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PubMed1996

MR imaging during intracavitary brachytherapy of vaginal and cervical cancer: preliminary results.

Intracavitary brachytherapy is an effective treatment for gynecologic cancers. Twelve magnetic resonance (MR) imaging studies were performed during intracavitary brachytherapy (10 initial studies and two during repeat brachytherapy) in 10 patients with clear cell adenocarcinoma (n = 9) or epithelioma (n = 1). Fifty percent of the vaginal lesions did not demonstrate high signal intensity on T2-weighted images. Individually tailored molded applicators allowed easy detection of abnormal vaginal parietal thickening on T1-weighted images: Results in seven cases were concordant with results of clinical examination, and there were no false-negative results. MR imaging was useful in controlling the relationships between the tumor and the applicator and facilitated treatment planning, since the radiation dose to the tumor volume and adjacent critical organs could be calculated accurately. Limitations of MR imaging were underestimation of superficial vaginal tumors and the inability to differentiate between tumor and inflammation after recent surgery or repeat intracavitary brachytherapy. MR imaging during intracavitary brachytherapy appears to be a useful adjunct to clinical examination.

Adenocarcinoma, Clear Cell↗
PubMed1995

Office laboratory diagnosis of vaginitis. Clinician-performed tests compared with a rapid nucleic acid hybridization test.

BACKGROUND: The traditional diagnosis of vaginitis incorporates patient symptoms, clinical findings observed during vaginal examination, and laboratory analysis of vaginal fluid. The purpose of this study was to evaluate routine clinician-performed office laboratory diagnostic techniques for women with abnormal vaginal symptoms, and to compare these results with those obtained by a DNA hybridization test for Trichomonas vaginalis, Gardnerella vaginalis, and Candida species. METHODS: The study included 501 symptomatic women who were between the ages of 14 and 67 years. Three vaginal specimens were obtained for saline wet mount, potassium hydroxide (KOH) prep, amine "sniff", pH, and nucleic acid hybridization (T vaginalis, G vaginalis, and Candida sp) tests. Clinicians and medical technicians independently evaluated the wet mount, KOH prep, amine, and pH tests. A medical technician processed the DNA tests according to manufacturer's protocol. RESULTS: Of 499 subjects for whom complete data were available, vulvovaginal candidiasis was diagnosed in 20.0%, vaginal trichomoniasis in 7.4%, and bacterial vaginosis in 52.1%. Fourteen percent of subjects had multiple vaginal infections. The sensitivity and specificity of clinician microscopically diagnosed vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 39.6% and 90.4%, 75.0% and 96.6%, and 76.5% and 70.8%, respectively. The sensitivity and specificity of the DNA probe diagnosis of the same types of vaginitis were 75.0% and 95.7%, 86.5% and 98.5%, and 95.4% and 60.7%, respectively. When only women with multiple vaginal infections were considered, the percentages of correct clinician diagnoses for vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 49.3%, 83.6%, and 59.7%, respectively. For the DNA probe test, the percentages of correct diagnoses were 72.9%, 92.9%, and 90.0%, respectively. CONCLUSIONS: Primary care clinicians demonstrated a high specificity but low sensitivity when identifying vaginal trichomoniasis and vulvovaginal candidiasis by microscopic techniques. Correct microscopic diagnosis of bacterial vaginosis was even more difficult for clinicians, as was the diagnosis of multiple vaginal infections. Clinicians were not as accurate as the DNA probe test in diagnosing vaginal infections. Clinicians need more education in the laboratory diagnosis of vaginitis. Clinicians should carefully scrutinize each microscopic slide, systematically examine the slide for each type of vaginitis, and consider specimen pH and the presence of leukocytes, Lactobacillus organisms, or amine odor as additional clues to infection.

Adolescent↗
PubMed1995

Post menopausal vaginal bleeding due to vaginal wall leech infestation.

A 50 year old para vi patient was referred to Mekelle Hospital on October 23, 1992 with post menopausal vaginal bleeding and haemorrhagic shock to rule out endometrial carcinoma. She was anaemic. Speculum examination revealed a darkish mass attached to the posterior vaginal fornix. The mass was instilled with about 5 ml (1%) Lidocaine, after which it detached itself and started movement. The mass was an aquatic leech. Previously, post menopausal vaginal bleeding due to leech infestation was not reported, and therefore, this has to be included in the differential diagnosis of abnormal vaginal bleeding. Emphasis should also be made to create awareness among professionals working in areas where leech infestation is prevalent.

Anemia↗
PubMed2005

Primary malignant melanoma of the vagina: a case report.

Primary malignant melanoma of the vagina is a very rare, but very aggressive tumor. We describe a case of primary vaginal melanoma and review the literature. The patient, a 73-year-old, gravida 2, para 2 postmenopausal Greek woman, presented with abnormal vaginal bleeding for 30 days. On vaginal examination there was a 5.5 x 5 x 2 cm raised, ulcerated and irregular lesion on the posterior vaginal wall. Pathology examination of the entire specimen demonstrated a nodular vaginal melanoma. The histologic diagnosis was confirmed by positive immunostaining. The patient began postoperative immunotherapy with interferon-a2b. She died 25 months later because of cerebral metastases. In conclusion, the prognosis of vaginal melanoma is very poor, despite the treatment modality, because most cases are diagnosed at a late stage.

Aged↗
PubMed2001

Determinants of reproductive tract infections among asymptomatic women in Harare, Zimbabwe.

OBJECTIVES: To determine the prevalence of and risk factors for reproductive tract infections (RTI) among asymptomatic women attending primary health care clinics in Harare, Zimbabwe. DESIGN: A cross sectional study. MAIN OUTCOME MEASURES: Prevalent RTI, HIV and socio-demographic data. SETTING: Two primary health care clinics in Harare. SUBJECTS: 393 consecutive, consenting women aged 15 to 49 years, presenting at the clinics for antenatal care, family planning, or bringing their children to attend preventive care clinics. RESULTS: More than half of the women had at least one ongoing RTI. Voluntary reporting of symptoms was almost non-existent. Prevalence of HIV was 29.3% and that of classical STIs was 15.4% Trichomoniasis vaginalis, 3.9% syphilis, 3.9% Chlamydia trachomatis and 1.8% Neisseria gonorrhoea. Bacteria vaginosis was diagnosed in 30.3% of the women and candidiasis in 25.4%. Presence of any RTI was significantly associated with lower level of education, sexual debut < 20 years, a non-monogamous partner, and use of a condom during the last sexual encounter. Independent factors associated with cervical infections were young age (< 20 years), being unmarried, current dysuria, warts, clinical signs of purulent or yellowish discharge, lower abdominal pain and cervical friability. Vaginitis was associated with sexual debut or marriage < 20 years, a partner who was a frequent traveller, history of STI, and presence of abnormal vaginal discharge. CONCLUSION: In view of the high prevalence of RTI and HIV and the low reporting of symptoms by infected women, it is recommended that strategies that improve women's awareness of urogenital symptoms be adopted, along with pro-active inquiry of genital symptoms by the health care workers, and treatment of RTIs, in order to reduce the unnecessary burden of RTIs.

Adolescent↗
PubMed1976

Congenital absence of the vagina. The Mayer-Rokitansky-Kuster-Hauser syndrome.

We describe 14 patients with congenital absence of the vagina associated with a variable abnormality of the uterus and review the literature. Associated developmental anomalies of the urinary tract and skeleton are common. As a result of the analysis of two affected families, we believe that the disorder may represent the variable manifestation of a single underlying genetic defect that can be expressed alone or in any combination of vertebral, renal, and genital abnormalities. Some affected persons may have lethal manifestations such as absence of both kidneys, and some cases may result from multifactoral causes rather than a single gene defect. Whatever the cause, the defect involves mesodermal development and the mesonephric kidney, the latter resulting in abnormalities in the paramesonephros (uterus and vagina) and in the metanephric kidney. Both nonoperative and surgical treatments are generally successful in repairing the vaginal abnormality.

Adolescent↗
PubMed1998

Correlation between endometrial cells on Papanicolaou smear and endometrial carcinoma.

BACKGROUND: A retrospective study was done to assess the correlation between endometrial cells on routine cervical cytology and carcinoma of the endometrium. METHODS: In a 4-year period, endometrial cells of some type were identified on the Papanicolaou (Pap) smears of 61 women, of whom 52 had further diagnostic evaluation of the endometrium. Data were analyzed with a multivariate stepwise logistic regression. RESULTS: The results indicated an association of endometrial cells in Pap smears with carcinoma of the endometrium in seven patients (13.5%). In 45 patients (86.5%), the final diagnosis was benign. Factors that impacted the diagnosis of carcinoma were the findings of atypical or cancerous endometrial cells on Pap smear and abnormal vaginal bleeding. CONCLUSIONS: These data indicate the importance of further diagnostic evaluation with endometrial sampling in postmenopausal patients with endometrial cells seen in Pap smears, especially those with abnormal bleeding.

Endometrial Neoplasms↗
PubMed1990

Transvaginal sonography as a screening method for ovarian cancer. A report of the first 1000 cases screened.

From November 1987 to April 1989, 1000 women 40 years or older underwent screening vaginal sonography at the University of Kentucky Medical Center (Lexington, KY). Patients included in this investigation were all asymptomatic and had no known pelvic abnormalities. Each ovary was measured in three planes and ovarian volume was calculated using the prolate ellipsoid formula. The upper limit of normal for ovarian volume was 18 cm3 in premenopausal women and 8 cm3 in postmenopausal women. In patients with normal scans, mean ovarian volumes decreased from 6.8 cm3 to 3.0 cm3 with menopause. Thirty-one patients (3.1%) had abnormal vaginal sonograms and 24 underwent exploratory laparotomy. All patients undergoing surgery had ovarian or fallopian tube tumors with dimensions identical to those predicted by ultrasound. Histologic diagnoses of these tumors included the following: adenocarcinoma, one, serous cystadenoma, eight; endometrioma, six; and cystic teratomas, two. Vaginal sonography was performed easily and without complications, and was well accepted by patients. All patients with normal sonograms have been rescreened annually and none have subsequently developed ovarian cancer. Further clinical trials to determine the efficacy of vaginal sonography as a screening method for ovarian cancer are indicated.

Adult↗
PubMed2003

BVBlue test for diagnosis of bacterial vaginosis.

Bacterial vaginosis (BV) is a disorder of the vaginal ecosystem characterized by a shift in the vaginal flora from the normally predominant Lactobacillus to one dominated by sialidase enzyme-producing mixed flora. It is the most common cause of abnormal vaginal discharge in adult women. The BVBlue system (Gryphus Diagnostics, L.L.C.) is a chromogenic diagnostic test based on the presence of elevated sialidase enzyme in vaginal fluid samples. BVBlue was compared to the standard method for diagnosing BV (Amsel criteria and Nugent score). Fifty-seven nonmenstruating women of > or =16 years of age who presented for a pelvic examination were recruited. Demographic features were collected via a self-administered questionnaire. The Amsel criteria were assessed based on three of four of the following characteristics of vaginal discharge: consistency, odor, pH, and presence of clue cells on Gram stain. BVBlue was compared to the Gram stain and Amsel criteria. The sensitivity, specificity, positive predictive value, and negative predictive value for BVBlue versus the Gram stain and Amsel criteria were 91.7, 97.8, 91.7, and 97.8% and 50.0, 100, 100, and 88.2%, respectively. A significantly greater proportion of patients with a vaginal pH of >4.5, a positive amine test, or with clue cells on vaginal Gram smear were found to have a positive BVBlue test (P < 0.001). Women previously treated for BV were 2.98 times more likely to have another episode of BV. BVBlue is a useful point-of-care diagnostic tool to provide a presumptive diagnosis of BV, especially in situations where microscopic capabilities are unavailable.

Adult↗
PubMed2005

Reduced quantity and hydrogen-peroxide production of vaginal lactobacilli in HIV positive women.

It has been suggested that vaginal lactobacilli may influence heterosexual transmission of HIV infection. The aim of this study was to compare the vaginal flora on Gram's stained and isolation rate, quantity and H2O2 production of lactobacilli between HIV positive and HIV negative women. Although, the prevalence of abnormal vaginal flora was increased in HIV infected women, there was no significant difference in isolation rate of vaginal lactobacilli between the two groups (71.87 vs. 83.33%; P>0.05). However, the results of this study showed significantly reduced quantity of lactobacilli in HIV infected women (P<0.01). In particular, the prevalence of H2O2-producing lactobacilli was lower in HIV positive as compared to HIV negative women (80 vs. 56.52%), with borderline significance (P=0.057). Taken together, our findings showed altered vaginal microflora with reduced quantity and hydrogen-peroxide production of vaginal lactobacilli in HIV positive women, but further studies are needed to assess its actual significance and potential benefit from the use of probiotic therapy.

Adult↗
PubMed2006

Mitotically active leiomyoma of the uterus in a postmenopausal breast cancer patient receiving tamoxifen.

OBJECTIVE: Mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding has never been reported in Taiwan. Here, we present a case of mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding in a breast cancer patient who had been receiving tamoxifen for 2 years. CASE REPORT: A 56-year-old woman visited our clinic due to abnormal vaginal spotting for 3 months. This patient had been menopausal for about 6 years without hormone replacement therapy. She had been suffering from breast cancer, had undergone conservative breast surgery, and had been taking tamoxifen (20 mg/day) for 2 years. Pelvic ultrasound was performed and revealed an 8.9 x 7.7 cm uterine mass. After simple total hysterectomy, we found an enlarged uterus with a mass over the posterior wall. Final pathology demonstrated a mitotically active leiomyoma, adenomyosis of the uterus, and proliferation of the endometrium. CONCLUSION: Endometrial cancer is rarely noted in breast cancer patients taking tamoxifen. Further, none have reported mitotically active leiomyoma of the uterus. From this case, endometrial proliferation and mitotically active leiomyoma of the uterus may be related to tamoxifen therapy, and should not be neglected in breast cancer patients.

Antineoplastic Agents, Hormonal↗
PubMed1996

Comparison of Gram-stained smears prepared from blind vaginal swabs with those obtained at speculum examination for the assessment of vaginal flora.

OBJECTIVE: To determine whether Gram-stained smears obtained from blind vaginal swabs could be used reliably for the assessment of the vaginal flora. DESIGN: A prospective, blind comparative study. SETTING: The antenatal clinic of a district general hospital. PARTICIPANTS: Eighty-eight women examined and screened for the presence of bacterial vaginosis during their first antenatal clinic visit. Two smears were obtained for each woman, the first prepared from a vaginal swab taken blindly and the second at speculum examination. The smears were Gram-stained and classified according to the Nugent score: Grade 1 (normal), Grade 2 (intermediate), Grade 3 (bacterial vaginosis). RESULTS: Eight of the 88 pregnant women were identified as having bacterial vaginosis on the basis of the smear taken at speculum examination, and these were correctly identified as having bacterial vaginosis by smears prepared from the blindly taken swab. This gives the blind vaginal swab technique for detecting bacterial vaginosis a sensitivity and specificity of 100% when compared with swabbing at speculum examination. The flora of two women were graded as intermediate, and of 75 as normal by both techniques. Only in three cases was there a disparity between the two techniques, a difference that was not statistically significant (kappa = 0.8546, 95% CI 0.6945 to 1.0). CONCLUSIONS: Vaginal smears prepared from correctly taken blind vaginal swabs can be used to assess the vaginal flora and screen for bacterial vaginosis. This method could be used in epidemiological studies of bacterial vaginosis in the general population and for screening antenatal populations for abnormal vaginal flora.

Double-Blind Method↗
PubMed1983

Partial abortion associated with genital Escherichia coli infection in a bitch.

A five-and-a-half weeks pregnant Airedale terrier with a genital haemorrhage was presented. It had a history of oestrous irregularities. It was found to be anaemic and Escherichia coli was isolated from vaginal swabs. Oestradiol and progesterone levels were normal. Two fetuses were aborted on day 41 of gestation. Antibiotic treatment was given. The haemorrhage ceased but on day 61 an abnormal vaginal discharge was seen. A caesarean operation was performed from which resulted three dead and two live fetuses, which died within two days. E coli was isolated from the uterine content, although the bitch was still receiving antibiotics; it was also still anaemic. It is probable that the haemorrhage was caused by an endotoxin produced by the E coli. The anaemia in the bitch did not improve the chances of fetal survival.

Abortion, Septic↗
PubMed1993

Vaginal discharge in general practice--women's perceptions, beliefs and behaviour.

OBJECTIVES: To describe women's perceptions and beliefs about their vaginal secretion and to relate these to their behaviour with respect to complaints of vaginal discharge. DESIGN: A multi-practice study including questionnaires for women and doctors and a semi-structured interview study. SETTING: North Jutland County and Aarhus County, Denmark. SUBJECTS: 283 women with and 417 women without complaints of vaginal discharge answered a questionnaire about their vaginal secretion. Ten women with vaginal discharge took part in the in-depth interviews. RESULTS: 179/274 (65%) women with and 111/417 (27%) women without complaints of vaginal discharge were bothered by their usual secretion. In 54/269 (20%) women with complaints, the pelvic examination was normal. In 59/416 (14%) women without complaints, the doctor found an abnormal vaginal secretion. Most women complaining of vaginal discharge had an external locus of control in relation to their symptoms, but an internal locus of control in relation to health in general. Fear of having a serious disease or a sexually transmitted disease was the reason for the visit to the general practitioner in 164/281 (58%). CONCLUSION: Women's perceptions and beliefs about their vaginal secretion varied and were related to their health seeking behaviour. In addition to information about possible biological causes of vaginal discharge, the general practitioner should also actively seek information about the women's perception of normality and beliefs in relation to the symptoms she experiences.

Adult↗
PubMed1996

High-grade endometrial carcinoma in secretory endometrium in young women: a report of five cases.

Five cases of high-grade carcinoma occurring adjacent to secretory endometrium are described. One of the patients had the Lynch II syndrome, the others appeared to be sporadic. None of these cases appeared to be related to hyperestrogen. The presenting symptom in four was abnormal vaginal bleeding, and the other case was found incidentally in the course of investigations for infertility. There were delays in diagnosis due to the patients not seeking medical attention for abnormal bleeding, a reluctance of clinicians to perform dilatation and curettage, and difficulty in pathologic interpretation of the curettings. The interpretive problems related to extremely small volumes of tumor, difficulty in distinguishing carcinoma from menstrual endometrium, and difficulty in determining whether a carcinoma was endometrial rather or endocervical in origin. The tumors were aggressive, manifest by their high grade and stage. The importance of these cases is to impress upon clinicians and pathologists that endometrial carcinoma may occur in young women without any of the usual risk factors.

Adult↗
PubMed2002

Endometrial safety of hormone replacement therapy: review of literature.

Unopposed estrogens for treating menopausal symptoms were extensively used when epidemiological findings associated them with an increased endometrial cancer risk. Adding progestogens reverse this side effect efficiently but patient, dose, type and especially time during which the progestogen is administered are important. Long-term uterine safety of the long cycle HRT with administration of the progestogen every 3 months remains unclear. Because regular bleeding lowers compliance, continuous combined estrogen-progestogen treatment has become popular. Many different regimens are now available using oral, transdermal, subcutaneous, intravaginal or intra-uterine application of the estrogen and/or progestogen. Available but inadequate studies seem to point towards a slightly decreased endometrial cancer risk with continuous combined preparations compared with non-HRT-users and an increased risk with long-term oral but not vaginal treatment with low-potency estrogen formulations such as estriol. Newer compounds for menopausal health such as tibolone and raloxifene seem to be safe. As for any women with abnormal vaginal bleeding, those on HRT must have an intra-uterine evaluation. Transvaginal ultrasound (TVU) is very accurate in predicting a normal uterine cavity but inaccurate in predicting endometrial pathology because of a low specificity and positive predictive value of a thick echogenic endometrium. In all such cases a three-dimensional visualisation of intra-uterine lesions is more accurate. Periodic examination with TVU and/or endometrial biopsy of HRT exposed endometrium in asymptomatic women is not cost-effective. The available limited data on the use of HRT in hysterectomised women for early stage endometrial cancer show little evidence in terms of recurrence.

Biopsy↗
PubMed1981

Diagnosis and treatment of primary vaginal carcinoma in situ and dysplasia.

Fifteen cases of primary carcinoma in situ or severe or moderate dysplasia of the vagina have been diagnosed and treated during the period 1966-75 at the Department of Obstetrics and Gynecology, Turku University Central Hospital. Because of abnormal vaginal cytology the lesion was localized by means of colposcopy and iodine staining. For 6 patients local estrogen treatment was applied to increase the thickness of the epidermal layer. For 6 patients, treatment consisted of simple excision. Nine patients, including both those with carcinoma in situ, were treated with intravaginal radiation therapy. The radiation dosage was 2 000 to 2 600 rad at a distance of 1 cm from the surface of the epithelium. None of the patients showed any complications, and all are now symptom-free.

Adult↗
PubMed2002

[The Dutch College of General Practitioners' practice guideline, "Vaginal bleeding"; reaction from a gynaecological perspective].

The Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' is a useful instrument for general practitioners. The changes in the present version are based on recent developments in diagnostic and therapeutic possibilities, such as (hydro-)ultrasonography to diagnose intracavitary abnormalities, progesterone-containing 'intra-uterine devices' (IUDs) and endoscopic techniques for destroying the endometrium. The recommendation to prescribe cyclical progestogens in the case of hypermenorrhoea is not supported by randomised studies. On balance, this guideline provides clear and useful advice for the treatment of abnormal vaginal blood loss.

Female↗