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At least 91 records · Page 5Linked to original sources
PubMed1990

Vaginal bleeding and diethylstilbestrol exposure during pregnancy: relationship to genital tract clear cell adenocarcinoma and vaginal adenosis in daughters.

Comparing 186 cancer cases and 1772 cancer-free controls and reexamining several previously published studies, we found genital tract clear cell adenocarcinoma and vaginal adenosis to be moderately, but nonsignificantly, associated with vaginal gestational bleeding when in utero diethylstilbestrol exposure was statistically controlled. Considering the prevalence of diethylstilbestrol exposure in the general population, the relative risks of vaginal clear cell adenocarcinoma for in utero exposure were 365.6 and 459.0 when vaginal bleeding did and did not occur during the index pregnancy, respectively. The relative risks of vaginal adenosis for such diethylstilbestrol exposure were 15.4 and 92.8, respectively, for these women. The strong associations between in utero diethylstilbestrol exposure and both vaginal adenosis and genital tract clear cell adenocarcinoma cannot be attributed to the occurrence of problem pregnancy. However, among daughters exposed to diethylstilbestrol, maternal vaginal bleeding during the index pregnancy does appear to be associated with reduced risks of vaginal adenosis and vaginal clear cell adenocarcinoma.

Adenocarcinoma↗
PubMed1997

Multicenter comparison of clotrimazole vaginal tablets, oral metronidazole, and vaginal suppositories containing sulfanilamide, aminacrine hydrochloride, and allantoin in the treatment of symptomatic trichomoniasis.

BACKGROUND AND OBJECTIVES: Trichomonas vaginalis is a common vaginal pathogen. Oral metronidazole is the drug of choice for the treatment of trichomoniasis. Oral metronidazole, however, may cause unpleasant side effects and is contraindicated during the first trimester of pregnancy. In vitro studies and preliminary clinical data have suggested that intravaginal clotrimazole may be effective against this pathogen. GOALS: To compare the efficacy of clotrimazole vaginal tablets, oral metronidazole, and vaginal suppositories containing sulfanilamide, aminacrine, and allantoin (AVC suppositories) in the treatment of women with symptomatic trichomoniasis. STUDY DESIGN: In a multicenter, open-label trial conducted in 1982 and 1983, 168 symptomatic women with microscopically evident vaginal trichomoniasis were randomized to receive any of 2 g of metronidazole as a single oral dose, two 100-mg clotrimazole vaginal tablets once a day for 7 days, or vaginal suppositories containing 1.05 g of sulfanilamide, 14 mg of aminacrine hydrochloride, and 140 mg of allantoin (AVC suppositories) twice a day for 7 days. Wet mounts and cultures were repated at 1 to 2 and 4 to 6 weeks after completion of treatment. RESULTS: The number of patients who had positive cultures after treatment were 40/45 (88.9%) in the clotrimazole group, 35/43 (81.4%) in the AVC suppository group, and 9/45 (20%) in the metronidazole group (P < 0.001). All treatments were associated with a reduction in reported symptoms. Oral metrohidazole was more effective in reducing symptoms than either of the topical preparations. Adverse events, mostly mild or moderate in severity, were reported by 7 (14.6%) of 48 patients who had received oral metronidazole and 4 (7.8%) of 51 women who used AVC suppositories. There were no adverse events reported by the 50 women who used clotrimazole vaginal tablets. CONCLUSIONS: Oral metronidazole was more effective in eradicating T. vaginalis than clotrimazole vaginal tablets or AVC vaginal suppositories. All three regimens reduced symptoms; oral metronidazole was more effective in reducing symptoms than either topical preparation.

Administration, Intravaginal↗
PubMed1997

The use of sequential self-obtained vaginal smears for detecting changes in the vaginal flora.

BACKGROUND AND OBJECTIVES: The ability to study daily changes in the vaginal flora may provide insight into the pathogenesis of bacterial vaginosis. Because culture of the vaginal fluid is tedious and expensive, the utility of self-obtained vaginal smears for documenting changes in the flora was evaluated. GOALS: To validate the adequacy of self-collected vaginal fluid Gram stains and use them to monitor vaginal flora. STUDY DESIGN: Ten asymptomatic premenopausal women collected daily vaginal smears for 30 days. The smears were Gram stained and interpreted using a standardized scoring system (Nugent criteria). In addition, results from self- and clinician-obtained vaginal smears from 18 women were compared to validate the adequacy of self-obtained smears. RESULTS: Two women had asymptomatic bacterial vaginosis. One woman, who was postpartum, had intermediate flora that toward the end of the collection period changed to Lactobacillus predominant. The remaining seven women exhibited two patterns. One was Lactobacillus morphotypes only; the second consisted of Lactobacillus-predominant days interspersed with days with moderate to high numbers of Gardnerella/Bacteroides morphotypes. There was a significant correlation of the point of change in the flora of this group with menses. CONCLUSIONS: The adequacy of self-collected vaginal fluid Gram's stains was validated. Changes in vaginal flora were demonstrated over a 30-day period by use of this methodology.

Female↗
PubMed2001

Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study.

OBJECTIVE: To evaluate short-term recovery of vaginal hysterectomy with those of laparoscopic assisted vaginal hysterectomy performed in a prospective, randomized multicentric study. STUDY DESIGN: Eighty patients referred for hysterectomy for benign pathology were randomized to either vaginal hysterectomy (40 patients) or laparoscopic assisted vaginal hysterectomy (40 patients). Inclusion criteria were uterine size larger than 280 g and one or more of the following: previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses, and indication for adnexectomy. No upper limit of uterine size was set. All the laparoscopic and the vaginal hysterectomies were done under endotracheal general anesthesia. RESULTS: There was no statistically significant difference in terms of patient's age, parity, postmenopausal state, indication for surgery and mean uterine weight between the 2 groups. Laparoconversion was performed in three women in the laparoscopic group. Operative time was significantly shorter in the vaginal versus the laparoscopic groups 108+/-35 and 160+/-50 respectively (p<0.001). The use of paracetamol, non steroidal anti-inflammatory drugs, and opioid during hospitalization were similar in the 2 groups. There was no difference in the 1st day hemoglobin level drop, time of passing gas and stool, or hospital stay between the 2 groups. CONCLUSION: In contrast with earlier reports, there was no difference in short-term recovery between patients undergoing vaginal or laparoscopic hysterectomy. No advantage was found performing laparoscopic assisted vaginal hysterectomy in comparison with the standard vaginal hysterectomy.

Female↗
PubMed2003

Study of the effect of cervix uteri buffeting on the vaginal musculature with identification of the cervico-vaginal inhibitory reflex.

OBJECTIVES: During penile thrusting, the penis repeatedly buffets the cervix uteri (CU). We investigated the hypothesis that CU stimulation induces a change in the motor activity of the vaginal wall musculature. MATERIALS AND METHODS: The response of the vaginal wall musculature to electrical and mechanical CU stimulation was recorded in 27 healthy women (age 34.8+/-7.3 years). The test was repeated after separate anesthetization of CU and vagina and after normal saline injection. RESULTS: Resting electric activity in the form of slow waves (SWs), followed or superimposed by action potentials (APs), was recorded from two electrodes applied to the vagina. The waves displayed the same frequency, amplitude and conduction velocity from the two electrodes. Electrical or mechanical stimulation of the CU effected disappearance of the electric waves; this response was reproducible. Individual stimulation of the anesthetized CU or vagina did not evoke the response, but saline infiltration did. CONCLUSIONS: CU stimulation resulted in disappearance of the vaginal electric activity which presumably denotes vaginal tone disappearance. Meanwhile, stimulation of the anesthetized CU or vagina did not evoke that response. The data suggested the presence of a reproducible reflex relationship between the CU and vaginal musculature that seems to be mediated through a reflex which we call "cervico-vaginal inhibitory reflex". Disappearance of the vaginal tone probably enhances vaginal penetration and penile thrusting during the sexual act and penile buffeting of the CU. The cervico-vaginal reflex may be incorporated as an investigative tool in sexual act disorders.

Action Potentials↗
PubMed1994

A comparative multicenter study of the effects of continuous low-dose estradiol released from a new vaginal ring versus estriol vaginal pessaries in postmenopausal women with symptoms and signs of urogenital atrophy.

OBJECTIVE: Our purpose was to study the efficacy, safety, and acceptability of a new estradiol-releasing (6.5 to 9.5 micrograms per 24 hours) silicone rubber vaginal ring compared with Ovesterin 0.5 mg estriol vaginal pessaries. STUDY DESIGN: Gynecologic clinical status, vaginal pH, cytologic characteristics, and occurrence of bacteriuria were determined before starting and after 3 and 12 weeks of treatment in 146 postmenopausal women. RESULTS: Both treatments alleviated the subjective and objective symptoms of estrogen deficiency excellently, and both were equally effective at restoring the vaginal pH to levels normally seen in fertile women (< 5.5). Vaginal cytologic studies showed a significant difference in maturation value in favor of the estradiol-releasing silicone rubber vaginal ring, as measured by the pathologist's assessment of the proliferation of the vaginal mucosa. A total of 77% of users were classified as responders, compared with 39% in the pessary group. Both treatments were well accepted. The administration of the pessary was associated with a significantly higher (p < 0.001) incidence of discomfort than that of the ring, which was given better (p < 0.001) rating by the patients at the 12-week visit. A strong preference (p < 0.001) for the ring was shown by patients with previous experience with pessaries. CONCLUSION: Treatment of urogenital symptoms in postmenopausal women with an estradiol-releasing vaginal ring is shown to be an effective and safe method, exhibiting advantages over treatment with estriol vaginal pessaries.

Administration, Intravaginal↗
PubMed2005

Porcine vaginal mucosa as an in vitro permeability model for human vaginal mucosa.

The availability of human tissue for experimental purposes is often problematical and use is thus made of animal tissue as models of the human tissue. In this study, porcine vaginal mucosa was used as an in vitro permeability model for human vaginal mucosa using tritium-labelled permeants (17beta-estradiol, r-arecoline, vasopressin, oxytocin and water). Fresh porcine and human vaginal tissues were frozen in liquid nitrogen and stored at -85 degrees C. In vitro permeability studies were performed using a flow-through diffusion apparatus (24 h, 20 degrees C, 1.5 ml/h). The mean steady state flux values for water, r-arecoline and vasopressin were approximately 4, 12 and 5% lower, while those for 17beta-estradiol and oxytocin were approximately 17 and 53% higher, through porcine vaginal mucosa as compared to human vaginal mucosa, respectively. Using a F-test (comparing whole curves), statistically significant differences in the diffusion of 17beta-estradiol, r-arecoline and oxytocin were indicated when comparing human and porcine vaginal mucosa. Generally, porcine vaginal mucosa seems a good in vitro permeability model for human vaginal mucosa. However, permeability of these two mucosa towards all permeants tested does not always correspond closely. These differences must always be considered when using porcine tissue as an in vitro permeability model for human vaginal mucosa.

Animals↗
PubMed2005

The effect of vaginal pH on labor induction with vaginal misoprostol.

OBJECTIVE: To estimate the association of vaginal pH on the induction to vaginal delivery interval in labor induction with vaginal misoprostol. METHODS: Women presenting at term with intact membranes for labor induction were recruited. The pH of the vagina was measured during a digital examination of the cervix to determine the Bishop Score. Labor was induced with 25 microg of vaginal misoprostol placed every 6 h until spontaneous rupture of membranes or active labor occurred. The primary outcome was the induction to vaginal delivery interval in the lower pH (< 5) versus higher pH (> or = 5) group. Secondary outcomes assessed maternal and neonatal morbidities. Sample size calculated a priori estimated 120 subjects were required for a power of 95% and a 2-tailed a of 0.05. RESULTS: 120 women met inclusion criteria and had available pH data. There was no difference in the induction to vaginal delivery interval in the lower pH (1455 min) versus higher pH group (1295 minutes, Mean difference 160 [- 147,468] P = .30). No difference was observed for operative delivery rates or neonatal outcomes. CONCLUSION: The pH of the vagina may not affect the length of the induction to vaginal delivery interval in women undergoing labor induction with vaginal misoprostol. Further research is required to determine factors that may influence the efficacy of vaginal misoprostol when used for labor induction.

Administration, Intravaginal↗
PubMed2004

Vaginal-perianal compared with vaginal-rectal cultures for identification of group B streptococci.

OBJECTIVE: To estimate whether the rates of recovery of group B streptococci from combined vaginal and perianal cultures and combined vaginal and rectal cultures are equivalent. METHODS: We performed a prospective cohort study of vaginal-perianal versus vaginal-rectal culture for group B streptococci. Two hundred pregnant women in the third trimester were enrolled. Three specimens were collected from each patient in the following order: lower third of the vagina, perianal skin, and rectum. Each specimen was cultured serially in selective broth media, then on sheep's blood agar. Suspicious colonies were confirmed by latex agglutination. Culture positivity rates from the combined sites of vagina and perianal skin were compared with vagina and rectum. Laboratory personnel were blinded to the collection site of each individual swab. RESULTS: Of the 200 subjects, 71 (36%) had a positive culture from at least 1 site. Vaginal culture was positive in 55 patients (28%), compared with 48 patients (24%) with positive perianal cultures and 50 patients (25%) with positive rectal cultures. Results of combined vaginal and perianal cultures were positive in 68 patients (34%); results of combined vaginal and rectal cultures were positive in 67 patients (34%) (P = 1.0). CONCLUSION: The group B streptococci detection rate from vaginal-perianal specimens is not significantly different from the detection rate from vaginal-rectal specimens. Therefore, pregnant women do not need to be subjected to the discomfort of collection of a rectal specimen. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2001

Value of vaginal culture in management of acute vaginitis.

OBJECTIVE: To evaluate the relative contribution of clinical assessment and vaginal discharge cultures in the treatment of acute vaginitis. METHODS: A prospective observational study of 75 consecutive sexually active women with acute vaginal symptoms was undertaken. Each patient underwent an evaluation that included a standardized history, interview a thorough pelvic examination and vaginal culture. The treatment was administered based upon patient symptomatology and macroscopic appearance of vaginal discharge. RESULTS: There was an agreement between initial diagnosis and culture isolates in 38 patients (50.6%). Of the 75 enrolled women 9 have not returned for reevaluation 8 days after initiation of the treatment. Fifty three (80.3%) of the remaining 66 women were free of symptoms 8 days after initiation of the treatment. The remaining 13 women were treated successfully in accordance with the vaginal culture result. CONCLUSION: A high cure rate of acute vaginitis could be achieved based upon physical examination. Vaginal cultures are valuable in initial therapy failures.

Adolescent↗
PubMed1994

Vaginal template implant for cervical carcinoma with vaginal stenosis or inadvertent diagnosis after hysterectomy.

PURPOSE: For cervical carcinoma patients with poor geometry for conventional intracavitary radiotherapy, a simple vaginal template for interstitial implantation as a substitute was used. This template has also been used to treat patients who had hysterectomy done without knowledge of an early tumor in the cervix, and for patients with recurrent disease. This is a report of the treatment results. METHODS AND MATERIAL: A total of 21 patients were treated over from July 1987 to June 1991 with this vaginal template implant forming part of the treatment, 12 of these were performed for vaginal stenosis. The applicator consists of a front piece and an end piece. Holes were drilled in the front piece to guide the implantation of the cervix or vaginal vault. The diameter of applicators varied from 2 cm to 3.5 cm. Depending on the diameter of the applicators, six to eight needles on the periphery, or eight peripheral plus one central needle were used. The activity of the needles were around 8 mCi with a total length of 5.5 cm. The end piece was locked onto the front piece by a bayonet-type locking device. The purpose of the end piece was two-fold: to make up the length of the whole applicator to fit the vagina and to keep the implanted needles in place without being extruded. The implantation was performed under general anesthesia. RESULTS: One of the twelve patients treated with the vaginal template implant for vaginal stenosis had relapsed centrally but subsequently died of intercurrent disease. Two other patients died of intercurrent disease at 26.2 and 41.9 months, respectively, without evidence of relapse. Nine other patients had been followed with no evidence of local relapse for 23.7 to 54.6 months. CONCLUSION: This vaginal template implantation is a satisfactory means of treating patients with vaginal stenosis and those who had hysterectomy done without knowledge of an early tumor in cervix.

Adult↗