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PubMed2005

A rat model to study the structural properties of the vagina and its supportive tissues.

OBJECTIVE: The purpose of this study was to investigate the rat as a model for evaluating the structural properties of the vagina and its supportive tissues. STUDY DESIGN: The in situ relationships between the vagina and its supportive tissues were studied grossly (n = 10), and in serial cross sections (n = 4). For biomechanical testing (n = 10), the lumbar spine was fixed to a testing machine while the distal vagina was gripped with a soft-tissue clamp mounted to a load-cell on the crosshead of the machine. The vagina was systematically pulled through the pelvis until failure of the supportive tissues occurred. Parameters describing the structural properties of the tissues (linear stiffness, ultimate load, ultimate elongation, and energy absorbed to failure) were determined from the resulting load-elongation curve. A coefficient of correlation (R) was used to determine experimental reproducibility. RESULTS: The rat vagina is supported by structures analogous to those in humans. The parameters describing the structural properties of these tissues were highly correlated among specimens (R = 0.95). The mechanism of failure was similar for all specimens. CONCLUSION: We have developed a mechanical testing protocol in which the structural properties of the vagina-supportive tissue complex can be measured. This will be a powerful tool for testing the impact of life events on vaginal support.

Animals↗
PubMed1997

An evaluation of the amount of nonoxynol-9 remaining in the vagina up to 4 h after insertion of a vaginal contraceptive film (VCF) containing 70 mg nonoxynol-9.

The objectives of this study were to determine the amount of nonoxynol-9 (N-9) remaining in the vagina 30 min and 1, 1.5, 2, and 4 h after vaginal insertion of a single sheet of VCF containing 70 mg N-9 and to compare these results to the manufacturer's instructions for use of this product. A new method of vaginal lavage was used to obtain samples for N-9 determination. This was an open-label, noncomparative, pharmacokinetic study in 12 healthy women volunteers not at risk for pregnancy. The study consisted of a screening visit followed by five test visits approximately 1 month apart and a final visit 1 week after all test visits were completed. At each test visit, the investigator inserted a single sheet of VCF in the vagina of the volunteer at midcycle. The volunteer remained in the clinic and underwent vaginal lavage with normal saline after one of five specified time intervals had elapsed. The sequence of the intervals completed by each volunteer was determined by randomization. When undissolved film was found in the vagina, it was removed prior to lavage and assayed for N-9 content separately from that recovered in lavage fluid. It was assumed that the N-9 in undissolved film would not contribute significantly to sperm immobilization. Between 18.5 and 28.5 mg of N-9 were recovered in lavage fluid after intervals of 0.5, 1, 1.5, and 2 h. These levels did not differ statistically (p > 0.05). The amount of N-9 recovered dropped significantly at 4 h to 11.0 mg. If it is assumed that an N-9 concentration of 0.100 mg/mL is required to immobilize sperm in vitro, this study suggests that the amount of N-9 remaining in the vagina in the form of dissolved film up to 4 h after insertion of VCF is sufficient to immobilize sperm. The lavage procedure may not have recovered all N-9 remaining in the vagina. However, intercourse did not take place between insertion and lavage; if it had, the proportion of the film remaining undissolved and the total amount N-9 remaining in the vagina at the time of examination might have been affected.

Administration, Intravaginal↗
PubMed2000

Contrast vaginography is more accurate than the radiopaque rod for localization of the vagina.

PURPOSE: To compare the radiopaque vaginal rod method with contrast vaginography in localization of the vagina. METHODS AND MATERIALS: In 25 female patients who needed pelvic radiotherapy, both our standard localization procedure using the vaginal rod and a localization procedure using contrast vaginography were performed. As a rod can change the position of the vagina, contrast vaginography was considered to display the true anatomic position of the vagina. The corresponding rod and nonrod X-rays of each patient were compared. The distance from the true vaginal apex to the displaced vaginal apex (= the top of the rod) was measured in the sagittal plane. This distance was called the inaccuracy of the rod method. Furthermore, the size of the vaginal vault was measured using the contrast vaginography. RESULTS: The median inaccuracy of the rod method was 13 mm (range 2 to 24 mm). The maximal width of the vagina ranged from 24 to 68 mm in the frontal plane (median 39 mm) and from 3 to 22 mm in the sagittal plane (median 10 mm). CONCLUSION: The rod method is not accurate to localize the vagina. Furthermore, the rod gives no information on the actual size of the vaginal vault. Contrast vaginography is the method of choice to localize the vagina.

Contrast Media↗
PubMed1994

Toxic shock syndrome toxin-1 (TSST-1) production and phage susceptibility of Staphylococcus aureus strains from human vaginas and anterior nares in Trinidad.

The carriage rates of Staphylococcus aureus in the anterior nares of children and women as well as in the vagina of women were determined. The ability of strains of S. aureus to produce toxic shock syndrome toxin-1 (TSST-1) and their susceptibility to phages of the international phage set (IPS) for human strains were also investigated. Of 200 women studied, the carriage rate of S. aureus in high vaginal swabs and anterior nares swabs was 57 (28.5%) and 73 (36.5%), respectively. Eight (4.0%) and 16 (8.0%) patients were carriers of TSST-1-producing strains in their vaginas and anterior nares, respectively. Amongst the 220 children sampled, 100 (45.5%) were carriers of S. aureus in their anterior nares, with 51 (23.2%) children being positive for TSST-1 producing strains. Overall, of the 233 strains of S. aureus isolated from all sources 176 (75.5%) were typable and 75 (32.2%) were positive for TSST-1 production. For strains from anterior nares, isolates from children were more susceptible (81.2%) to IPS phages than those from women (67.1%) but the difference was not significant (P > or = 0.05; chi 2). Forty-five (76.3%) of 59 strains of vaginal origin were typable. The frequency of production of TSST-1 amongst strains isolated from children, i.e. (50.5% (51 of 101), was significantly higher (P > or = 0.001; chi 2) than that found for isolates from women's anterior nares (21.9%) and vagina (13.6%). S. aureus was recovered from both the anterior nares and vaginal swabs of 11 patients sampled. The phage patterns of 5 of the 6 typable pairs of isolates established their relatedness suggesting that the same strains colonized the anterior nares and vagina of each of these patients. It was concluded that the carriage of TSST-1-producing strains of S. aureus in the anterior nares and vagina of women was much lower than that detected in children's anterior nares and that the risk of vaginal toxic shock syndrome (TSS) in Trinidadian women was relatively low. Susceptibility of strains was high to IPS phages. Epidemiological significance was attributed to the finding that the same strains of S. aureus colonized the anterior nares and vaginas of some women.

Bacterial Toxins↗
PubMed2001

Sympathetic efferent pathways projecting to the vagina in the dog.

The level of the thoracolumbar sympathetic outflow projecting to the vagina and the laterality of the signals passing through the splanchnic nerves to the vagina have not been well understood. This study was undertaken to explore the sympathetic innervation of the canine vagina by measuring intraluminal pressure of the vagina and contraction of the vaginal wall by electrical stimulation of each of the thoracolumbar splanchnic nerves with or without transection of unilateral hypogastric nerve (HGN). The 2nd-4th lumbar splanchnic nerve (LSN) stimulation elicited elevation of intraluminal pressure of the vagina and contraction of the vaginal wall. In contrast, intermesenteric plexus stimulations caused no response in both the vaginal pressure and the wall itself. On the right side, 12 of 27 LSNs that were stimulated elicited elevation of vaginal pressure and 16 of 32 LSN stimulations caused contraction of the wall, 10 increases in tension and 6 reductions. On the left side, 14 of 26 LSN stimulations elicited elevation of vaginal pressure and 12 of 27 LSN stimulations caused contraction of the wall, 5 increases in tension and 7 reductions. After transection of the right HGN, 6 of 14 right LSN stimulations elicited elevation of vaginal pressure and 10 of 15 right LSN stimulations caused contraction of the wall, 9 increases in tension and 1 reduction. After transection of the left HGN, 13 of 19 left LSN stimulations elicited elevation of vaginal pressure and 10 of 18 left LSN stimulations caused contraction of the wall. 4 increases in tension and 6 reductions. The results indicate that each of the L2-L4 LSNs on either side sends signals to the canine vagina via multiple routes with a crossing site at the level of the caudal mesenteric plexus (CMP).

Animals↗
PubMed1986

Time required for spermatozoa to remain in the vagina of the ewe to ensure conception.

Oestrous ewes (N = 202) were inseminated with 0.1 ml of semen containing 500 X 10(6) motile spermatozoa and the spermatozoa were flushed from their vagina either immediately or 0.25, 0.5, 1, 2, 4 and 8 h after insemination. Pregnancy was determined by returns to service and laparoscopy. Some ewes became pregnant (10.71%) after spermatozoa had been flushed from the vagina only seconds after insemination and about 40% of ewes became pregnant after spermatozoa had been in the vagina for 15 min. Maximum conception (55%) was achieved when spermatozoa had been in the vagina for at least 2 h. It was concluded that the losses of spermatozoa that occur from the vagina will not influence the chance of a ewe conceiving because sufficient spermatozoa to ensure a normal conception move up the reproductive tract before large losses from the vagina take effect.

Animals↗
PubMed2006

A prospective study examining the anatomic distribution of nerve density in the human vagina.

INTRODUCTION: Women possess sufficient vaginal innervation such that tactile stimulation of the vagina can lead to orgasm. However, there are few anatomic studies that have characterized the distribution of nerves throughout the human vagina. AIM: The aim of this prospective study was to better characterize the anatomic distribution of nerves in the adult human vagina. A secondary aim was to assess whether vaginal innervation correlates with the subject's demographic information and sexual function. METHODS: Full-thickness biopsies of anterior and posterior vagina (proximal and distal), cuff, and cervix were taken during surgery in a standardized manner. Specimens were prepared with hematoxylin and eosin, and S100 protein immunoperoxidase. The total number of nerves in each specimen was quantified. Enrolled patients completed a validated sexual function questionnaire (Female Sexual Function Index, FSFI) preoperatively. MAIN OUTCOME MEASURES: A description of vaginal innervation by location and an assessment of vaginal innervation in association with the subject's demographic information and sexual function. RESULTS: Twenty-one patients completed this study, yielding 110 biopsy specimens. Vaginal innervation was somewhat regular, with no site consistently demonstrating the highest nerve density. Nerves were located throughout the vagina, including apex and cervix. No significant differences were noted in vaginal innervation based on various demographic factors, including age, vaginal maturation index, stage of prolapse, number of vaginal deliveries, or previous hysterectomy. There were no correlations between vaginal nerve quantity and FSFI domain and overall scores. Fifty-seven percent of the subjects had female sexual dysfunction; when compared to those without dysfunction, there were no significant differences in total or site-specific nerves. CONCLUSIONS: In a prospective study, vaginal nerves were located regularly throughout the anterior and posterior vagina, proximally and distally, including apex and cervix. There was no vaginal location with increased nerve density. Vaginal innervation was not associated with demographic information or sexual function.

Adult↗
PubMed1988

Vagina: evaluation with MR imaging. Part I. Normal anatomy and congenital anomalies.

The appearance of the vagina was evaluated on magnetic resonance (MR) images of 65 subjects who were healthy or had disease unrelated to the vagina and 24 patients with suspected congenital anomalies of the vagina. MR imaging accurately demonstrated the presence of (n = 78) or complete (n = 7) or partial (n = 4) absence of the vagina in each case. Partial (n = 2) or complete (n = 2) duplication of the vagina was also correctly diagnosed. Regardless of field strength, T2-predominant images were essential for evaluation. The transverse plane was optimal, and a 5-mm section thickness was preferable. Estrogen stimulation affected the appearance of the vagina: The contrast between the vaginal wall and the central mucus-containing area was greatest during the early proliferative and late secretory phases. MR imaging offers unique depiction of congenital anomalies and should be used when results of physical examination or other radiologic studies, such as ultrasound, are inconclusive.

Disorders of Sex Development↗
PubMed2006

Global gene expression in mouse vaginae exposed to diethylstilbestrol at different ages.

Estrogens regulate proliferation and differentiation of cells in target organs such as the female reproductive tract. In mature mice, estrogens stimulate cell proliferation, whereas ovariectomy results in atrophy of the female reproductive tract. In contrast, perinatal exposure to estrogens, including diethylstilbestrol (DES), induces persistent, ovary-independent vaginal stratification and cervico-vaginal tumors later in life. These effects are due to altered cell fate following DES exposure during a critical developmental period. The detailed mechanisms underlying the reversible and irreversible cell proliferation in vaginae induced by DES at different ages has not been clarified. Therefore, we examined differences in gene expression pattern using DNA microarray analysis in mouse vaginae 6 hrs after a single injection of 2 mug DES per gram of body weight, and proliferation of vaginal epithelial and stromal cells 24 hrs after the injection at postnatal days (PNDs) 0, 5, 20, and 70. After DES stimulation, vaginal epithelial and stromal cells showed cell proliferation at PNDs 20 and 70, and at PNDs 0 and 5, respectively. DNA microarray analysis exhibited 54 DES-induced genes and 9 DES-repressed genes in vaginae at PND 0, whereas more than 200 DES-induced genes were found in vaginae at PNDs 5 and 20, and 350 genes at PND 70. Clustering analysis of DES-induced genes in the vaginae at different ages revealed that genes induced by DES at PND 5 were closer to the adult type than that of PND 0. Genes related to keratinocyte differentiation, such as Gadd45alpha, p21, 14-3-3 sigma, small proline-rich protein 2f (Sprr2f), and Krupple-like factor 4 (Klf4), were induced by DES. The number of DES-induced genes during the critical period, PND 0, was smaller than those found after the critical period. These results give insight toward understanding the molecular mechanisms underlying the critical period in mouse vaginae.

Animals↗
PubMed1987

Growth-promoting effects of relaxin and related compositional changes in the uterus, cervix, and vagina of the rat.

Although the precise role of relaxin has yet to be elucidated, it has been implicated in the regulation of physiological and biochemical processes in the reproductive tract during pregnancy and parturition. In this study, the growth-promoting effects of relaxin and related compositional changes in the uterus, cervix, and vagina of immature ovariectomized estrogen-primed rats were examined. Relaxin increased the wet weight of the uterus, cervix, and vagina in a significant and linear manner over the log of the dose range (1-30 micrograms; 6 h). The increase in uterine weight was due to increases in both dry weight and water content at all doses. A dose of 1 microgram relaxin induced maximal increases in dry weights in the cervix and vagina over control values; higher doses increased wet weight, but these changes were due solely to increases in water content. Thirty micrograms of relaxin were found to increase total soluble protein and glycogen content of the vagina above control values after 6 h. Relaxin did not alter the total collagen levels of the uterus or cervix, and collagen concentrations were significantly reduced in these organs 6 and 24 h after treatment. Total glycosaminoglycan levels were elevated by relaxin in the uterus (6 h) and cervix (24 h). Total vaginal collagen was increased 24 h after relaxin injection, but the collagen concentration was decreased over the time interval studied, and glycosaminoglycan levels in the vagina were unaltered. In summary, relaxin stimulates growth of the uterus, cervix, and vagina by increasing water content and tissue mass. The increases in distensibility that relaxin induces in these organs appear to be related to changes in the fluid matrix and proteoglycan metabolism rather than alterations in collagen concentration, at least 6-24 h after a single injection. These results support the hypothesis that relaxin plays a significant role in the maintenance of pregnancy through its contribution to fetal accommodation and in the facilitation of parturition through expansion of the entire birth canal.

Animals↗
PubMed2001

Evidence that relaxin inhibits apoptosis in the cervix and the vagina during the second half of pregnancy in the rat.

The growth of the cervix and vagina that occurs during the second half of rat pregnancy is accompanied by an increase in both epithelial and stromal cells. Neither the mechanism(s) that regulates this accumulation of cells nor its hormonal control is known. To test the hypothesis that the rate of apoptosis declines during the second half of pregnancy, cervices and vaginas were collected on days 5, 10, 15, 18, and 21 of pregnancy. Terminal deoxynucleotidyl transferase-mediated deoxyuridine 5'-triphosphate nick end-labeling was used to detect apoptotic cells. The rate of apoptosis declined (P < 0.05) in epithelial and stromal cells in both the cervix and vagina during the second half of pregnancy, when blood levels of relaxin are increasing. To test the hypothesis that relaxin inhibits apoptosis, cervices and vaginas were collected 6, 12, 24, 48, and 72 h after the neutralization of endogenous relaxin, on days 19-21 of pregnancy, with a monoclonal antibody for rat relaxin. Both the terminal deoxynucleotidyl transferase-mediated deoxyuridine 5'-triphosphate nick end-labeling method and electron microscopy were used to detect apoptotic cells. Withdrawal of relaxin caused an increase in the rate of apoptosis in both the cervix and the vagina (P < 0.05). It is concluded that the rate of apoptosis declines in the cervix and the vagina during the second half of rat pregnancy, and that relaxin likely contributes to this process.

Animals↗
PubMedDate not supplied

Establishment and characterization of clonal cell lines from the vagina of p53-deficient young mice.

Clonal cell lines have been established from vagina of prepubertal female p53(-/-) mice. Because the mouse vagina has a dual origin (the cranial three-fifths derived from the Müllerian duct and the caudal two-fifths derived from the urogenital sinus), both parts were separately subjected to cloning. Sixteen epithelial and two fibroblastic cell lines were established from the cranial three-fifths (Müllerian vagina group), and four epithelial and three fibroblastic cell lines were established from the caudal two-fifths (sinus vagina group). They were maintained in Dulbecco's modified Eagle medium and Ham's nutrient mixture F-12 containing 10% fetal calf serum and 17 beta-estradiol at 10(-8) M. Two cell lines (one epithelial and one fibroblastic) were examined using soft agar assay, but no colonies were formed. The doubling time of the cell lines was approximately 24 h, and all of them divided more than 200 times without crisis, suggesting that they were immortalized. All epithelial cell lines expressed cytokeratin 8. However, the epithelial cell lines expressed cytokeratin 14 and cytokeratin 10 when exposed to medium containing different concentrations of Ca(2+). Fibroblastic cell lines expressed vimentin. All epithelial and fibroblastic cell lines expressed estrogen receptor-alpha protein. This is the first successful establishment of clonal cell lines from the normal mouse vagina, and these lines may provide good models in vitro of the vagina for the study of the mechanism of estrogen action.

Animals↗
PubMed1999

[Study of concurrent reconstruction of posterior wall of vagina with pedicled muscular flap of uterus after resection of rectum carcinoma].

OBJECTIVE: To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma. METHODS: From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus. RESULTS: The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm. CONCLUSION: Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it's suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.

Adult↗
PubMed2004

[Improved laparoscopic Vechitti procedure for constructing a functioning vagina].

OBJECTIVE: To investigate the clinical effect of improved laparoscopic Vechitti procedure for constructing a functioning vagina. METHODS: By using the method of raising vestibular mucosa, 18 patients with congenital absence of vagina and uterus underwent surgery in our hospital. No cave was made between bladder and rectum. The procedure involved puncturing the vulvar vestibulum pit with an epidural paracentetic needle or specially-made needle into abdominal cavity through rectovesical interspace, two drag-lines was introduced through anterior abdominal wall, using the line to tie a clothes button of 2.0-2.5 cm diameter to the vulva, rasing the lines day by day, the vestibule go upward along with the button, then the vagina was formed. RESULTS: After the procedures, the artificial vagina of all 18 patients could hold a speculum and the mucosa appeared soft and smooth with normal lubrication. The vulvar tissues appeared uninjured and normal in all cases. The married patients were satisfactory to the intercourse. One case of vagino-rectal fistula was observed in a patient after she rode a bicycle with the vaginal mould. CONCLUSION: The improved laparoscopic Vechitti procedure for constructing a functioning vagina has less trauma than conventional operation and is easy to operate. Therefore, the new improved procedure is a preferred way in constructing vagina for treating those patients.

Adult↗
PubMed2006

Vaginal and uterine pressure response to semen deposition into the vagina and uterus: human study.

PURPOSE OF INVESTIGATION: The effect of semen deposition in the vagina or uterine cavity on both uterine and vaginal pressure has scarcely been reported in the literature. We investigated the hypothesis that semen deposition in the vagina or uterus effects changes in their pressure. METHODS: The study comprised 27 healthy women volunteers (mean age 36.4 +/- 11.6 years). Both uterine and vaginal pressure were measured under basal conditions and on semen or saline deposition in the vagina and uterus. RESULTS: Upon semen deposition in the vagina, the vaginal pressure showed no significant changes (p > 0.05) while the uterine pressure exhibited a significant intermittent rise (p < 0.05). Semen deposition into the uterine cavity caused no vaginal pressure changes (p > 0.05) while the uterine pressure exhibited an intermittent increase (p < 0.01). Saline injection into the vagina or uterus showed no significant pressure changes (p > 0.05). CONCLUSION: Semen deposition into the vagina or uterine cavity was associated with uterine pressure elevation that might eventually help transport the sperm to the oviduct. Further studies are required to define the substances responsible for this effect.

Adult↗
PubMed2006

A study on the etiology of uterine pressure rise on semen deposition in the vagina or uterus.

PURPOSE OF INVESTIGATION: In a recent study we have demonstrated that semen deposition into the vagina or uterus effects uterine pressure rise which is suggested to assist in "sucking" semen into the uterine cavity. The purpose of this study was to investigate whether the uterine pressure rise is effected by the sperm or the substances contained in the seminal plasma, and to test the response of the vagina and uterus to abnormal semen deposition. METHODS: Semen was obtained from 60 men divided into four groups: A) obstructive azoospermia, B) Sertoli cell-only syndrome, C) oligozoospermia and D), fertile subjects. Before and after semen deposition into the vagina and uterus both vaginal and uterine pressure were recorded. RESULTS: Semen from groups A and B produced no significant vaginal or uterine pressure changes (p > 0.05) when it was deposited into either the vagina or uterus. Group C and D semen when placed in the vagina or uterus separately effected significant intrauterine pressure rise (p < 0.05) but no vaginal pressure changes (p > 0.05). The pressure rise was higher when the semen was deposited in the uterus than in the vagina (p < 0.05) and with the normospermic than oligozoospermic semen (p < 0.05). In groups C and D, the seminal plasma produced no vaginal or uterine pressure changes (p > 0.05), whereas the sperm effected intrauterine pressure rise (p < 0.05) which was more elevated with sperm from normospermic than oligozoospermic semen (p < 0.05). CONCLUSIONS: Aspermic semen did not effect vaginal or uterine pressure rise, while oligozoospermic and normospermic semen produced rise of uterine but not vaginal pressure. Uterine pressure rise was induced by the sperm and not the seminal plasma. Further studies are required to define the sulstances secreted by the sperm which produce this increased uterine pressure.

Adult↗
PubMed1977

Effect of preoperative scrub on the bacterial flora of the endocervix and vagina.

A study was designed to evaluate the effectiveness of a preoperative vaginal and perineal scrub in reducing bacteria. An iodophore soap followed by an iodophore solution was used for the scrub. Cultures were taken from the vagina and endocervix of 50 patients before and after the scrub, and cultured for aerobes, anaerobes, and mycoplasma. An average of 5.62 bacterial species per patient was cultured from the vagina before the scrub and 3.9 from the endocervix. The corresponding numbers after the scrub were 0.08 species per patient from the vagina and 1.84 from the endocervix. The reduction of organisms from the vagina was unrelated to the reduction in the endocervix. The scrub was by far more effective in the vagina than in the endocervix. The vagina was bacteria free in 92% of cases while the endocervix was bacteria free in only 8% of cases. No organisms could be recovered from the cervix of 8 patients who had removal of the endocervix by hot conization followed by the iodophore scrub. There was an average of 4.25 species per patient from the 8 cultures of the endocervix prior to the cone and scrub.

Adolescent↗
PubMed1988

Primary squamous cell carcinoma of the vagina treated by radiotherapy: a failures analysis--the M. D. Anderson Hospital experience 1955-1982.

The retrospective study concerns 167 patients with primary squamous cell carcinoma of the vagina treated at The University of Texas M. D. Anderson Hospital and Tumor Institute between January 1955 and December 1982. Of these 167 patients, 162 were evaluable and 5 were lost to follow-up. For small tumors, localized treatment by brachytherapy alone, transvaginal irradiation with 125 to 250 kV alone or in combination with brachytherapy, was mainly used, with emphasis on use of colpostats and transvaginal irradiation for tumors of the upper half of the vagina and interstitial (with radium needles or, later, afterloaded stainless-steel guides with iridium wires) for the lower half. For medium-size tumors, local treatment was combined with external irradiation, mainly using conservative-size fields. For the majority of larger tumors or when the anatomy was distorted, external irradiation alone was used, also with portals of conservative size. Failures were analyzed in relation to FIGO (International Federation of Obstetrics and Gynecology) staging, tumor location, and modality of treatment. As expected, central failures were higher in Stage III disease (9 of 38 patients, 24%) but also uncomfortably high for Stage I patients (13 of 71 patients, 18%) treated locally or with external and local irradiation. The incidence of central treatment failures in tumors of the lower vagina (13/51 patients, 25%) was somewhat higher than for tumors located in the upper vagina (13/85 patients, 15%), but the percentage of large tumors in the lower vagina was 53% compared with 31% in the upper vagina. Severe complications were related to high doses of irradiation alone or in combination with aggressive surgery, and to pelvic inflammatory disease.

Aged↗