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Results for “Vaginal Abnormalities”

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At least 199 records · Page 11Linked to original sources

PubMed2005

Malignant mixed mullerian tumor (MMMT) of the cervix.

OBJECTIVES: To characterize the clinical characteristics, therapeutic options, and potential outcomes in patients diagnosed with malignant mixed mullerian tumor (MMMT) of the uterine cervix. METHODS: Five women ranging in age from 25 to 66 (mean 49.6 years) were diagnosed with MMMT of the cervix and treated at the University of Iowa Hospitals and Clinics between 1986 and 2001. Data were retrospectively analyzed from available charts and pathological reports with particular attention to patient demographics, presenting symptoms, treatment, and follow-up. RESULTS: Abnormal vaginal bleeding was a common presenting symptom in all but one patient, in whom an abnormal screening Pap smear was the primary reason for referral. FIGO disease staging at initial diagnosis included two patients with stage IB1 (ages 29 and 66 years), two patients with stage IB2 (ages 25 and 64 years), and one patient with stage IVB (age 64 years) MMMT of the cervix. Organ-confined, early stage lesions (stages IB1 and IB2) responded well to regimens of either surgery alone or surgery plus radiation therapy, with no evidence of recurrent disease at last follow-up 28, 35, 42, and 65 months later, respectively. The lone patient with advanced stage IVB disease, however, was unresponsive to both external beam radiation therapy and ifosfamide chemotherapy, and succumbed to disease within 5 months. CONCLUSIONS: Cervical MMMT is an uncommon disease, but long-term survival is possible in organ-confined early stage disease with primary therapy.

Adult↗

PubMed1994

Use of bowel for vaginal reconstruction.

There is a wide range of congenital vaginal abnormalities that can be reconstructed using bowel. From 1964 to 1993 we used bowel for vaginal reconstruction in 65 patients and all but 5 were treated since 1981. Patient age ranged from 9 months to 26 years. In 29 patients the bowel was used to extend a short vagina to the perineum, and in 36 the entire vagina was absent and required a substitute vagina. Indications for surgery included cloacal malformations in 34 cases, congenital absence of vagina in 12, cloacal exstrophy in 9 genetic male subjects, postoperative exenteration in 7, intersex in 2 and bladder exstrophy in 1. Rectum was used in 12 cases, sigmoid colon in 27 and small bowel in 26. Ten patients who are now adults have reported satisfactory coitus.

Adolescent↗

PubMed1991

Persistent vaginal discharge in a sexually active adolescent female.

With the high prevalence of unprotected sexual activity among adolescents, health-care providers are frequently called upon to evaluate patients with abnormal vaginal discharges. Usually, thorough pelvic and laboratory examinations will identify offending organisms which can be promptly eradicated with the judicious use of antibiotics. Occasionally, however, an abnormal discharge may persist despite these interventions. Health-care providers need to be aware of the fact that anal intercourse may be a common practice among sexually active teenagers. Penile-vaginal contact after anal intercourse may cause vaginal discharge due to contamination. Health-care providers should make it a routine part of their history-taking of adolescent patients to inquire about anal intercourse. Not only might it reveal useful clinical information, but it may indicate the need for additional health education and counseling.

Adolescent↗

PubMedDate not supplied

Vaginal flora morphotypic profiles and assessment of bacterial vaginosis in women at risk for HIV infection.

Specific morphotypic profiles of normal and abnormal vaginal flora, including bacterial vaginosis (BV), were characterized. A prospective study of 350 women yielded concurrent Gram-stain data and clinical assessment (n = 3455 visits). Microbiological profiles were constructed by Gram stain. Eight profile definitions were based on dichotomizing the levels of Lactobacillus, Gardnerella, and curved, Gram-negative bacillus (Mobiluncus) morphotypes. Of these, two were rare, and the other six demonstrated a graded association with the clinical components of BV. The proposed profiles from the Gram stain reflect the morphotypic categories describing vaginal flora that may enable clearer elucidation of gynecologic and obstetric outcomes in various populations.

Adolescent↗

PubMed2004

The social context of reproductive health in an Egyptian hamlet: a pilot study to identify female genital schistosomiasis.

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet (ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women's arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women's health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research.

Egypt↗

PubMed2001

Primary pelvic non-Hodgkin's lymphoma.

OBJECTIVE: To describe five cases of primary pelvic non-Hodgkin's lymphoma, a rare gynecologic malignancy. METHODS: The charts of five women with primary pelvic non-Hodgkin's lymphoma were reviewed. Histologic classification was based on the Working Formulation, and staging was based on the Ann Arbor system. Disease status was monitored with physical examination and imaging studies. RESULTS: During a 10-month period, five women were diagnosed with primary pelvic non-Hodgkin's lymphoma, including one parasacral, one uterine, one vaginal, and two ovarian tumors. Presentations included abdominal and pelvic pain, abdominal and pelvic mass, and abnormal vaginal bleeding. Treatment included combination chemotherapy, with or without radiation. Four patients were alive and disease free 20--33 months after therapy. CONCLUSION: Primary pelvic non-Hodgkin's lymphoma may present like other more common gynecologic cancers. It should be considered in the differential diagnosis of gynecologic malignancy.

Adult↗

PubMed1993

Abnormal uterine bleeding. Finding and treating the cause.

Abnormal vaginal bleeding is a common presenting symptom with an extensive list of potential causes. In evaluating abnormal bleeding, nonuterine causes and pregnancy should first be excluded; after that, it is important to differentiate between ovulatory and anovulatory bleeding (dysfunctional uterine bleeding). Initial laboratory tests, in addition to a sensitive pregnancy test, include hemoglobin and hematocrit determinations, platelet count, and occasionally coagulation studies. An endometrial biopsy or dilation and curettage may be necessary to rule out endometrial hyperplasia or other pathology associated with the long-term unopposed estrogen stimulation experienced by anovulatory patients. In evaluating abnormal ovulatory bleeding, hysteroscopy with selected biopsy or curettage is superior to routine dilation and curettage. Anovulatory patients should be treated with an oral progestin, an oral contraceptive, or, if pregnancy is desired, an ovulation stimulant. Treatment options for patients having ovulatory cycles include an oral contraceptive, an oral progestin, danazol (Danocrine), a gonadotropin-releasing hormone agonist, mefenamic acid (Ponstel), and surgery.

Diagnosis, Differential↗

PubMed1997

Effects of prenatal testosterone on sexual behavior, reproductive morphology and LH secretion in the female rat.

Sexual differentiation of many brain structures and functions is dependent on levels of testosterone (T) or its metabolites during certain 'sensitive' developmental periods. If T is present during these perinatal periods, masculinization and defeminization of sexual behavior occur; also, reproductive physiology, and central nervous system morphology and function are altered. The purpose of the present study was to characterize the influence of T at specific prenatal developmental intervals on offspring reproductive morphology, physiology, locomotor activity and sexual behavior during postnatal development. To avoid complications induced by endogenous testicular activity, only females were examined. Free T was used because of its relative short half-life, so that the effects induced by its administration on a specific gestational day (GD) could be evaluated. Pregnant rats received a single subcutaneous injection of either sesame oil (controls) or 5 mg of T on GD 16, 17, 18, 19, 20, 21, or 22. Female offspring of pregnant rats exposed to T displayed significant alterations in morphology and behavior. The anogenital distance, measured at 25 days postbirth, was significantly increased if T was administered on GD 16, 17 or 18. T treatment on GD 16 or each day thereafter through GD 20 significantly delayed the normal occurrence of vaginal opening (controls at 37.5 days vs. T treatment which ranged from 38.5 to 41.4 days). Abnormal vaginal morphology (enlarged clitoris) was also observed when T was injected during a similar prenatal interval (i.e. GD 16 to GD 22). Furthermore, prenatal T treatment on GD 18 (and each day thereafter), until GD 22 significantly decreased lordotic behavior compared to control values. However, exposure to T, on any prenatal GD did not alter the animals' ability to exhibit an induced luteinizing hormone (LH) surge. These results suggest that the onset for altered reproductive morphology occurs at least as early as GD 16, whereas the onset of sexual behavior sensitivity occurs precisely at GD 18, and that the normal pattern of adult LH release in females is not altered by prenatal androgen treatment using this specific paradigm.

Animals↗

PubMed2006

TNFA-308G>A polymorphism influences the TNF-alpha response to altered vaginal flora.

OBJECTIVE: To investigate the association between a tumor necrosis factor-alpha (TNF-alpha) gene polymorphism, vaginal TNF-alpha level, and microbial flora in pregnant women. METHODS: Vaginal samples from 203 women at 18-22 weeks' gestation were analyzed for microflora. TNFA-308G>A polymorphism was analyzed by polymerase chain reaction and restriction endonuclease analysis and TNF-alpha concentration was determined by ELISA. Outcome data were subsequently obtained. RESULTS: The vaginal TNF-alpha concentration was elevated in TNFA-308A carriers only in the presence of abnormal vaginal flora. A median TNF-alpha level of 10.94 pg/ml in TNFA-308A carriers with bacterial vaginosis (BV) was significantly higher than that of 1.77 pg/ml in TNFA-308A carriers without BV (P=.02), and 1.72 pg/ml in TNF-308G homozygotes with BV (P=.01). CONCLUSION: The TNFA-308G>A polymorphism influences the local TNF-alpha response to altered vaginal microflora. This suggests that the nature of the host response to microbial invasion in the lower female genital is genetically determined.

Adult↗

PubMed2006

Anastrozole versus tamoxifen treatment in postmenopausal women with endocrine-responsive breast cancer and tamoxifen-induced endometrial pathology.

PURPOSE: To investigate the effect of switching from adjuvant tamoxifen to anastrozole (Arimidex) treatment in postmenopausal women with endocrine-responsive breast cancer and histologically proven tamoxifen-induced benign endometrial pathology. EXPERIMENTAL DESIGN: Two hundred twenty-six postmenopausal women who had received adjuvant tamoxifen 20 mg/d (> or =12 months, < or =48 months) and developed abnormal vaginal bleeding and/or an asymptomatic endometrial thickness >10 mm [measured by transvaginal ultrasound (TVUS)] were subjected to hysteroscopy and dilation and curettage (D&C). Thereafter, 171 patients were randomized in a phase III study to continue tamoxifen treatment (n = 88) or switch to anastrozole 1 mg/d (n = 83). Patients were monitored for < or =42 months using TVUS at 6-monthly intervals. RESULTS: At study entry, there were no significant differences in vaginal bleeding, endometrial thickness, and histologic findings between the two treatment groups. Throughout the treatment period, there was no significant difference in recurrent vaginal bleeding between groups [anastrozole, 4 of 83 (4.8%); tamoxifen, 9 of 88 (10.2%); P = 0.18]. Six months after randomization, the mean endometrial thickness for patients who switched to anastrozole was significantly reduced compared with those who continued tamoxifen treatment (P < 0.0001). Significantly fewer anastrozole patients required a repeat hysteroscopy and D&C compared with those on tamoxifen [4 of 83 (4.8%) and 29 of 88 (33.0%), respectively; P < 0.0001]. Repeat hysteroscopy and D&C revealed endometrial atrophy in all 4 cases in the anastrozole group and 14 polyps, 8 hyperplasias, and 7 atrophies in the tamoxifen group. CONCLUSIONS: Switching from tamoxifen to anastrozole treatment significantly reduced the need for a second hysteroscopy and D&C due to recurrent vaginal bleeding or thickening of the endometrium in postmenopausal breast cancer patients with tamoxifen-induced endometrial abnormalities.

Aged↗

PubMed1985

The pathology of tampon usage and of the toxic shock syndrome.

Tampon usage is commonly associated with the development of transient, asymptomatic focal vaginal abnormalities such as dehydration, epithelial peeling and micro-ulceration. These abnormalities occur most commonly with superabsorbent tampons and are probably due to a fluid shift across the vaginal epithelium. Clinically apparent vaginal ulceration due to tampon usage is rare: these ulcers may develop from asymptomatic tampon-induced micro-ulcers. The pathological changes seen in the toxic shock syndrome are inconsistent but are, in general, due either to reduced tissue perfusion, or to the effects of a toxin. Cervico-vaginal ulceration in women with the toxic shock syndrome is probably a consequence rather than a cause of toxin entry into the systemic circulation.

Adult↗

PubMed2000

Management of uterine Müllerian adenosarcoma with extrauterine metastatic deposits.

OBJECTIVE: The aim of this study was to provide the management and outcome of three patients who presented with uterine Müllerian adenosarcoma associated with extrauterine metastases. METHODS: A retrospective study of three patients who were referred to our hospital was performed. One patient was referred because of vaginal metastatic deposits that were noted during investigations for primary infertility. The other two were referred because of abnormal vaginal bleeding; one of these had a large polyp protruding through her cervix into the vagina. RESULTS: In two patients the preoperative diagnosis and extent of their disease were known while in the third patient the diagnosis was only made postoperatively. All patients had a type II radical abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Two patients were given three cycles of neoadjuvant chemotherapy and pelvic irradiation over 12 weeks. Both of these patients had their diagnosis made preoperatively and the chemotherapy consisted of 240 mg/m(2) carboplatin and 80 mg/m(2) farmorubicin per cycle. The pelvic irradiation consisted of daily fractions of 1.8-Gy irradiation to a total of 45 Gy over the first 6 weeks. The other patient was given the same regime postoperatively. All patients are still alive and free of disease between 34 and 56 months. CONCLUSION: Radical surgery, chemotherapy, and irradiation provide a management option with seemingly favorable outcome for patients with uterine Müllerian adenosarcoma associated with extrauterine metastases.

Adenosarcoma↗

PubMed2003

Identification of symptoms that indicate a pelvic examination is necessary to exclude PID in adolescent women.

BACKGROUND: Diagnosis of chlamydia, gonorrhea, and vaginitis is now possible in adolescents using urine testing and vaginal swabs obtained by care provider or patient. However, a complete pelvic examination is necessary to diagnose pelvic inflammatory disease (PID). It is thus important to identify patients who might have pelvic inflammatory disease to assure complete gynecologic assessment of genitourinary symptoms. PURPOSE: To determine whether adolescent patients with pelvic inflammatory disease report predictable symptoms during the medical interview and to determine what proportion of patients diagnosed with PID report at least one predictor symptom. METHODS DESIGN: Observational study. SETTINGS: Hospital-based adolescent clinic and Job Corps health service. PATIENTS: A convenience sample (n = 193) of adolescent and young adult women who had a pelvic examination performed to evaluate a wide range of genitourinary symptoms. MAIN OUTCOME MEASURE: Clinical diagnosis of pelvic inflammatory disease. ANALYSIS: Sensitivity, specificity, and positive and negative predictive value of predictor symptoms for identifying patients given a diagnosis of pelvic inflammatory disease. RESULTS: Twenty (10.4%) patients received a clinical diagnosis of PID. Lower abdominal pain was the most common symptom (90.0%) reported by these patients. All of the patients with PID reported either lower abdominal pain or dyspareunia in the medical history compared with 97 (56.1%) of those without PID. The presence of lower abdominal pain and/or dyspareunia in the clinical history yielded a sensitivity of 100%, specificity of 44%, and positive and negative predictive value of 17% and 100%, respectively, for identifying patients given a diagnosis of PID. CONCLUSION: This study identified two symptoms reported in the medical history (lower abdominal pain and dyspareunia) that were associated with a clinical diagnosis of pelvic inflammatory disease. If lack of these two symptoms was used as a criterion for omitting a pelvic examination, more than one third of the patients in this study could have been evaluated for cervical and vaginal infections with urine and directly obtained vaginal swabs. Although some of these patients might have required a pelvic examination to exclude other causes of abnormal vaginal bleeding, at least 30% of the total sample could have been evaluated without a speculum and bimanual examination. If further studies support these findings, patients with symptoms suggestive of uncomplicated genitourinary infection (e.g., vaginal discharge, vaginal pruritus, or dysuria) who deny lower abdominal pain and dyspareunia can be evaluated with urine and vaginal samples in place of a speculum and bimanual examination.

Abdominal Pain↗

PubMed1996

Vaginal microbiology of women with acute recurrent vulvovaginal candidiasis.

Alterations in the autochthonous vaginal microflora can predispose women to recurring attacks of Candida vaginitis. Quantitative aerobic and anaerobic cultures were obtained from 24 premenopausal women with acute recurrent vulvovaginal candidiasis and from 21 healthy asymptomatic premenopausal women. Lactobacillus species constituted the predominant flora in both groups, with a mean log10 CFU/ml of 8.7, a total isolation rate of 96%, and a mean of 1.6 Lactobacillus species isolated per patient compared with a mean log10 CFU/ml of 8.9, a total isolation rate of 90%, and a mean of 1.2 Lactobacillus species isolated per patient in the vaginitis and control groups, respectively. The results of this small study failed to provide evidence of an altered or abnormal vaginal bacterial flora in women with non-antibiotic-induced recurrent vulvovaginal candidiasis suffering from acute Candida vaginitis.

Adult↗

PubMed1990

Treatment of bacterial vaginosis in pregnancy with a lactate gel.

10 pregnant women with bacterial vaginosis were treated vaginally with a low-pH lactate gel intermittently during 6 weeks. Reappearance of a lactobacillus-dominated vaginal flora was observed after a few days treatment in all patients. All women experienced a subjective disappearance of abnormal vaginal discharge and malodour. This local treatment restores the normal vaginal acidity and facilitates recolonization with lactobacilli. It may be preferable to oral antimicrobial therapy, especially during pregnancy.

Administration, Intravaginal↗

PubMed1981

Vaginitis associated with vaginal malodour.

In two general practices in Perth, Western Australia, the most common microbiological causes of vaginal discomfort in 368 patients were Candida albicans. Gardnerella (Haemophilus) vaginalis, Trichomonas vaginalis and bacteroides fragilis. Amongst patients with abnormal vaginal odour, with or without vaginitis, the most common cause of odour was G. vaginalis. The writers advocate that heavy growths of group B streptococci, Escherichia coli, and enterococci should be considered to be the possible cause of vaginal discomfort. This reinforces the need for care in collection, transportation, and microbiological examination of swabs of the female genital tract. as well as in the clinical interpretation of these reports.

Candida albicans↗

PubMed2005

Association between vaginal 70-kd heat shock protein, interleukin-1 receptor antagonist, and microbial flora in mid trimester pregnant women.

OBJECTIVE: This study investigated the association among the inducible 70-kd heat shock protein, cytokines, and microbial flora in the vagina in mid trimester pregnant women and subsequent preterm delivery. STUDY DESIGN: Vaginal samples from 205 pregnant women, which were collected at 18 to 22 weeks of gestation, were analyzed for qualitative and quantitative vaginal microflora and for 70-kd heat shock protein, interleukin-1beta, interleukin-1 receptor antagonist, and tumor necrosis factor-alpha by enzyme-linked immunosorbent assay. Pregnancy outcome data were obtained subsequently. RESULTS: The 70-kd heat shock protein was detected in 38 vaginal samples (18.5%). Its presence was associated with elevated vaginal pH, a diagnosis of bacterial vaginosis, and elevated interleukin-1 receptor antagonist levels (P < .001). Among women with bacterial vaginosis, 70-kd heat shock protein-positive subjects had a >80% increase in median vaginal concentration of interleukin-1 receptor antagonist (P < .05). CONCLUSION: Vaginal 70-kd heat shock protein expression is associated with the down-regulation of the proinflammatory immune response to abnormal vaginal flora in mid trimester pregnant women.

Adult↗

PubMed2005

Primary carcinoma of the fallopian tube: A clinicopathologic analysis of 27 patients.

OBJECTIVES: To analyze the clinicopathologic features of women with primary fallopian tube carcinoma DESIGN: Descriptive cross sectional study MATERIAL AND METHOD: Twenty-eight women diagnosed with primary fallopian tube carcinoma treated at Chiang Mai University Hospital between January 1997 and December 2004. RESULTS: During the study period, the primary fallopian tube carcinoma accounted for 0.48% of all gynecologic malignancies. Of the 28 patients, one was excluded for unavailable medical records. Mean age at diagnosis was 53 years (range, 38-76 years). Seventeen (63.0%) were menopausal women. The most common clinical presentation was pelvic mass (55%), followed by abnormal vaginal bleeding (18.5%). Hydrops tubae profluens was present in three (11.1%) women. The rare presenting symptoms included pelvic peritonitis and abnormal glandular cells on cervicovaginal smear were noted in one (3.7%) woman of each category. In all women, primary fallopian tube carcinoma could not be diagnosed preoperatively. During the operation, an abnormal tubal lesion was suspected in only eleven (40.7%) women. Histology were serous adenocarcinoma (70.4%), endometrioid adenocarcinoma (22.2%), undifferentiated adenocarcinoma (3.77%) and carcinosarcoma (3.7%). As opposed to epithelial ovarian cancer, the majority of women in the present study were in the early stages of the disease. CONCLUSION: Primary fallopian tube carcinoma is a rare gynecologic malignancy that has various and nonspecific presentations. Definite diagnosis is usually made postoperatively. This malignancy should be considered in differential diagnosis of peri- and postmenopausal women who present with complex adnexal mass, unexplained uterine bleeding, abnormal glandular cells on cervicovaginal smear and complicated pelvic inflammatory disease.

Adult↗