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PubMedDate not supplied

Diagnosis and management of infectious vaginitis.

Vaginitis is an important gynecologic disorder that accounts for nearly 5 million office visits to physicians each year. Infectious vaginitis is the most common cause for an abnormal vaginal discharge; other possible causes include cervicitis, atrophic vaginitis, physiologic discharge, physicochemical vaginitis, and psychosomatic vaginitis. Although the history and physical examination may suggest the diagnosis, laboratory confirmation is required. The vaginal pool wet mount remains the cornerstone in the office diagnosis of vaginitis, with the "sniff" test, vaginal pH determination, and the "swab" test all playing important adjunctive roles. Metronidazole is the only effective treatment for trichomoniasis in the United States. The vaginal administration of an imidazole antifungal agent is the mainstay of treatment of vaginal candidiasis. Despite a search for alternative drug regimens, a 7-day course of metronidazole therapy remains the treatment of choice for bacterial vaginosis.

Clinical Protocols↗

PubMed1987

Comparison of gynecologic health care problems between lesbians and bisexual women. A survey of 2,345 women.

A survey of reproductive system problems was conducted in a large group of lesbians (n = 1,921) and bisexual women (n = 424) in a nonclinical setting. Demographically the groups were similar: the majority of respondents were white, urban and well educated. A history of heterosexual coitus was common in both groups (bisexuals, 95%; lesbians, 77%). Bisexuals were more likely than lesbians to report an abnormal Papanicolaou smear, cystitis, genital herpes, gonorrhea and vaginal infections. When sexual orientation was controlled for, most, but not all, of these differences were associated with a difference in reported frequency of (prior) coitus. Despite the lower risk of certain problems, however, the lesbians who reported no previous coitus did report the occurrence of vaginitis, abnormal Papanicolaou smears and genital herpes. There were no differences in past oral contraceptive use, endometriosis, menstrual dysfunction or breast disease. The lesbian group reported a greater percentage of hysterectomies. These data suggest that, overall, the sexual behaviors of lesbians are associated with a lower risk of most sexually transmitted diseases.

Adult↗

PubMed1994

Malignant mixed Müllerian tumors of the uterus.

OBJECTIVE: To review the prognostic factors of Chinese women with mixed Müllerian tumors of the uterus. METHOD: A retrospective review of 21 cases of malignant mixed Müllerian tumors of the uterus treated during the 10-year period from 1980 to 1990. RESULTS: All patients except one were postmenopausal. The incidence of previous pelvic irradiation was 9.5%. The most common presenting symptom was abnormal vaginal bleeding. One-third of patients yielded an abnormal cervical smear. Treatment included surgery, chemotherapy and radiotherapy in the majority of patients. Prognosis was poor with only three long-term survivors, all with stage-I homologous tumors with superficial myometrial invasion. The survival rate for stage-I and -II disease at 2 years was 50% and for more advanced disease extending beyond the uterus was 0%. The survival rate for all stages at 5 years was 14.3%, and the cumulative probability of survival at 5 years was 0.165. CONCLUSION: The most important prognostic factors appear to be the extent of tumor involvement at the time of diagnosis and the depth of myometrial invasion.

Combined Modality Therapy↗

PubMed1995

[Orifice dyspareunia: the surgeons point of view].

Various organic lesions can give rise to superficial dyspareunia. Easily surgically treated, they must be recognised: 1) minor hymenal abnormalities: cribriform, microperforate, septate, fleshy or hyperelastic hymens; 2) vaginal abnormalities: longitudinal or transverse septum; 3) post obstetrical or post operative vulvar outlet stenosis; 4) sexual trauma: tears of the vestibular fossa or hymenal tears; 5) stenosing lichen sclerosus, lichen planus, bowenoid papulosis and Bowen's disease; 6) focal vestibulitis associated with more or less obvious psychological outcomes.

Congenital Abnormalities↗

PubMed1994

Diagnostic pitfalls of ultrasonographic uterine screening in women treated with tamoxifen.

Recent reports of an association between tamoxifen treatment for breast cancer and endometrial pathology prompted a screening program for women receiving tamoxifen. Twenty-two women were examined; 15 were asymptomatic, and 7 were referred because of abnormal vaginal bleeding. All underwent vaginal ultrasonography followed by endometrial sampling. The sonographic studies showed endometrial abnormalities in all 22 women--typically, irregular thickening of the endometrium. Some had cystic formations, and three had fluid in the endometrial cavity. No pathology or inadequate material was found in the endometrial samples from the 15 asymptomatic women. Endometrial polyps were suspected sonographically and removed from two of the five women with vaginal bleeding. The discrepancy between the sonographic findings and histology in the asymptomatic women could have been due to stromal edema from tamoxifen treatment. Abnormal ultrasonographic findings in asymptomatic women treated with tamoxifen probably represent insignificant changes in the endometrial architecture and not a true abnormality. The need for routine endometrial sampling or hysteroscopy in every case is therefore questionable.

Aged↗

PubMed2004

Resectoscopic treatment of complete longitudinal vaginal septum.

Every gynecologist can easily recognize vaginal abnormalities and the subsequent disturbances of sexual function, such as dyspareunia and apareunia, arising from them. In the case of congenital vaginal septum, it is extremely important to completely assess the abnormality before planning for surgical treatment. Because normal vaginal development is subsequent to the canalization and fusion of the two Müllerian ducts once vacuolization has occurred, but not their union, a duplication of different degree will be the consequence. If the defect is complete, a didelphys uterus with a double vagina will result. The aim of our report is to describe the endoscopic technique used to treat three cases of complete longitudinal vaginal septum and to highlight the main differences between our technique and the standard surgical procedure.

Adolescent↗

PubMed1989

Clinical manifestations of vaginal trichomoniasis.

Trichomonas vaginalis was detected by culture or wet-mount examination in 118 (15%) of 779 randomly selected women attending a sexually transmitted disease clinic. Vaginal trichomoniasis was significantly associated with symptoms of yellow discharge, abnormal vaginal odor, and vulvar itching and with signs of colpitis macularis ("strawberry cervix"), purulent vaginal discharge, and vaginal and vulvar erythema. A logistic regression model was used to adjust for coinfections, as well as for demographic, behavioral, and other possible confounding variables. Trichomonas vaginalis remained significantly associated with symptoms of yellow vaginal discharge (odds ratio [OR] = 2.4) and vulvar itching (OR = 3.0) and with signs of colpitis macularis (OR = 241), purulent vaginal discharge (OR = 8.0), vulvar erythema (OR = 2.5), and vaginal erythema (OR = 4.3). The sensitivity of symptoms and signs associated with trichomoniasis was relatively low. Nevertheless, clinical manifestations can be used to identify those patients for whom a wet-mount examination would likely have high yield. Careful clinical examination and selective use of wet-mount examination together with wider use of more sensitive tests for subclinical infection, such as culture or direct immunofluorescent staining of vaginal fluid, could lead to improved detection and control of this infection.

Adult↗

PubMed1995

Screening for ovarian cancer using serum CA125 and vaginal examination: report on 2550 females.

This study was undertaken to assess the effectiveness of using serum CA125 and vaginal examination as a screening test for ovarian cancer in apparently healthy females. Two thousand five hundred and fifty healthy females aged 40 and over were recruited to participate in a screening study involving a questionnaire, serum CA125 measurement and vaginal examination. Females with either an elevated CA125 level or abnormal vaginal examination had a pelvic ultrasound performed as a secondary procedure. The positive predictive values of an elevated serum CA125 level, and a combination of CA125 level measurement and vaginal examination for ovarian cancer, were 1/100 and 1/3, respectively. The specificities of serum CA125 levels, vaginal examination and both in combination were 96.1%, 98.5% and 99.9%, respectively. In postmenopausal females the positive predictive values were improved with CA125 measurement alone, giving a positive predictive value of 1/24. Seventeen females underwent operative procedure as a result of the screening-only one of these was for an ovarian cancer. The combination of serum CA125 measurement and vaginal examination is not an effective screening test in the general population, although in postmenopausal females it does achieve acceptable specificities and positive predictive values.

Journal Article↗

PubMed1997

Pioneers of the intrauterine device.

The history of the intrauterine device is remarkably short and its survival has been jeopardized several times from the beginning when Gräfenberg introduced the intrauterine ring in 1928, and later when product liability claims in the USA forced companies to withdraw the IUD from the market. However, a revival is happening, and one of the withdrawn copper IUDs has been re-introduced in the USA. In the 1980s, pessimism about the future of the IUD was based on the fact that there are still two major imperfections inherent in intrauterine contraception: its lack of protection against both 'gyne' and sexually transmitted disease. That IUDs, in contrast with some other methods, do not protect the wearer against microbiological invasion from the lower genital tract is correct, and will probably remain so notwithstanding the prophylactic use of antibiotics at the time of insertion. However, the solution to this imperfection is quite simple: clinicians must learn once and for all to adhere to the principle that bilateral monogamy is the first prerequisite for the safe use of this method of contraception. The second drawback of the IUD is the absence of so-called 'gyne' protection. Although seldom threatening women's health, menorrhagia, occasionally accompanied by pain, is a nuisance, and bleeding problems remain the most frequent single reason for the removal of an IUD. Consequently, research should concentrate on the alleviation of abnormal vaginal bleeding. Prevention is difficult, mainly because the etiopathology of abnormal bleeding is insufficiently understood. Menstrual hemostasis is a complex phenomenon and attempts at etiological treatment give poor results. However, because bleeding is, in all probability, related to an endometrial trauma caused by the geometric incompatibility between the frame of the IUD and the uterine cavity, it was logical for research to concentrate on correcting this factor. This review provides some historical notes about the pioneers who contributed to the improvement of intrauterine contraception since the introduction of the intrauterine ring by Gräfenberg in 1928 until the invention of the frameless device by Wildemeersch in 1984.

Consumer Product Safety↗

PubMed2006

Female genital malformations and their associated abnormalities.

OBJECTIVE: With an incidence of up to 5% in the general population, genital malformations are a frequent clinical occurrence. The aim of this study was to assess whether a connection could be demonstrated between various degrees of severity of genital malformations and associated abnormalities. DESIGN: All patients were classified using the Vagina, Cervix, Uterus, Adnex, and Associated Malformation (VCUAM) classification. SETTING: University hospital. PATIENT(S): Two hundred eleven premenopausal patients with female genital malformations. INTERVENTION(S): The patients underwent diagnostic workup for genital malformations using laparoscopy as well as hysteroscopy. Associated malformations were detected by either magnetic resonance imaging (MRI) or ultrasound. MAIN OUTCOME MEASURE(S): Demonstration of a connection between various degrees of severity of genital malformations and associated abnormalities. RESULT(S): In 72 cases (36%) out of 202 patients with uterine malformations (VCUAM U1-4) we found associated abnormalities. The predominant findings were alterations in the renal system. When vaginal abnormality (VCUAM V1-5) alone was taken into consideration, an associated developmental disturbance in the renal tract was found in 30% of cases (n = 32 from 107). CONCLUSION(S): A close connection was demonstrated between genital malformations and associated abnormalities. For this reason, the diagnostic workup in patients with malformations should always include the renal system. Depending on the severity of the clinical picture, examinations may need to be extended further.

Abnormalities, Multiple↗

PubMed1986

Volatile fatty acid findings in vaginal fluid compared with symptoms, signs, other laboratory results, and susceptibility to tinidazole of malodorous vaginal discharges.

The relevance of volatile fatty acids as a diagnostic test in 79 women with abnormal vaginal discharge was evaluated by a blind, randomised, and placebo controlled trial of tinidazole as a single oral 2 g dose. Automated gas chromatography of ether extracts of discharges taken before treatment showed volatile fatty acids in 18. Volatile fatty acids correlated with malodorous, colour, and microscopically assessed altered bacterial flora and clue cells. At follow up one week later, the odour, colour, and volatile fatty acids in the vaginal discharge of women treated with tinidazole had become normal more often than in those receiving placebo. The disappearance of volatile fatty acids correlated with clinically assessed improvement in women treated with tinidazole. The volatile fatty acid test as an indicator of anaerobic bacterial flora is objective, technically simple and fast, has few problems of sample size and transportation, and may be useful in the aetiological classification and follow up treatment of non-specific vaginal discharges.

Body Fluids↗

PubMed2002

Bacterial vaginosis in climacteric and menopausal women.

The objective was to determine how frequently an abnormal vaginal flora occurred in women attending a menopause clinic and whether any abnormality might be related to a particular risk factor. Women completed a questionnaire on their gynaecological, sexual and medical history. Whether they were perimenopausal or postmenopausal was determined on the basis of symptomatology, duration of amenorrhoea and on a follicle-stimulating hormone (FSH) assay when clinically indicated. A speculum examination of the vagina was undertaken, at which time a smear of vaginal secretion was Gram stained and the bacterial flora graded as follows: grade 1, normal; grade 2, intermediate, and grade 3, bacterial vaginosis (BV). Of 100 women examined, 44 had grade 1 flora, 17 had grade 2 flora and 18 had BV. An apparent absence of, or very scanty, vaginal bacteria in which grading was not possible was found in 21 women. Women with BV had had more sexual partners than the others, but otherwise there were no discernible factors associated with the occurrence of BV. Women with vaginal atrophy were more likely to have an apparent absence of vaginal bacteria, but a few had BV.

Adolescent↗

PubMed1978

Microbiology of the vagina in children: normal and potentially pathogenic organisms.

Vaginal cultures from 100 healthy girls, 2 months to 15 years of age, were examined for the presence of normal and potentially pathogenic microorganisms. Corynebacterium vaginale, yeast species, and genital mycoplasmas were isolated from vaginal cultures from 13.5 %, 28%, and 28% of the girls examined, respectively. Colonization with these organisms was not associated with signs or symptoms of vaginitis. Neisseria gonorrhoeae was isolated from a 4-year-old with purulent vaginitis. Trichomonas vaginalis was recovered from two 13-year-olds, both of whom had an abnormal vaginal discharge. Vaginal antibody to Chlamydia trachomatis was found in two girls 4 and 13 years of age. In neither girl was the organism recovered from the vaginal culture. Chlamydia trachomatis was recovered from the vaginal culture of another 4-year-old who had no abnormal findings on examination. Cultures from 59 of the girls were examined for aerobic and facultatively anaerobic bacteria. Diphtheroids and Staphylococcus epidermidis were the most frequently isolated organisms. Lactobacilli were isolated most frequently from the older girls, whereas enteric organisms were isolated most frequently from the younger girls.

Adolescent↗

PubMed1982

Vaginal organisms in prepubertal children with and without vulvovaginitis. A vaginoscopic study.

In a prospective clinical and microbiological study covering 67 prepubertal children the vaginal flora of 31 asymptomatic children was compared to 36 children suffering from abnormal vaginal discharge and/or vulvovaginitis. Vaginoscopy was employed to obtain bacteriological specimens without contamination. Swabs were inoculated into prereduced transportmedia (PORT A CUL, BBL) and cultured aerobically and anaerobically. The most prevalent aerobic organisms were Staphylococcus epidermidis. Enterococci and Escherichia coli; the predominant anaerobic bacteria were Peptococcus and Peptostreptococcus, Veillonella parvula, Eubacteria, Propionibacterium and Bacteroides species. A similar microbiological pattern was found in both groups, although anaerobes, like Peptococci and Peptostreptococci and Bacteroides species, as well as yeasts, like Candida albicans were significantly more frequent in the group with signs and symptoms. Lactobacilli were less common in this group.

Adolescent↗

PubMed2006

Safety and acceptability of the candidate microbicide Carraguard in Thai Women: findings from a Phase II Clinical Trial.

OBJECTIVE: To determine the safety and acceptability of vaginal application of Carraguard, a carrageenan-derived candidate microbicide gel. DESIGN: A randomized, placebo-controlled, triple-blinded clinical trial was conducted in Chiang Rai, northern Thailand. METHODS: Women were asked to insert one applicator of study gel vaginally at least three times per week (with or without sex) and to use gel with condoms every time they had sex. Safety was assessed by visual inspection of the vagina and cervix, changes in vaginal flora and self-reported symptoms at day 14, month 1 and then monthly for up to 1 year. Acceptability was assessed through reported use of the gel, return of used and unused applicators, and quarterly interviews. RESULTS: One hundred sixty-five women were randomized: 83 to Carraguard and 82 to the placebo (methylcellulose gel) group. Study gel use was similarly high in both groups throughout the trial with an average of four applicators per week. Carraguard use was not associated with abnormal genital clinical findings, abnormal vaginal flora, Pap smear abnormalities or other abnormal clinical signs or symptoms. Adverse events were mostly mild, not attributed to gel use, and similarly distributed between groups. Participants in both groups reported high acceptability. CONCLUSIONS: Carraguard can safely be used an average of four times per week with or without sex and is acceptable to Thai women. A Phase III efficacy trial of Carraguard is warranted and is currently ongoing in South Africa.

Administration, Intravaginal↗

PubMed2005

Factors affecting vaginal pH levels among female adolescents attending genitourinary medicine clinics.

OBJECTIVES: Vaginal pH is related to hormonal status, and adolescents experience disturbed hormonal patterns following menarche. We assessed hormonal factors and risk of abnormal vaginal pH and bacterial vaginosis (BV) among adolescents attending genitourinary medicine (GUM) clinics. METHODS: In a cross sectional study adolescents within 5 years of menarche, < or =17 years, or with oligo-amenorrhoea were recruited. Vaginal pH and BV were assessed and among those not using hormonal contraceptives, estrone-3-glucuronide (E3G) and pregnanediol-3alpha-glucuronide (P3G) concentrations were measured. RESULTS: Among 102 adolescents, 59.8% (61) had a high vaginal pH (>4.5), which was higher than the prevalence of BV, detected in 33% (34). No association was found between presence of sexually transmitted infections (STI) and vaginal pH. In logistic regression, after controlling for BV and condom use, vaginal pH was positively associated with cervical ectopy (OR = 2.5; 95% CI 1.0 to 6.6, p = 0.05) and STI treatment history (OR = 2.5; 95% CI 0.9 to 6.5, p = 0.07), and negatively associated with use of Depo-Provera (OR = 0.1; 95% CI 0.03 to 0.6, p = 0.003) and recent onset (<12 months) of sexual activity (OR = 0.2; 95% CI 0.1 to 0.7, p = 0.004). Among 23 adolescents not using hormonal contraceptives, a high pH occurred more often in abnormal compared to normal menstrual cycles (OR = 10.8; 95% CI 1.4 to 85.4; p = 0.026). E3G concentrations were inversely correlated with vaginal pH in the follicular phase (Spearman: r = 0.51; p = 0.024). CONCLUSIONS: Ectopy and abnormal menstrual cycles are common features of adolescence. Their presence is associated with increased risk of abnormal pH, and may also predispose to BV.

Adolescent↗

PubMed2005

Thin endometrial echo complex on ultrasound does not reliably exclude type 2 endometrial cancers.

OBJECTIVE: The objective of this study was to determine the ultrasonographic characteristics of the uterus and endometrial echo-complex (EEC) of postmenopausal patients diagnosed with type 2 endometrial cancer, including uterine papillary serous carcinoma (UPSC), clear cell carcinoma (CCC), and other endometrial high-grade carcinomas (HGC). METHODS: Postmenopausal patients with type 2 endometrial cancer who underwent preoperative pelvic ultrasound were identified. Histologic diagnoses were made by biopsy or hysterectomy. Ultrasound reports were abstracted for the following parameters: EEC thickness, presence of intracavitary fluid or lesion, myometrial mass, uterine size, and adnexal mass. Ultrasound films were re-reviewed by a single gynecologic ultrasonographer. RESULTS: Fifty-two patients with detailed ultrasound reports comprised the study population. Twenty-six films were available for re-review and inter-examiner agreement was 92%. Forty-four women (85%) presented with abnormal vaginal bleeding. Thirty-four patients (65%) had a thickened EEC measuring >5 mm. In 9 cases (17%), the EEC measured <4 mm. In an additional 9 patients (17%) the EEC was indistinct. One or more other ultrasound abnormalities were found in each of the 18 cases with a non-thickened EEC: intracavitary fluid or lesion (8; 44%), myometrial mass (12; 67%), enlarged uterus (13; 72%), or adnexal mass (5; 28%). CONCLUSION: A thin or indistinct endometrial stripe, especially when associated with other ultrasound abnormalities does not reliably exclude type 2 endometrial cancer. Postmenopausal vaginal bleeding requires endometrial sampling despite a thin EEC in the presence of other ultrasonographic abnormalities or persistent bleeding.

Adnexa Uteri↗

PubMed2006

Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar.

Uterine scar has been reported as a possible cause of intermenstrual bleeding in women with previous cesareans. We evaluated the effectiveness of combined hormonal therapy (estrogen and progesterone tablets containing 0.5 mg of norgestrel and 0.05 mg of ethynyl estradiol) in patients with recurring vaginal bleeding after cesarean section. Several cycles of the hormonal therapy eliminated the problem of abnormal vaginal bleeding, and the patients were satisfied with the treatment.

Adult↗