[Description of a vaginoplasty technique using a peritoneal flap harvested by coelioscopic approach for male-to-female gender affirmations (MtF)]. / Description d'une technique de vaginoplastie utilisant un lambeau péritonéal prélevé par voie cœlioscopie pour les affirmations de genre homme-à-femme (HtF).

AIM: The aim of this article is to provide a comprehensive description of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery, particularly in cases of insufficient depth after penile inversion vaginoplasty. RESULTS: Our short-term results reveal that the peritoneal flap vaginoplasty, adapted from the Davydov procedure, has shown significant potential for improving functional and aesthetic outcomes, including the creation of a self-lubricating neovagina. However, the complexity of the procedure requires advanced surgical expertise and appropriate postoperative care. Patient selection also plays an essential role as not all patients are ideal candidates for this procedure. CONCLUSION: Despite its promises, the widespread adoption of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery is hindered by several challenges, including the need for specialized training and potential postoperative complications. Thus, this technique should be considered as an alternative or complement to traditional methods, depending on individual patient factors. Further research and extensive clinical trials are needed to better understand its potential and limitations in order to enhance the arsenal of effective surgical options for MtF gender affirmation surgery.

Fourteen steps to relevance: taking probiotics from the bench to the consumer.

Much is made of the need to translate scientific research into improved care of people or other life forms. Grant applications invariably start with the extent of a problem and end by claiming that their work will or could result in making an impact. In truth, very few projects ever lead to translation at the level of the host, nor was that really their intent. For those who are focused on applied science, there are many ways to reach the desired goal, sometimes through serendipity or by logical stepwise progress. The following paper will provide personal insight into the stages, pitfalls, and ultimate assessment of relevance in the context of using probiotic lactobacilli for human health and other applications.

Place of radiotherapy for treatment of metastatic cervical, vaginal and endometrial uterine cancer.

Beyond classical palliative-intent irradiation schemes, there are increasing data suggesting a benefit for intensive locoregional treatments in metastatic gynecological cancers. Such approach aims at avoiding local symptoms related to tumor progression, but may also improve survival outcome by shrinking tumor burden to a microscopic state. This strategy is rarely considered upfront (in highly selected patients with very limited oligometastatic disease), but rather after systemic treatment. In case of tumor response (especially if complete response) of the metastatic sites, pelvic±para-aortic radiotherapy can be considered in combination with a brachytherapy boost to obtain long-term local control, in particular in cervical or vaginal cancer patients. Such approach seems particularly relevant when there is isolated persistence or progression of macroscopic disease within the pelvis. In parallel, there is also an increasing place for radiotherapy of oligo-metastatic sites. We review the literature on the place of radiotherapy in the management of cancers of the cervix and metastatic endometrial cancer.

Alexei Vagin (1944-2023).

Alexei Vagin is remembered.

Use of an intravaginal spacer in young girls treated with brachytherapy for bladder neck rhabdomyosarcoma: Dosimetric impact for organs at risk sparing and acute tolerance.

PURPOSE: Interstitial brachytherapy is indicated as part of a conservative strategy for children with bladder and/or prostate rhabdomyosarcoma (RMS), providing high local control probability with acceptable functional results. Vaginal and/or rectal complications were however reported, due to the close proximity to the implanted volume. We investigated the dosimetric impact of a vaginal spacer in terms of rectal and vaginal doses. METHODS AND PATIENTS: Medical records of 12 consecutive female patients with bladder neck RMS, median age 32 months (range: 1.3-6 years), were reviewed. Five patients were treated prior to 2017 without a vaginal spacer and seven patients treated after 2017 had their brachytherapy delivered with a vaginal spacer placed at time of implant. RESULTS: Minimal doses delivered to the most exposed 2cm3, 1cm3, and 0.5cm3 of the rectum were all statistically significantly lower among patients treated with a vaginal spacer, as compared to those treated without a spacer. Median rectal D2cm3 was 22GyEQD2 versus 38GyEQD2 (P=0.02), D1cm3 was 29GyEQD2 versus 51GyEQD2 (P=0.013), and D0.5cm3 was 32GyEQD2 versus 61GyEQD2 (P=0.017), with and without the vaginal spacer, respectively. The posterior vaginal wall D0.5cm3 dose was also significantly decreased, with median D0.5cm3 of 92GyEQD2 versus 54GyEQD2 (P<0.0001), with and without the spacer, respectively. Acute tolerance was excellent in all patients, with no need for replanning and no acute complication. CONCLUSIONS: The use of vaginal spacers in brachytherapy of female pediatric patients with bladder neck RMS resulted in significantly decreased doses to the rectum and the posterior vaginal wall. Though the clinical impact of such dose reduction remains undemonstrated, routine utilization of a vaginal spacer could be a method to decrease long-term morbidity in these patients.

Role of radiotherapy in the treatment of primary vaginal cancer: Recommendations of the French society for radiation oncology.

Primary vaginal cancers are rare tumours, for which external beam radiotherapy and brachytherapy are major treatment tools. Given the complexity of brachytherapy techniques, the treatment should be performed in specialised centres. We present the recommendations of the French society for radiation oncology on the indications and techniques for external beam radiotherapy and brachytherapy for primary vaginal cancer.

[Recurrent Urogynecological Infections]. / Rezidivierende urogynäkologische Infektionen.

Recurrent Urogynecological Infections Abstract. Changes in the urogenital microbiome of the bladder, urethra, vagina and cervix can cause recurrent infections. We distinguish between obligate and facultative pathogens. In the case of facultative pathogens, treatment with antibiotic, antiviral or antifungal drugs should only be considered in cases with attributable symptoms. Sexually transmitted diseases (STD) manifest either urogenitally alone or in association with an ascending infection of the adnexa as a pelvic inflammatory disease. STD may be asymptomatic, as in cases of chlamydia, or may cause a high burden of symptoms, impairment of quality of life or infertility. The aim of this minireview is to give an overview of the pathogenicity of the different germs and their treatment.

[Recurrence of a glassy cell carcinoma of the vagina: An exceptional situation]. / Récidive d'un glassy cell carcinoma du vagin : une situation exceptionnelle.

Glassy cell carcinoma is a rare neoplasm that occurs most frequently in the uterine cervix. We describe the second reported case of glassy cell carcinoma arising in the vagina. We present a case of a 24-year-old woman with a history of post-coïtal bleeding associated with menometrorrhagia. Different explorations have concluded in a glassy cell carcinoma arising in the vagina, with clinical staging III according to the International Federation of Obstetrics and Gynecology. The patient received three cycles of neoadjuvant chemotherapy with a good response. Then she had a para-aortic lymphadenectomy and ovarian transposition. Following the surgery, she had radiotherapy. The gynecological examination showed no budding lesion and the biopsy was negative. Six months later, the patient complained of a pelvic pain. The examination revealed a locoregional recurrence. Surgical revision was not possible and the patient was a candidate for a palliative chemotherapy. Although, glassy cell carcinoma runs an aggressive clinical course, an early diagnosis may help in a more effective management and offer a better prognosis.

[Acquired caustic vagina stenosis: Surgical outcomes of 21 cases]. / Rétrécissements du vagin d'origine caustique. À propos de 21 plasties.

OBJECTIVE: To document epidemiology, causes, anatomical varieties and surgical management outcomes of caustic acquired vagina stenosis. METHODOLOGY: Retrospective study of 21 patients involved from 1996 to 2012 at the department of obstetrics and gynecology of Yopougon's teaching hospital in Abidjan, Côte d'Ivoire. Vaginal stenosis due to genital malformation, vaginal irradiation of pelvic tumours, repair of bladder and vaginal fistulae or intersexual disorders were excluded. RESULTS: The prevalence was 0.14/1000 admissions, mean age was 32.1 years, mean gravidity was 1.76 and mean parity was 1.1. Vaginal stenosis seat and extent were variable and 100 % had a caustic origin by use of traditional medicine vaginal pessaire. Of the patients, 95.2 % underwent surgical treatment followed by several dilations sessions with glass dilators. Successful surgical outcome allowing coitus was achieved in 47.6 % of cases with 52.4 % failure. CONCLUSION: Acquired caustic vagina stenosis are frequently occurring and are a public health problem related to ignorance. Health education and establishment of expert centers with exchange of experiences in West Africa should be able to improve surgical outcomes.

Isolation and comparative investigation of vaginal mycoflora in feline population of urban and dairy cattle herds.

OBJECTIVE: The aim of this work was to identify the predominant fungal species present at vaginal site in different healthy cats including households, stray and cats in industrial dairy cattle herds. MATERIALS AND METHODS: Fungal isolates of vaginal fluids of 100 cats were collected using the sterilized cotton swabs from discharges of vagina. The isolates were identified according to their morphological characteristics and biochemical profile. Were included 34%, 33% and 33% households, stray cats and cats of industrial dairy cattle herds of Mashhad-Iran, respectively. They were short hair cats. RESULT: Vaginal fungi were isolated from 69% of feline population. Fungal isolates were obtained from vagina of 22%, 25% and 22% of households, stray cats and cats of industrial dairy cattle herds, respectively. There were no significant differences among the cats. The highest fungal agent was recovered in cats of 1-2 years old. Twenty two different isolates were recovered in this study. The most frequently recovered species samples were Penicillum spp. (11%) followed by Aspergillus section Nidulanti (4%). However, the vagina of healthy cats could be contaminated by 2-4 different fungal agents. CONCLUSION: It is concluded that fungal infections can occur in vaginal cavity of different healthy kinds of cats.

Vaginal metastasis of pancreatic cancer.

Vaginal metastasis from pancreatic cancer is an extreme case and often indicates a poor prognosis. We present a case of pancreatic carcinoma with metastasis to the vagina that was discovered by vaginal bleeding. To our knowledge, this is the third case in the world of a primary pancreatic adenocarcinoma discovered of symptoms from a vaginal metastasis.

Feminino pela experiência do enigma da vagina / The Feminine by the experience of the enigma of the vagina / Femenino por la experiencia del enigma de la vagina / Le féminin par l'expérience de l'énigme du vagin

RESUMO O autor aborda o feminino como substantivo neutro, correspondendo ao estádio da vida mental do recém-nascido. Conceitua os termos feminino, feminina, feminilidade, mulher e mãe com especificidades diferenciadas, elaborando conceito próprio em torno do que denominou enigma da vagina. Segundo a observação, a aquisição cognitiva proporcionada pelo meio empático-cuidador moldaria a mente da menina em uma fonte imaginativa de crenças oriundas do enigma da vagina em teorias próprias. Também repensa o complexo de castração da menina.

ABSTRACT The author approaches the feminine as a neutral noun, corresponding to the stage of the newborn's mental life. He conceptualizes the terms feminine, femininity, woman and mother with different specificities. He elaborates his own concept around what he called the enigma of the vagina. Cognitive acquisition provided by the empathic-caregiver, would mold the girl's mind into an imaginative source of beliefs arising from the enigma of the vagina in her own theories. The girl's castration complex is rethought.

RESUMEN El autor desarrolla el femenino como un sustantivo neutral, correspondiente a la etapa de la vida mental del recién nacido. Conceptualiza los términos femenino, femenina, feminidad, mujer y madre con diferentes especificidades. Elabora su propio concepto en torno a lo que llamó el enigma de la vagina. La adquisición cognitiva proporcionada por el cuidador empático moldearía la mente de la niña en una fuente imaginativa de creencias que surgen del enigma de la vagina en sus propias teorías. El complejo de castración de la niña repensado.

RÉSUMÉ L'auteur aborde le féminin comme un nom neutre, correspondant au stade de la vie mentale du nouveau-né. Il conceptualise les mots : féminin, féminité, femme et mère, à partir de spécificités différentes, en élaborant son propre concept autour de ce qu'il a appelé l'énigme du vagin. L'acquisition cognitive, fournie par l'empathie du soignant, ferait de l'esprit de la jeune fille une source imaginative de croyances issue de l'énigme du vagin dans ses propres théories. Le complexe de castration de la jeune fille est aussi repensé.