the mucosal FRT environment.


Assuntos
Ciclo Menstrual , Microbiota , Doenças Sexualmente Transmissíveis , Vagina , Animais , Biomarcadores , Citocinas , Feminino , Humanos , Estudos Longitudinais , Macaca fascicularis , Microbiota/genética , Vagina/microbiologia
8.
J Gynecol Obstet Hum Reprod ; 51(5): 102365, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35405417

RESUMO

Uterine leiomyomas are the most common benign pelvic tumor in females. Pedunculated submucous FIGO type 0 leiomyomas may eventually protrude through the cervical canal and prolapse into the vagina taking the name of "nascent" leiomyomas. Vaginal myomectomy is the main treatment for isolated prolapsed myoma and is successful in more than 95% of cases. We propose a hybrid technique that consists of a transvaginal myomectomy followed by an operative hysteroscopy with cervical torsion to complete the removal of the leiomyoma's pedicle. Our case demonstrates an uneventful removal of a large nascent leiomyoma using a hybrid technique for complete resection of the leiomyoma limiting the risk of recurrence.


Assuntos
Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Prolapso , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Vagina
9.
Urologiia ; (2): 27-33, 2022 May.
Artigo em Russo | MEDLINE | ID: mdl-35485811

RESUMO

AIM: To study the pathogenetic factors in the development of postcoital cystitis and the efficiency of extravaginal transposition of the urethra. MATERIALS AND METHODS: Literature data and our point of view on the causes of postcoital cystitis are described. Case histories of 438 patients aged 18 to 61 (mean 24+/-1.3) were analyzed. The efficiency of extravaginal transposition of the urethra for the prevention of recurrence of postcoital cystitis was evaluated. RESULTS: The long-term results of operations in 315 patients were studied. A positive effect was noted in 297 (94.3%), which means the complete recovery or reduction in the frequency of cystitis to 2 or less times a year, while complete recovery occurred in 214 patients. In 18 (5.7%), the surgical procedure was ineffective, which required repeated interventions. DISCUSSION: According to our observations, the external opening of the urethra is located in patients with postcoital cystitis and in healthy women at the same level - before the introitus. During sexual intercourse, everyone experiences vestibulo-vaginal frictional dislocation of the urethra, however, exacerbations of the inflammatory process in the bladder occur only in some females, which is associated with the multifactorial nature of the disease. CONCLUSION: Postcoital cystitis develops as a result of a complex of factors, the most significant ofwhich are the state of the vaginal microflora, the virulence of uropathogenic bacteria, the anatomical features of the urethra and vagina, its narrowness with a mismatch with the penile size, the intensity and duration of sexual intercourse, severe, complicated childbirth and surgical procedures in this area. Performing extravaginal transposition of the urethra according to Komyakov demonstrated high efficiency in the prevention of recurrence of postcoital cystitis.


Assuntos
Cistite , Procedimentos Cirúrgicos Reconstrutivos , Cistite/etiologia , Cistite/cirurgia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Uretra/cirurgia , Bexiga Urinária/cirurgia , Vagina/patologia
10.
J Med Case Rep ; 16(1): 173, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35477487

RESUMO

INTRODUCTION AND IMPORTANCE: The most common complication of pelvic organ prolapse is stress urinary incontinence, whereas hydronephrosis or stasis ulcers are quite rare and typical of severe stages. The best treatment for this unusual presentation is still controversial. Here we present our approach. CASE PRESENTATION: Here we present the case of a 70-year-old White/Caucasian woman who presented to our hospital with genital procidentia lasting for 10 years that was associated with both hydronephrosis and stasis ulcers. CLINICAL FINDINGS AND INVESTIGATIONS: The Pelvic Organ Prolapse Quantitation system was used to assess the severity of the prolapse, being evaluated as stage IV with the apical compartment leading. A thorough search of the literature was conducted to find any similar cases and evaluate the best evidence treatment. INTERVENTIONS AND OUTCOMES: A no-mesh procedure comprising vaginal hysterectomy, axial apex suspension, and anterior and posterior repair with ulcerated skin removal resulted in complete resolution of both mechanical and functional symptoms. At 3- and 6-month follow-up visits, a satisfying vaginal profile without hydronephrosis was seen. The Pelvic Organ Prolapse Quantitation at 6 months follow-up was as follows: Aa -3, Ba -3, C -7; gh 2, pb 3, tvt 9; Ap -3, Bp -3. RELEVANCE AND IMPACT: Pelvic organ prolapse involves many organs and causes further complications, leading seldom to renal insufficiency and stasis ulcers. A temporary solution to the obstruction can be achieved by utilizing a pessary, but this device cannot be applied when a stasis ulcer has been previously established. The use of mesh for pelvic floor repair is controversial, but a previous vaginal ulcer may represent a contraindication. A complete evaluation and a challenging surgery may allow the recovery of complicated and severe pelvic organ prolapse. Native tissue pelvic repair gives no erosion postsurgical risk, which is the typical complication of the prosthesis.


Assuntos
Hidronefrose , Prolapso de Órgão Pélvico , Prolapso Uterino , Úlcera Varicosa , Idoso , Feminino , Humanos , Hidronefrose/etiologia , Hidronefrose/cirurgia , Masculino , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Prolapso Uterino/complicações , Prolapso Uterino/cirurgia , Vagina/cirurgia
11.
Clin Infect Dis ; 74(Supplement_2): S144-S151, 2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35416968

RESUMO

In preparation for the 2021 Centers for Disease Control and Prevention (CDC) sexually transmitted infections (STIs) treatment guidelines, the CDC convened an advisory group in 2019 to examine recent literature addressing updates in the epidemiology, diagnosis, and management of STIs. This article summarizes recent data in each of these key topic areas as they pertain to bacterial vaginosis (BV), the most common cause of vaginal discharge. The evidence reviewed primarily focused on updates in the global epidemiology of BV, risk factors for BV, data supportive of sexual transmission of BV-associated bacteria, BV molecular diagnostic tests, and novel treatment regimens. Additionally, recent literature on alcohol abstinence in the setting of 5-nitroimidazole use was reviewed.


Assuntos
Doenças Sexualmente Transmissíveis , Vaginose Bacteriana , Centers for Disease Control and Prevention, U.S. , Feminino , Humanos , Técnicas de Diagnóstico Molecular , Fatores de Risco , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/prevenção & controle , Estados Unidos/epidemiologia , Vagina/microbiologia , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/epidemiologia
12.
Front Cell Infect Microbiol ; 12: 759156, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35402312

RESUMO

Background: Little is known about the relationship of proximal urogenital microbiomes in the bladder and the vagina and how this contributes to bladder health. In this study, we use a microbial ecology and network framework to understand the dynamics of interactions/co-occurrences of bacteria in the bladder and vagina in women with and without urgency urinary incontinence (UUI). Methods: We collected vaginal swabs and catheterized urine specimens from 20 women with UUI (cases) and 30 women without UUI (controls). We sequenced the V4 region of the bacterial 16S rRNA gene and evaluated using alpha and beta diversity metrics. We used microbial network analysis to detect interactions in the microbiome and the betweenness centrality measure to identify central bacteria in the microbial network. Bacteria exhibiting maximum betweenness centrality are considered central to the microbe-wide networks and likely maintain the overall microbial network structure. Results: There were no significant differences in the vaginal or bladder microbiomes between cases and controls using alpha and beta diversity. Silhouette metric analysis identified two distinct microbiome clusters in both the bladder and vagina. One cluster was dominated by Lactobacillus genus while the other was more diverse. Network-based analyses demonstrated that vaginal and bladder microbial networks were different between cases and controls. In the vagina, there were similar numbers of genera and subgroup clusters in each network for cases and controls. However, cases tend to have more unique bacterial co-occurrences. While Bacteroides and Lactobacillus were the central bacteria with the highest betweenness centrality in controls, Aerococcus had the highest centrality in cases and correlated with bacteria commonly associated with bacterial vaginosis. In the bladder, cases have less than half as many network clusters compared to controls. Lactobacillus was the central bacteria in both groups but associated with several known uropathogens in cases. The number of shared bacterial genera between the bladder and the vagina differed between cases and controls, with cases having larger overlap (43%) compared to controls (29%). Conclusion: Our study shows overlaps in microbial communities of bladder and vagina, with higher overlap in cases. We also identified differences in the bacteria that are central to the overall community structure.


Assuntos
Microbiota , Incontinência Urinária , Bactérias/genética , Feminino , Humanos , Lactobacillus/genética , Microbiota/genética , RNA Ribossômico 16S/genética , Bexiga Urinária/microbiologia , Incontinência Urinária/microbiologia , Vagina/microbiologia
13.
PLoS One ; 17(4): e0264309, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35363775

RESUMO

BACKGROUND: Group B Streptococcus (GBS) is a major cause of serious neonatal infection but its role in maternal morbidity has received little investigation. The aim of this study was to determine whether GBS colonization at delivery is associated with increased risk of maternal peripartum infection. METHODS: In this prospective cohort study, 1746 unselected women had a vaginal-rectal culture taken at the onset of labor. Diagnosis of maternal peripartum infection was based on a combination of two or more signs or symptoms including fever, breast pain, severe wound or pelvic pain, purulent discharge and abnormal laboratory tests including C-reactive protein and white blood cell count occurring from labor until 2 weeks postpartum. The main outcome measure was the proportion of women with maternal peripartum infection according to GBS colonization status. RESULTS: A total of 25.9% (452/1746) women were colonized with GBS. The rate of peripartum infection was almost twice as high in colonized women (49/452 [10.8%]) vs. non-colonized women (81/1294 [6.3%]); OR 1.82 [1.26-2.64], p = 0.002). This association was confirmed in a multivariable model (OR 1.99 [1.35-2.95], p = 0.001). Women diagnosed with peripartum infection had a significantly longer hospital stay compared to women without peripartum infection (4 days (median) vs. 3 days, p < 0.001). Length of hospital stay did not differ between colonized and non-colonized women. Serotype IV GBS was more frequent in colonized women with peripartum infection than in women without peripartum infection (29.3% vs. 12.5%, p = 0.003). CONCLUSIONS: GBS colonization at delivery is associated with increased risk of peripartum infection. Whether this increase is due directly to invasion by GBS or whether GBS colonization is associated with a more general vulnerability to infection remains to be determined.


Assuntos
Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Feminino , Humanos , Recém-Nascido , Período Periparto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Reto , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae , Vagina
14.
Dis Model Mech ; 15(5)2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35394036

RESUMO

The uterus is responsible for the nourishment and mechanical protection of the developing embryo and fetus and is an essential part in mammalian reproduction. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by agenesis of the uterus and upper part of the vagina in females with normal ovarian function. Although heavily studied, the cause of the disease is still enigmatic. Current research in the field of MRKH mainly focuses on DNA-sequencing efforts and, so far, has been unable to decipher the nature and heterogeneity of the disease, thereby holding back scientific and clinical progress. Here, we developed long-term expandable organoid cultures from endometrium found in uterine rudiment horns of MRKH patients. Phenotypically, they share great similarity with healthy control organoids and are surprisingly fully hormone responsive. Transcriptome analyses, however, identified an array of dysregulated genes that point to potentially disease-causing pathways altered during the development of the female reproductive tract. We consider the endometrial organoid cultures to be a powerful research tool that promise to enable an array of studies into the pathogenic origins of MRKH syndrome and possible treatment opportunities to improve patient quality of life.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual , Anormalidades Congênitas , Transtornos 46, XX do Desenvolvimento Sexual/genética , Anormalidades Congênitas/genética , Endométrio , Feminino , Humanos , Masculino , Ductos Paramesonéfricos/anormalidades , Organoides , Qualidade de Vida , Vagina
15.
J Sex Med ; 19(5): 761-770, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35370104

RESUMO

BACKGROUND: Among treatments for vulvo-vaginal atrophy (VVA), there is a new kind of energy-based device, the non-ablative CO2 laser. AIM: This study aimed to assess the efficacy and safety of the non-ablative CO2 laser in menopausal women with VVA as a monotherapy or in association with vaginal estriol or moisturizer. METHODS: Seventy-five women with VVA received laser treatment (Laser group), laser plus estriol gel (Laser+E) or laser plus moisturizers (Laser+M). The study protocol consisted of 3 monthly laser sessions (t0, t1, t2) and a gynecological examination at baseline and 1 month after last laser treatment (t3). Objective measures included VHI (Vaginal Health Index) and VuHI (Vulvar Health Index); subjective symptoms of VVA (Dryness, Burning, Itching, Dysuria) evaluated via visual analog scales, sexual function evaluated by FSFI (Female Sexual Function Index), FSDS (Female Sexual Distress Score) and MENQOL (Mopause-specific Quality Of Life). Adverse events and discomfort encountered during the procedure were also assessed. OUTCOMES: Primary outcomes were the evaluation of VHI and VuHI and secondary outcomes were changes in VVA symptoms (VAS), sexual function (MENQOL, FSFI, FSDS) and discomfort during the procedure. RESULTS: Seventy-five women (25 in Laser, 25 in Laser+E and 25 in Laser+M group) completed the study. At t3, mean VHI, VuHI, dryness, burning and itching VAS scores improved significantly with no differences between the groups. The lubrication domain of FSFI improved significantly only in the Laser+M group, while the pain domain improved significantly in all women with no differences between the groups. FSFI and FSDS overall scores and MENQOL sexual domain improved in all women with no significant difference between the groups. The mean score of the pain during the procedure was low at t0 and did not change throughout the study. CLINICAL IMPLICATIONS: This study extends knowledge concerning the effectiveness of a new non-ablative CO2 laser in post-menopausal women with VVA. STRENGTHS & LIMITATIONS: This is one of the first studies on this kind of laser and is the first to compare the effectiveness of laser treatment alone or in combination with vaginal estriol or moisturizers. Parameters of VVA and sexual function were evaluated using validated tools. Study limitations include short follow-up time, the limited number of participants and the absence of a sham-controlled group. CONCLUSION: Non-ablative CO2 laser seems to be an effective treatment for VVA in menopausal women. Our preliminary data shows that it can be effective as monotherapy or with adjuvant treatments. Alvisi S, Lami A, Baldassarre M, et al. Short-Term Efficacy and Safety of Non-Ablative Laser Treatment Alone or with Estriol or Moisturizers in Postmenopausal Women with Vulvovaginal Atrophy. J Sex Med 2022;19:761-770.


Assuntos
Pós-Menopausa , Doenças Vaginais , Atrofia/patologia , Dióxido de Carbono/uso terapêutico , Estriol/uso terapêutico , Feminino , Humanos , Dor , Prurido/patologia , Qualidade de Vida , Resultado do Tratamento , Vagina/patologia , Vagina/cirurgia , Doenças Vaginais/tratamento farmacológico , Vulva/patologia
16.
Front Cell Infect Microbiol ; 12: 858155, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35402309

RESUMO

Bacterial vaginosis (BV) is the most common infectious disease of the reproductive tract in women of childbearing age. It often manifests as an imbalance in the vaginal microbiome, including a decrease in Lactobacillus and an increase in anaerobic bacteria. While Gardnerella spp. are considered a major cause of BV, they are also detected in the vaginal microbiome of healthy women. G. vaginalis was the only recognized species of Gardnerella until a recent study characterized three new species, G. leopoldii, G. piotii, and G. swidsinskii. This review describes the different types and genetic diversity of Gardnerella, as well as new findings on the correlation between different Gardnerella spp. and BV.


Assuntos
Microbiota , Vaginose Bacteriana , Feminino , Gardnerella , Gardnerella vaginalis/genética , Humanos , Microbiota/genética , Vagina/microbiologia , Vaginose Bacteriana/microbiologia
17.
J Med Case Rep ; 16(1): 141, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35392959

RESUMO

BACKGROUND: Uterovaginal prolapse is the descent of the uterus and vagina down the birth canal toward the introitus. The occurrence of uterovaginal prolapse in a primigravida is very rare. It can cause preterm labor, fetal demise, spontaneous abortion, postpartum hemorrhage, maternal urinary complications, sepsis, and death. This case report presents the rare occurrence of uterovaginal prolapse in a primigravida woman with no major risk factors identified for prolapse, who presented in active first stage of labor and delivered vaginally. CASE PRESENTATION: A 30-year-old Oromo primigravida woman who did not remember her last normal menstrual period but claimed amenorrhea of 9 months duration presented with the urge to bear down of 12 hours duration and passage of liquor of 8 hours duration. She was referred from the local health center to Jimma Medical Center with a diagnosis of prolonged labor. At presentation, she was in active first stage of labor with cervix 5-6 cm and fetal heartbeat was negative. She was followed for the progress of labor, and 4 hours after admission to the labor ward, she delivered a freshly dead male neonate weighing 3000 g. Her postpartum period was uneventful, and she was discharged on her third postpartum day and referred after 6 weeks to the outpatient department. CONCLUSION: Uterovaginal prolapse occurring in primigravida and during labor at first recognition is very rare, with congenital weakness being a possible underlying pathology. Management of uterovaginal prolapse during labor should be individualized on the basis of fetal condition and the severity of prolapse. For a patient with pelvic organ prolapse in labor, expectant management is a good option when there is no severe edema resulting in obstructed labor, as in our case, where the patient delivered vaginally and the prolapse resolved postpartum.


Assuntos
Trabalho de Parto , Prolapso de Órgão Pélvico , Prolapso Uterino , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Prolapso Uterino/complicações , Útero , Vagina
18.
BMC Womens Health ; 22(1): 113, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35413875

RESUMO

BACKGROUND: Female reproductive tract dysbiosis impacts implantation. However, whether gut dysbiosis influences implantation failure and whether it accompanies reproductive tract dysbiosis remains scantly explored. Herein, we examined the gut-vaginal microbiota axis in infertile women. METHODS: We recruited 11 fertile women as the controls, and a cohort of 20 infertile women, 10 of whom had recurrent implantation failure (RIF), and another 10 had unexplained infertility (UE). Using amplicon sequencing, which employs PCR to create sequences of DNA called amplicon, we compared the diversity, structure, and composition of faecal and vaginal bacteria of the controls with that of the infertile cohort. Of note, we could only sequence 8 vaginal samples in each group (n = 24/31). RESULT: Compared with the controls, α-diversity and ß-diversity of the gut bacteria among the infertile groups differed significantly (p < 0.05). Taxa analysis revealed enrichment of Gram-positive bacteria in the RIF group, whereas Gram-negative bacteria were relatively abundant in the UE group. Strikingly, mucus-producing genera declined in the infertile cohort (p < 0.05). Hungatella, associated with trimethylamine N-oxide (TMAO) production, were enriched in the infertile cohort (p < 0.05). Vaginal microbiota was dominated by the genus Lactobacillus, with Lactobacillus iners AB-1 being the most abundant species across the groups. Compared with the infertile cohort, overgrowth of anaerobic bacteria, associated with vaginal dysbiosis, such as Leptotrichia and Snethia, occurred in the controls. CONCLUSION: The gut microbiota had little influence on the vaginal microbiota. Gut dysbiosis and vaginal eubiosis occurred in the infertile women, whereas the opposite trend occurred in the controls.


Assuntos
Infertilidade Feminina , Microbiota , Disbiose/complicações , Disbiose/microbiologia , Feminino , Humanos , RNA Ribossômico 16S/genética , Vagina/microbiologia
19.
BMC Urol ; 22(1): 67, 2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459159

RESUMO

BACKGROUND: Suburethral sling with tension-free vaginal tape (TVT) has become a popular treatment for stress urinary incontinence (SUI). Erosion of the tape into the vaginal is rare. Very few patients present with vaginal tape erosion and recurrence of SUI. CASE PRESENTATION: A 49-year-old female patient with stress urinary incontinence was treated with a retropubic suburethral TVT sling. 2 months later, recurrent symptoms of SUI developed. 6 months later, the patient complained of repeated vaginal discharge and foreign body sensation. Body physical examination revealed a 1-cm-long tape extrusion at the left anterior vaginal wall beside the midline. Cystourethroscopy revealed no urethral mesh erosion. Surgical removal of the extrusion tape revealed that the left arm of the tape was in the vaginal mucosa layer rather than between the whole thickness of the vaginal mucosa and urethral. The tape around the urethral was dissected and removed. A new retropubic tape was placed simultaneously. At the 8-months follow-up after surgery, the patient was continent without tape vaginal exposure. CONCLUSIONS: Vaginal mesh erosion should be considered in a patient who presents with sustained vaginal discharge after being treated with a suburethral sling. It is important to place the tape between the whole thickness of the vaginal mucosa and the urethral in SUI surgery. A shallow placement of the tape may lead to vaginal tape erosion and recurrence of SUI. These complications can be avoided by following the correct manipulation procedure and referring to the tissue layer anatomy.


Assuntos
Slings Suburetrais , Incontinência Urinária por Estresse , Descarga Vaginal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Slings Suburetrais/efeitos adversos , Uretra , Incontinência Urinária por Estresse/cirurgia , Vagina/cirurgia
20.
Biomed Res Int ; 2022: 3620232, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35463993

RESUMO

Many microorganisms live in the vagina of healthy women. They interact with and compete with the microenvironment in the female vagina to form a dynamic balance of the microenvironment in the female vagina. However, imbalanced vaginal microecology can lead to vaginal resistance to pathogenic microorganisms. Poor capacity can cause women to develop infections of the reproductive tract. This article analyzes the vaginal microecological status of women with high-risk HPV infection for more than 6 months and healthy women and explores the risk factors that cause long-term high-risk HPV infection for timely detection and regulation of possible vaginal microecological imbalance in women with high-risk HPV infection for more than 6 months to prevent further development of cervical lesions in such patients. This article covers women with a sexual life history who attended the gynecology department of a hospital from January 2020 to September 2021. There were 280 patients in the experimental group: positive high-risk HPV; and there were 140 patients in the control group: negative high-risk HPV test. The correlation between vaginal microecology of CIN patients and patient prognosis according to the subject's vaginal microecology test results and prognosis of various levels of cervical lesions was analyzed. The experiment proved that the detection rate of normal vaginal microecology in the experimental group was 12.14% (34/280) compared with the detection rate of 29.29% (41/140) in the control group, and there was a trend of decrease, and the difference was statistically significant (χ 2 = 17.23, P < 0.05). The detection rate of vaginal BV in the experimental group was 10.36% (29/280) compared with the detection rate of 5.0% (7/140) in the control group, and the difference was statistically significant (χ 2 = 5.19, P < 0.05). This indicates that women with high-risk HPV infections for 6 months or longer have a higher incidence of vaginal microecological imbalances than healthy individuals and aggressive vaginal microecological screening. It is necessary to carry out the program. Detect and treat possible abnormal conditions in time to prevent the further onset of the disease.


Assuntos
Infecções por Papillomavirus , Neoplasias do Colo do Útero , Feminino , Humanos , Papillomaviridae , Prognóstico , Fatores de Risco , Microambiente Tumoral , Vagina/patologia , Esfregaço Vaginal
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