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At least 55 records · Page 3Linked to original sources
PubMed1997

Continuous low dose estradiol released from a vaginal ring versus estriol vaginal cream for urogenital atrophy.

OBJECTIVES: To determine if the efficacy of continuous low dose estradiol released from a vaginal ring is equivalent to estriol vaginal cream regarding improvement of the patient's subjective feeling of vaginal dryness and to determine if there is a preference for either of the two study treatments. METHODS: Open-label randomized parallel group trial with active control with a blind evaluation of vaginal cytology and with a cross-over (change-over) phase for preference comparison. One hundred and sixty five postmenopausal women with symptoms of vaginal dryness and signs of vaginal atrophy were randomized to an estradiol ring (Estring) or estriol cream (Synapause). The duration of each treatment period was 12 weeks. RESULTS: Both study treatments were equally effective regarding the ability to alleviate the symptom feeling of vaginal dryness and the signs of vaginal atrophy. Both treatments were efficient in restoring the vaginal mucosa, recorded as higher maturation values and as decreased vaginal pH. Estring was superior to estriol cream regarding preference of treatment. Both treatments were equivalent for the occurrence of adverse events, including bleeding. CONCLUSION: data from this change-over study confirm efficacy and safety of both the vaginal ring and cream in the treatment of postmenopausal women with urogenital atrophy symptoms and signs. The patients had a strong preference for the vaginal ring.

Administration, Intravaginal↗
PubMed2004

Vaginal leucocyte counts in women with bacterial vaginosis: relation to vaginal and cervical infections.

OBJECTIVES: To evaluate whether an elevated vaginal leucocyte count in women with bacterial vaginosis (BV) predicts the presence of vaginal or cervical infections, and to assess the relation of vaginal WBC counts to clinical manifestations. METHODS: We retrospectively analysed the relation of vaginal leucocyte counts to vaginal and cervical infections and to clinical manifestations in non-pregnant women diagnosed with BV at an STD clinic visit. RESULTS: Of 296 women with BV studied, the median age was 24 years and 81% were African-American. Elevated vaginal leucocyte counts were associated with objective signs of vaginitis and cervicitis and also predicted candidiasis (OR 7.9, 95% CI 2.2 to 28.9), chlamydia (OR 3.1, 95% CI 1.4 to 6.7), gonorrhoea (OR 2.7, 95% CI 1.3 to 5.4), or trichomoniasis (OR 3.4, 95% CI 1.6 to 7.3). In general, as a screening test for vaginal or cervical infections, vaginal leucocyte count had moderate sensitivities and specificities, low positive predictive values, and high negative predictive values. CONCLUSIONS: An elevated vaginal leucocyte count in women with BV was a strong predictor of vaginal or cervical infections. Vaginal leucocyte quantification may provide an alternative approach to assessing need for empirical therapy for chlamydia and gonorrhoea, particularly in resource-limited high STD risk settings that provide syndromic management.

Adolescent↗
PubMed2003

Action of 25 microg 17beta-oestradiol vaginal tablets in the treatment of vaginal atrophy in Greek postmenopausal women; clinical study.

PURPOSE: To evaluate the clinical efficacy and safety of intravaginal application of 25 microg micronized oestradiol in postmenopausal women from the Greek population suffering from symptoms related to vaginal atrophy. MATERIALS AND METHODS: 91 women suffering from vaginal dryness, vaginal itching and dyspareunea were treated with 25 microg 17beta-oestradiol vaginal tablets. The duration of treatment was 12 weeks. During the first two weeks the women inserted one vaginal tablet intravaginally once daily. Thereafter, the women inserted one tablet twice per week with at least a 3-day interval between treatments to maintain therapeutic response for ten weeks. Efficacy was evaluated by the relief of vaginal symptoms and safety by the concentrations of serum oestradiol (E2) and follicular-stimulating hormone (FSH). Pretreatment and post-treatment findings were compared and each patient served as her own control. RESULTS: The rates of symptoms of vaginal dryness, vaginal itching and dyspareunea showed statistically significant differences over the course of the trial (Cochran Q test, p < 0.001). No one complained of vaginal dryness and vaginal itching after four and six weeks of treatment respectively, while in one patient the sensation of dyspareunea remained constant after the fourth week of treatment. Despite the statistically significant increase in blood oestradiol levels in relation to baseline values (ANOVA model of repeated measures, p < 0.001), these levels were within the normal range for postmenopausal women. Also, serum FSH levels were statistically significantly reduced from 47.4 mIU/ml at entry into the study to 45.5 mIU/ml after two weeks of treatment (dependent samples t-test, p < 0.003), but were clearly within the postmenopausal range. CONCLUSIONS: The twice-weekly local single treatment with vaginal tablets containing 25 microg of 17beta-oestradiol was effective and safe for the relief of symptoms related to atrophic vaginitis in postmenopausal women from the Greek population.

Administration, Intravaginal↗
PubMed2003

Vaginal evisceration after hysterectomy: the repair by a laparoscopic and vaginal approach with a omental flap.

BACKGROUND: Vaginal evisceration is generally repaired by vaginal or abdominal route. We describe two cases of vaginal evisceration using a combined laparoscopic and vaginal approach employing an omental flap. CASES: Case 1: A radical abdominal hysterectomy was performed in a premenopausal patient for a FIGO IB1 cervical cancer. Four months later, she was found to have a vaginal cuff dehiscence which was repaired by a vaginal approach. Two months later, she had a vaginal cuff evisceration which was repaired using a combined laparoscopic and vaginal approach employing an omental flap with good success. Case 2: A postmenopausal woman who underwent an abdominal hysterectomy and pelvic lymphadenectomy for a FIGO IB endometrial cancer was noted to have a vaginal evisceration two months after primary surgery. This was also successfully repaired using a combined laparoscopic and vaginal approach employing an omental flap. CONCLUSION: The combined laparoscopic and vaginal approach with omental flap is effective for repair of a vaginal cuff dehiscence with bowel evisceration. The addition of laparoscopy provides an opportunity for inspection of the small bowel, the peritoneal toilet, and mobilization of an omental flap.

Adult↗
PubMed2004

Vaginal yeast colonisation, prevalence of vaginitis, and associated local immunity in adolescents.

OBJECTIVES: To evaluate point prevalence vaginal yeast colonisation and symptomatic vaginitis in middle adolescents and to identify relation of these yeast conditions with reproductive hormones, sexual activity, sexual behaviours, and associated local immunity. METHODS: Middle adolescent females (n = 153) were evaluated for sexually transmitted infections (STIs), asymptomatic yeast colonisation, and symptomatic vulvovaginal candidiasis (VVC) by standard criteria. Also evaluated were local parameters, including vaginal associated cytokines, chemokines, and antibodies, vaginal epithelial cell antifungal activity, and Candida specific peripheral blood lymphocyte responses. Correlations between yeast colonisation/vaginitis and local immunomodulators, reproductive hormones, douching, sexual activity, condom use, and STIs were identified. RESULTS: Rates of point prevalence asymptomatic yeast colonisation (22%) were similar to adults and similarly dominated by Candida albicans, but with uncharacteristically high vaginal yeast burden. In contrast with the high rate of STIs (18%), incidence of symptomatic VVC was low (<2%). Immunological properties included high rates of Candida specific systemic immune sensitisation, a Th2 type vaginal cytokine profile, total and Candida specific vaginal antibodies dominated by IgA, and moderate vaginal epithelial cell anti-Candida activity. Endogenous reproductive hormones were in low concentration. Sexual activity positively correlated with vaginal yeast colonisation, whereas vaginal cytokines (Th1, Th2, proinflammatory), chemokines, antibodies, contraception, douching, or condom use did not. CONCLUSION: Asymptomatic vaginal yeast colonisation in adolescents is distinct in some ways with adults, and positively correlates with sexual activity, but not with local immunomodulators or sexual behaviours. Despite several factors predictive for VVC, symptomatic VVC was low compared to STIs.

Adolescent↗
PubMed1995

Anterior vaginal suspension for vaginal vault prolapse.

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.

Adult↗
PubMed1993

Laparoscopically assisted vaginal hysterectomy in a university hospital: report of 82 cases and comparison with abdominal and vaginal hysterectomy.

OBJECTIVE: The objective of this study was to critically review the indications, outcomes, complications, and costs of laparoscopically assisted vaginal hysterectomy in comparison with abdominal and vaginal hysterectomy. STUDY DESIGN: The operating room log was reviewed to determine the number and route of hysterectomies performed over a 1-year period. The charts of 50 consecutive laparoscopically assisted vaginal hysterectomies and 50 vaginal hysterectomies were reviewed. Charts from 50 selected abdominal hysterectomies were also reviewed. Information on patient characteristics, indications, complications, uterine weights, hospital stay, and patient costs were obtained and analyzed. RESULTS: Of 509 hysterectomies, 82 were performed as laparoscopically assisted vaginal hysterectomies and 73 as vaginal hysterectomies. The patient characteristics and indications of the laparoscopically assisted group more closely matched those of the abdominal hysterectomy group. The complication rate in the laparoscopically assisted group was intermediate between the other two groups, but the hospital stay was significantly less. Patient cost for laparoscopically assisted vaginal hysterectomy was significantly greater than either abdominal or vaginal hysterectomy, in spite of the shortened hospital stay. CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy offers a technique to convert some abdominal hysterectomies into vaginal hysterectomies. It appears particularly useful when an adnexal indication for surgery exists. Uterine leiomyoma does not appear to be an indication for laparoscopically assisted vaginal hysterectomy. The costs are significant because of increased operating time and costs of disposable equipment.

Abdomen↗
PubMed1994

Desquamative inflammatory vaginitis: a new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy.

OBJECTIVE: Desquamative inflammatory vaginitis is an uncommon clinical syndrome of unknown cause characterized by diffuse exudative vaginitis, epithelial cell exfoliation, and a profuse purulent vaginal discharge. The purpose of this report is to describe 51 patients with desquamative inflammatory vaginitis, the majority of whom were treated with 2% topical clindamycin in an open observational study. STUDY DESIGN: A retrospective chart review found 51 patients seen in a referral university vaginitis clinic between 1987 and 1993 who met the case definition of desquamative inflammatory vaginitis. All patients had diffuse exudative purulent vaginitis, signs of epithelial cell exfoliation (increased parabasal cells), elevated vaginal pH, and Gram stain findings of complete or relative absence of the normal long gram-positive bacilli and their replacement by gram-positive cocci. RESULTS: No consistent microbiologic pathogen was identified except for the absence of lactobacilli and an overall increase in prevalence of group B streptococci. Intravaginal treatment with 2% clindamycin suppositories resulted in clinical improvement in > 95% of patients and, although relapse occurred in 30%, overall antimicrobial cure was accomplished in all patients. Postmenopausal patients with desquamative inflammatory vaginitis occasionally required supplementary estrogen therapy to maintain remission. CONCLUSION: Desquamative inflammatory vaginitis responsive to topical clindamycin 2% therapy represents an uncommon cause of purulent vaginitis with unique clinical and laboratory characteristics. Evidence suggests a microbial, possibly gram-positive coccal, cause for this syndrome, although a specific bacterial species responsible for all cases has not been identified. The majority of cases occurred in patients in whom estrogen deficiency may have played a role in pathogenesis.

Administration, Topical↗
PubMed1998

Immunity to vaginal infection by herpes simplex virus type 2 in adult mice: characterization of the immunoglobulins in vaginal mucus.

Progestin-treated female mice are susceptible to vaginal infection by two sexually transmitted disease organisms: herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis. Vaccination of mice with HSV-2 or chlamydial antigens elicits immunity to vaginal infection that may be due in part to secreted antibodies in the vaginal lumen. Analysis of the role of these antibodies in immunity would be aided by information about the vaginal secretion in progestin-treated mice and the antibodies it contains. Gross and histologic observations of progestin-treated mice that were immune to vaginal HSV-2 infection indicated that the vaginal lumen was filled with mucus. A procedure for extraction of immunoglobulin from the mucus was developed and shown to recover at least 98% of the secretory IgA (S-IgA) that was free to diffuse from the mucus. Immunoblotting revealed that the predominant molecular form of IgA in vaginal mucus was dimeric S-IgA. Immunoglobulin concentrations in vaginal secretions were higher in immune mice than in non-immune mice and S-IgA concentrations were higher than those of IgG. The IgG concentration in vaginal secretions of immune mice was 4.5-fold higher than in non-immune mice, while serum IgG increased only 1.5-fold, suggesting local production of IgG or increased transudation in immune mice. Specific IgG antibody to HSV-2 was demonstrated in vaginal secretions of immune mice at a mean ELISA titer of 6200, whereas the titer of specific S-IgA in the same secretions was only 1.9. Thus, while the predominant immunoglobulin by weight in the vaginal mucus of immune mice was S-IgA, the ELISA titers suggested that the virus-specific antibody was almost entirely IgG.

Animals↗
PubMed2001

Changes in the vaginal flora after two percent clindamycin vaginal cream in women at high risk of spontaneous preterm birth.

OBJECTIVE: To analyse alterationS in the vaginal flora after 2% clindamycin vaginal cream or placebo administered for the prevention of preterm delivery in high risk women. DESIGN: Observational study during a randomised multicentre double-blind placebo controlled trial. SETTING: Twelve city hospitals in The Netherlands. PARTICIPANTS: One hundred and sixty-eight women were enrolled. Alterations in the vaginal flora could be analysed in one hundred and twenty-four women by comparing the Nugent score on entry to the trial and at 31 weeks' gestation. The Nugent score was classified into normal, intermediate and bacterial vaginosis. INTERVENTIONS: Two percent clindamycin vaginal cream or placebo cream administered daily for seven days at week 26 of pregnancy. MAIN OUTCOME: Changes in the vaginal flora at week 31 of pregnancy. RESULTS: The placebo group consisted of 64 women and the clindamycin group of 60 women. At week 31 the vaginal flora was similar to week 26 with placebo cream but changed from normal vaginal flora to intermediate or bacterial vaginosis with 2% clindamycin vaginal cream. CONCLUSION: Obstetricians should not prescribe 2% clindamycin vaginal cream to pregnant women with normal vaginal flora in order to reduce the incidence of preterm birth. because it has no beneficial effects and is actually harmful. 2% Clindamycin vaginal cream encourages the presence of bacterial vaginosis which is epidemiologically associated with preterm birth.

Administration, Intravaginal↗
PubMed2004

Efficacy and tolerability of a new chlorhexidine-based vaginal gel in vaginal infections.

OBJECTIVE: We evaluated the efficacy and tolerability of a new chlorhexidine-based bioadhesive vaginal gel (Clomirex) in women with vaginal infections. STUDY DESIGN AND SUBJECTS: A total of 90 nonpregnant women with vaginal infections of both bacterial (bacterial vaginosis: BV) or fungal (vaginal candidiasis VC) origin, were enrolled in the study: a randomised, controlled, 4-week, multicentre trial. Patients were randomly treated with either chlorhexidine 0.5% vaginal gel (CHX-VG), 2.5 g or with metronidazole vaginal tablets 500 mg (M) or clotrimazole (CL) vaginal cream, depending on aetiology of the infection, daily for 7 days (treatment phase) in a 2:1 ratio. A total of 45 women had a diagnosis of BV and 45 a diagnosis of VC. Sixty women were treated with CHX-VG, 15 with M and 15 with CL. All patients were followed for an additional 3 weeks without treatments (follow-up phase). For women with BV,clinical cure rate was defined as the disappearance of the following signs and symptoms: homogenous vaginal discharge; presence of >or= 2 or more clue cells at the wet mount microscopy; a vaginal pH > 4.7 and a positive whiff test. For women with VC, clinical cure rate was defined as a resolution of signs and symptoms plus absence of hyphae, pseudohyphae and blastospores on 10% KOH wet mount microscopy. Clinical cure rate was assessed at the end of the study (week 4) by an investigator unaware of the patient's treatment allocation. RESULTS: At week 4, in women with BV, 28 out of 30 (93%) women in the CHX-VG group were clinically cured in comparison with 11 out of 15 (74%) in the M group (p = 0.3). In women with VC, 26 out of 30 (86.6%) women in the CHX-VG group were clinically cured in comparison with 13 out of 15 (86%) in the CL group (p = 0.5). Tolerability was good and very good in 90% of the CHX-VG patients. Six women (10%) complained of a mild transient burning sensation after CHX-VG vaginal application. No serious adverse events were observed during the trial in all treated groups. No women presented with vaginal discharge after treatment.

Adult↗
PubMed1987

Non-specific vaginitis or vaginitis of undetermined aetiology.

Vaginitis is a complex syndrome that is probably the most common outpatient disease seen by the gynaecologist. The specific aetiologies of vaginitis are many. One of the most common entities, however, is "non-specific vaginitis" which can be subdivided into: Gardnerella vaginitis, anaerobic vaginosis, and vaginitis of undetermined aetiology. The role of Gardnerella as a causative agent for vaginitis has been studied in depth but its specific role remains controversial. Anaerobic vaginosis can be diagnosed by noting on microscopic examination the presence of clue cells, free-floating bacteria and numerous white blood cells (WBC's). Culturing an aliquot of the vaginal discharge reveals a high number of anaerobes. In addition, this condition responds to antibiotics effective against anaerobes, e.g., metronidazole. Vaginitis of undetermined aetiology is more complex and is characterized by a purulent vaginal discharge, a pH of 4.0-4.6, numerous WBC's, and a high concentration of bacteria. The microbiology of this vaginitis includes many facultative Gram-negative rods and Gram-positive cocci. Anaerobes may be present but do not make up a large component of the endogenous microflora. This condition does not respond to the usual antibiotic therapies employed in treating bacterial vaginitis. Since this condition appears to be primarily an inflammatory reaction, it may be responsive to topical antiinflammatory agents such as benzydamine.

Adolescent↗
PubMed1988

A localized vaginal allergic response in women with recurrent vaginitis.

In women with recurring vaginitis, treatment of a vaginal Candida infection is not always accompanied by an alleviation of symptoms, and infection frequently reappears after termination of the chemotherapeutic agent. To determine whether an allergic reaction might be involved in symptom prolongation and susceptibility to reinfection, sera and vaginal washes from patients were examined for specific IgE antibodies. With RAST modified to ELISA, anti-Candida albicans IgE was identified in 18.8% of saline vaginal washes, but in only 6.1% of sera, obtained from 64 patients. Similarly, 25% of 16 patients were positive for vaginal fluid IgE, but only 6.3% had serum IgE to their partners' seminal fluid. The detection of specific IgE antibodies vaginally but not in the peripheral circulation suggested the occurrence of a localized vaginal hypersensitivity response. Vaginal fluid-derived IgE antibodies reactive with contraceptive spermicides or present in the particulate fraction of saline vaginal washes were also identified. Vaginal fluids with IgE antibodies also contained detectable levels of prostaglandin E2. A vaginal allergic response can predispose to recurrent Candida infection by inducing prostaglandin E2 synthesis that suppresses cell-mediated immune responses.

Allergens↗
PubMed2003

Efficacy of the combination of 2 g oral tinidazole and acidic buffering vaginal gel in comparison with vaginal clindamycin alone in bacterial vaginosis: a randomized, investigator-blinded, controlled trial.

OBJECTIVE: To evaluate the efficacy of tinidazole (T) (Trimonase, Mipharm, Italy) and an acidic vaginal gel (Miphil) (M) in comparison with vaginal clindamycin (CL) (Cleocin Pharmacia Upjohn) in BV. DESIGN: A multicentre, randomised, investigator-blinded, controlled trial. POPULATION AND METHODS: 64 women with BV were enrolled. Thirty-two were allocated to receive oral T 2g, single dose, and 32 were assigned to CL 2% for 7 consecutive days. After week 1, T group were treated with an acidic vaginal gel, 2g every 3 days, for additional 3 weeks, whereas CL group did not received any additional treatment. Patients were evaluated at week 1 and 4. Vaginal pH, the BV-blue test (Gryphus Diagnostics, USA) and the whiff test were performed at baseline and at week 4. MAIN OUTCOMES MEASURES: Clinical cure rate; normalisation of vaginal pH (pH<4.5); and laboratory cure rate (defined as a clinical cure rate and a negative results of BV-blue and whiff test). RESULTS: At baseline, vaginal pH values were (mean+/-S.D.) 5.4+/-0.7 and 5.3+/-0.5 in T and CL groups, respectively. Six patients (2 in T group and 4 in CL group) withdrew from the study due to side effects. At week 1, the clinical cure rates were 84% in both T and CL treated group (P=N.S.). At week 4, clinical cure rates were 94% in T+M group and 77% in CL group (P=N.S.). The laboratory cure rates were 81% in T+M group and 59% in CL group (P<0.04). Vaginal pH normalisation (i.e. pH <4.5) was achieved in 78% and in 38% of T+M and CL groups, respectively (P<0.0007). CONCLUSIONS: In the short term, 2g single oral dose tinidazole was at least as effective as 7-day of vaginal clindamycin. The sequential treatment of tinidazole and acidic vaginal gel was superior to vaginal clindamycin in lowering vaginal pH and achieving a higher laboratory tests normalization rate at 1-month follow-up.

Administration, Intravaginal↗
PubMed2001

Nasal and vaginal vaccinations have differential effects on antibody responses in vaginal and cervical secretions in humans.

Sexually transmitted diseases are a major health problem worldwide, but there is still a lack of knowledge about how to induce an optimal immune response in the genital tract of humans. In this study we vaccinated 21 volunteers nasally or vaginally with the model mucosal antigen cholera toxin B subunit and determined the level of specific immunoglobulin A (IgA) and IgG antibodies in vaginal and cervical secretions as well as in serum. To assess the hormonal influence on the induction of antibody responses after vaginal vaccination, we administered the vaccine either independently of the stage in the menstrual cycle or on days 10 and 24 in the cycle in different groups of subjects. Vaginal and nasal vaccinations both resulted in significant IgA and IgG anti-cholera toxin B subunit responses in serum in the majority of the volunteers in the various vaccination groups. Only vaginal vaccination given on days 10 and 24 in the cycle induced strong specific antibody responses in the cervix with 58-fold IgA and 16-fold IgG increases. In contrast, modest responses were seen after nasal vaccination and in the other vaginally vaccinated group. Nasal vaccination was superior in inducing a specific IgA response in vaginal secretions, giving a 35-fold increase, while vaginal vaccination induced only a 5-fold IgA increase. We conclude that a combination of nasal and vaginal vaccination might be the best vaccination strategy for inducing protective antibody responses in both cervical and vaginal secretions, provided that the vaginal vaccination is given on optimal time points in the cycle.

Administration, Intranasal↗
PubMed1999

Vaginal fluid pH as a screening test for vaginitis.

OBJECTIVE: To assess how effective the pH test can detect infectious vaginitis. METHODS: Ambulatory gynecological patients attending the gynecological out-patient department of Srinagarind Hospital from May 1 to July 31, 1997 were assessed for vaginitis by history, overall physical examination and vaginal examination. Specimens were collected for microbiological examination and measurement of pH level. RESULTS: Among 422 women recruited, a vaginal fluid pH level greater than 4.5 was found in 149 (35.3%) cases. The vaginal fluid pH as a screening test for infectious vaginitis showed a sensitivity of 49.7% (95% C.I.: 42.6-56.9). When using vaginal fluid pH combined with clinical symptoms and signs to screen for vaginitis the sensitivity was 67.5% (95% C.I.: 60.4-73.9). If a pH test was used to screen for BV, its sensitivity was 73.4% (95% C.I.; 60.7-83.3). Using a pH test in combination with clinical symptoms and signs of vaginitis to screen for BV, its sensitivity was 81.3% (95% C.I.: 69.2-89.5). CONCLUSION: Vaginal fluid pH combined with clinical symptoms and signs had a considerably high sensitivity to screen for BV.

Adult↗
PubMed2002

Vaginal estrogen preparations: a review of safety and efficacy for vaginal atrophy.

BACKGROUND: A theoretical advantage of local (i.e., vaginal) therapy of genitourinary symptoms could be avoidance of systemic adverse effects. Review of efficacy and adverse effects of commonly prescribed vaginal estrogens is of great clinical relevance. METHODS: A Medline (1966-present) search was performed for randomized controlled trials involving vaginal estrogens. Reference lists of papers were reviewed for additional references. RESULTS: Twenty-two references were randomized controlled trials of vaginal estrogens used by postmenopausal women with signs or symptoms of vaginal atrophy. Subject numbers ranged from 20 to 251. Duration ranged from 2 weeks to 1 year. Different preparations and schedules were used across the trials. All treatments alleviated signs and symptoms of atrophic vaginitis, regardless of whether objective signs of atrophy were required for study entry. Data for urinary symptoms was conflicting; the ring may prevent recurrent urinary tract infections (UTIs). The trials with endometrial scrutiny were less than one year and had mixed results. Nonhormonal lubricant is effective in improving some atrophic signs and symptoms. All preparations were associated with vaginal irritation. Bleeding with vaginal estradiol tablets may be less than that with CEE cream. Vaginal tablets or rings were preferred over other preparations. There were no serious adverse events reported. There was occasional expulsion of estradiol ring in the setting of prior hysterectomy. CONCLUSIONS: All preparations are effective in decreasing signs and symptoms of vaginal atrophy, but they differ slightly in their adverse event profiles. Long-term safety of the preparations is best established for estradiol tablets (1 year), but is lacking for all preparations.

Administration, Intravaginal↗
PubMed1996

Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: a preliminary study with perineal ultrasonography using contrast medium.

Fifteen consecutive women (mean age 44.5 years) without pelvic relaxation underwent total abdominal (5), vaginal (5) and laparoscopic (5) hysterectomy for benign disease. The vaginal axes of the patients were examined prior to and on average 7 weeks (range 3-10) after the operation with perineal ultrasonography enhanced with an ultrasound contrast medium (SHU454/Echovist-300). Transabdominal and vaginal hysterectomies were performed in the classic manner, i.e. the round as well as cardinal and sacrouterine ligaments were attached to the vaginal vault, followed by peritonealization. In laparoscopic hysterectomy the round, broad and outer parts of the uterosacral and the upper parts of the cardinal ligaments were desiccated by bipolar electrocoagulation and cut with laparoscopic scissors. The vagina was closed by interrupted sutures with no specific fixation of the round, cardinal or uterosacral ligaments. Preoperative ultrasound findings showed that in all women the vagina was an angulated organ. The mean preoperative angle between the upper and lower vaginal portions was 108 degrees, in both the supine and the standing positions. Postoperatively this angulated shape remained almost unchanged after vaginal (mean angle 117 degrees ) and laparoscopic hysterectomy (mean angle 130 degrees ), whereas after transabdominal hysterectomy the vaginal axis rotated anteriorly and became an almost straight tube (mean angle 158 degrees). We conclude that the vaginal axis, at least at an early stage after vaginal and laparoscopic hysterectomy remained in almost the same position as preoperatively, in contrast to that after abdominal hysterectomy. A tight attachment of the round ligaments to the vaginal vault in the abdominal approach could explain the outcome of transabdominal hysterectomy, and should be called into question.

Adult↗