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PubMed1989

Cervical dysplasia and human papillomavirus.

Evidence suggests a link between human papillomavirus infections and cervical dysplasia-carcinoma. This has led to the recommendation that when human papillomavirus infections are identified on the cervix, especially in association with dysplasia, these patients should have colposcopic assessment and treatment. The natural history of cervical human papillomavirus infections, particularly when associated with mild or moderate dysplasia, is not clear. To assess this question, 235 women with mild to moderate cervical dysplasia associated with a human papillomavirus infection were prospectively evaluated at 6-month intervals by the Colposcopy Clinic. This review suggests that mild to moderate cervical dysplasia associated with human papillomavirus infection eventually spontaneously disappears or, at worse, lingers on over many months in a mild to moderate form. These observations do not support the current popular practice of treating all mild to moderate cervical dysplasias associated with human papillomavirus infection or cervical human papillomavirus infection not associated with dysplastic lesions.

Condylomata Acuminata↗
PubMed1989

Molecular diagnosis of genital human papillomavirus infection: comparison of two methods used to collect exfoliated cervical cells.

Human papillomavirus infection is implicated as an etiologic agent in the development of neoplasia and invasive carcinoma of the cervix. To detect human papillomavirus infection of the cervix, cells must be collected and assayed for human papillomavirus-related deoxyribonucleic acid sequences. Gynecologists and other clinical investigators generally use an exocervical spatula scrape and an endocervical swab for cell collection, analogous to Papanicolaou smear collection. However, inadequate cell recovery is common. To overcome this problem, we have developed the cervicovaginal lavage method for human papillomavirus detection. In the present study we compared the cervicovaginal lavage method with the widely used scrape-swab method in 48 women referred for colposcopic examination. After a Papanicolaou test, two samples were obtained from each woman, either with cervicovaginal lavage followed by scrape-swab or with the scrape-swab followed by cervicovaginal lavage. Human papillomavirus types were assessed by restriction analysis and Southern blot hybridization. In 21 women (44%) test results were positive for human papillomavirus with both the scrape-swab and cervicovaginal lavage cell collection methods; in nine women (19%) test results were positive only with the cervicovaginal lavage method; and in 18 women (38%) results were negative for human papillomavirus with both techniques. None of the women had human papillomavirus detected by scrape-swab without also having it detected with cervicovaginal lavage. The human papillomavirus deoxyribonucleic acid types identified were concordant in the 21 women whose infections were detected with both sampling methods, although the second virus type was detected only with cervicovaginal lavage in one woman who had a mixed genital tract infection. We concluded that cervicovaginal lavage is a more sensitive cell collection method than the scrape-swab technique for assessing human papillomavirus infection of the cervix.

Blotting, Southern↗
PubMed1991

Adverse psychologic consequences of positive cytologic cervical screening.

Cervical cancer is still widely prevalent in the female population. This study explores the relationship of cervical cancer screening, positive versus negative Papanicolaou's test results, and psychologic status among lower-income minority women. All patients were interviewed 3 months after they had received initial test results. One hundred six women with normal Papanicolaou's test results were compared with 118 women who were referred for colposcopic examination for follow-up of positive test results. Women with positive Papanicolaou's-test results showed statistically significant elevations in worries about cancer and impairments in mood, daily activities, sexual interest, and sleep patterns. More fine-grained analyses revealed that the effects of positive results were most pronounced among those women who did not comply with colposcopy (n = 53). These findings suggest that lack of compliance with follow-up may maintain high levels of uncertainty about disease and may interfere with successful psychologic adaptation. Health education targeted to psychologically vulnerable individuals may reduce psychologic distress and enhance compliance.

Adolescent↗
PubMed1992

Colposcopy to establish physical findings in rape victims.

OBJECTIVE: Conventional rape examination protocols have been poor in yielding genital findings (10% to 30% typically). We report our experience with a revised protocol employing colposcopy to perform genital examinations of victims and to document findings. STUDY DESIGN: Physical examinations were performed on rape victims seen by San Luis Obispo County's Suspected Abuse Response Team between 1985 and 1990, and the results were reviewed for this study. RESULTS: Of 131 patients seen within 48 hours and who experienced penile penetration, 114 (87%) had positive findings. Colposcopic magnification allowed examiners to characterize these findings as acute mounting injuries, typically seen at 3, 6, and 9 o'clock on the posterior fourchette and consisting chiefly of lacerations, ecchymosis, and swelling. CONCLUSIONS: An examination protocol that includes colposcopy may be the most reliable means to document and characterize genital findings in rape victims and to evaluate whether findings may be linked to a reported sexual assault.

Colposcopy↗
PubMed1993

Conservative management and pregnancy outcome in diethylstilbestrol-exposed women with and without gross genital tract abnormalities.

OBJECTIVES: Our goal was to determine the effect of conservative management on pregnancy outcome in diethylstilbestrol-exposed women with and without gross structural lesions of the genital tract. STUDY DESIGN: The study included a case series of women prospectively enrolled over a 10-year period. RESULTS: Pregnancy outcome and both antepartum and intrapartum events occurring in a case series of 120 conservatively managed pregnancies in 50 diethylstilbestrol-exposed women were reviewed. Group A (n = 34, 89 pregnancies) consisted of women with gross upper or lower genital tract lesions associated with diethylstilbestrol exposure, whereas group B (n = 16, 31 pregnancies) consisted of women whose lesions were limited to colposcopic findings. Cerclage was limited to women with a history of cervical incompetence (n = 1, two pregnancies) or acute cervical change in the second trimester (one pregnancy). Women with cervical change occurring after 25 weeks' gestation were managed with bed rest. Group A experienced more spontaneous first-trimester losses than group B (25.8% vs 12.9%, p < 0.01), whereas group B had a greater gestational age at delivery (39.8 +/- 1.5 vs 37.3 +/- 3.8 weeks, p < 0.01) than group A. Overall, pregnancies surviving the first trimester (n = 94) resulted in delivery of a viable infant discharged home 92.2% of the time; 77.9% of pregnancies reached term. The perinatal loss rate was 1.3%. Preterm labor (6.5%) and preterm rupture of membranes (3.8%) resulted in an overall rate of preterm birth of 9.2%. There were no significant differences in length of any labor stage between groups, nor were there any differences in the use of oxytocin augmentation or cesarean section rates between groups. Postpartum hemorrhage and retained placenta were infrequent complications. CONCLUSIONS: The majority of pregnancy loss in diethylstilbestrol-exposed patients occurs in the first trimester. Cervical incompetence is an infrequent cause of pregnancy loss even in patients with gross structural abnormalities of the genital tract. Patients who had conservative management had good pregnancy outcomes. Prophylactic cerclage for all diethylstilbestrol-exposed patients should not be recommended.

Abnormalities, Drug-Induced↗
PubMed1995

Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetermined significance.

OBJECTIVE: Our purpose was to determine the clinical value of human papillomavirus deoxyribonucleic acid testing with the hybrid capture test, specifically to examine whether human papillomavirus testing could identify which women with Papanicolaou smears read as atypical squamous cells of undetermined significance were most likely to have histologically confirmed cervical intraepithelial neoplasia. STUDY DESIGN: Hybrid capture testing for 14 human papillomavirus types, repeat Papanicolaou smears, and colposcopically directed biopsies were performed concurrently on 217 women referred to a student health colposcopy clinic with a previous Papanicolaou smear read as atypical squamous cells of undetermined significance. RESULTS: Human papillomavirus deoxyribonucleic acid positivity was associated with an eightfold increased likelihood of histologic confirmation of cervical intraepithelial neoplasia. The sensitivity of hybrid capture for any cervical intraepithelial neoplasia was 86% (43/50) and for grade 2 or 3 was 93% (14/15), whereas the corresponding values for the repeat Papanicolaou smear were 60% (30/50) and 73% (11/15), respectively. Moreover, high viral levels of human papillomavirus types known to be associated with cervical cancer were strongly predictive of high-grade cervical intraepithelial neoplasia. CONCLUSIONS: Testing for human papillomavirus deoxyribonucleic acid with hybrid capture appears to offer an effective means by which patients whose cervical Papanicolaou smears have been read as atypical squamous cells of undetermined significance could be triaged for colposcopy. In particular, sensitivity for high-grade cervical intraepithelial neoplasia could be maintained and specificity markedly improved by referring only those patients who had elevated levels of human papillomavirus deoxyribonucleic acid of cancer-associated viral types.

Adolescent↗
PubMed1995

Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching.

OBJECTIVE: Our purpose was to assess determinants of cervical ectopia and cervicitis, specifically after adjustment for cervical infection. STUDY DESIGN: A cross-sectional study was conducted with colposcopic, cytologic, and microbiologic examination of 764 randomly selected women attending a sexually transmitted disease clinic and 819 consecutive college students undergoing routine annual examination. RESULTS: After we controlled for potential confounders, cervical ectopia was positively associated with oral contraception and Chlamydia trachomatis infection and negatively associated with aging in both populations, with recent vaginal douching in patients with sexually transmitted diseases, and with current smoking in college students. Oral contraception wa also associated with the radius of ectopia, and among users of oral contraception ectopia was associated with duration of oral contraception. Cervicitis (evaluated by Gram stain, Papanicoloau smear, and colposcopy) was associated with cervical infection by C. trachomatis and cytomegalovirus (both populations) and with gonorrhea and cervical herpes simplex virus infection (patients with sexually transmitted diseases). Cervicitis was independently associated with ectopia but not with oral contraception after we adjusted for these four cervical infections. However, oral contraception was associated with edema and erythema of the zone of ectopia among women without cervical infection. CONCLUSIONS: Oral contraception, aging, cervical infection, smoking, and douching have effects on cervical ectopia that may influence the acquisition, transmission, or effects of sexually transmitted agents. Ectopia is associated with young age, oral contraception, and cervical infection; cervicitis is associated with ectopia and cervical infection by C. trachomatis, Neisseria gonorrhoeae, herpes simplex virus, and cytomegalovirus. In women without cervical infection, edema and erythema of the zone of ectopia are associated with oral contraception.

Adolescent↗
PubMed1995

Flashlamp-excited dye laser therapy of idiopathic vulvodynia is safe and efficacious.

OBJECTIVE: The management of chronic vulvovaginal pain, not explicable on specific histologic grounds, presents a major problem in referral centers for lower genital tract diseases. STUDY DESIGN: This article reports on a two-step protocol in a sample of 175 medical nonresponders, drawn from a 2-year cohort of 725 women with vulvovaginal pain. The first maneuver was the use of a flashlamp-excited dye laser to selectively photocoagulate symptomatic subepithelial blood vessels in 168 women; the second was the microsurgical removal of chronically painful Bartholin's glands in 52 women not responsive or not suited to flashlamp-excited dye laser photothermolysis. RESULTS: Dye laser response rates were independent of whether patients manifested macroscopic foci of painful erythema ("vestibular adenitis") or just colposcopically apparent hyperemia-ectasia of the individual blood vessels ("pruritic papillomatosis") (56% vs 45% after a single surgical procedure; 76% vs 65% after serial retreatment; p not significant). Conversely, response rates were much lower among women in whom pressure on the Bartholin's glands produced sharp, lancinating pain (15% vs 66% after a single surgical procedure; 22% vs 93% after serial retreatment; p < 0.001). Forty-two (85%) of 50 patients with flashlamp-excited dye laser failure had deep pain; however, the impasse to progress was broken by gland removal. Final response rates were 92.5% (complete response 62%; partial response 30%) in the "surface-only" group and 80.3% in the "surface-plus-deep" group (chi 2 = 14.9; p < 0.001). The major complication was acute bacterial cellulitis, occurring in the first postoperative week. Modification of the treatment protocol to include topical antibiotics with an occlusive dressing reduced the cellulitis rate from 17.2% to 2.5%. In four women (1.8%) Koebner-like exophytic condylomas also developed within 1 month of flashlamp-excited dye laser surgery. CONCLUSION: The availability of a safe, efficacious, and relatively noninvasive treatment should reduce the need for resective surgery in most patients with idiopathic vulvodynia.

Adolescent↗
PubMed1995

An evaluation of human papillomavirus testing for intermediate- and high-risk types as triage before colposcopy.

OBJECTIVE: Our purpose was to evaluate the role of testing for intermediate- and high-risk human papillomavirus by use of a hybrid capture technique for predicting which patients with abnormal Papanicolaou smears are most likely to have squamous intraepithelial lesions or cancer. STUDY DESIGN: Cervical cytologic studies, hybrid capture tests, and colposcopically directed biopsies were performed on 311 women referred to the colposcopy clinics with abnormal cytologic study results. RESULTS: There was a highly significant correlation (p < 0.0001) between a positive human papillomavirus test and the finding of squamous intraepithelial lesions or invasive cancer. The sensitivity of human papillomavirus testing to detect high-grade squamous intraepithelial lesions was 74% when it was used alone and increased to 91% when coupled with abnormal cytologic study results of low- or high-grade squamous intraepithelial lesions or cancer. In 44 women with atypical squamous cells of undetermined significance on cytologic study, human papillomavirus testing identified six of 10 who had high-grade squamous intraepithelial lesions. For the 96 patients with low-grade squamous intraepithelial lesions, human papillomavirus testing was successful in identifying 29 of the 37 with high-grade squamous intraepithelial lesions (sensitivity 0.76). CONCLUSION: Testing for intermediate- and high-risk human papillomavirus types by hybrid capture improves the detection of high-grade squamous intraepithelial lesions in women with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions over cytologic study used alone.

Cervix Uteri↗
PubMed1987

Recognition of cervical neoplasia by the estimation of a free-radical reaction product (octadeca-9,11-dienoic acid) in exfoliated cells.

The molar ratio between a diene-conjugated linoleic-acid isomer (18:2(9,11)) and the parent linoleic acid (18:2(9,12)), both esterified as phospholipids, was significantly different in exfoliated cells from normal cervices and from cervices with colposcopic and cytological evidence of precancer. The measurement may provide a simple and perhaps improved alternative to cytological screening.

Adult↗
PubMed1989

The development of gender-related behavior in females following prenatal exposure to diethylstilbestrol (DES).

Animal research has shown that diethylstilbestrol (DES) present during the sensitive developmental periods of the hypothalamus and adjacent areas of the brain affects the development of sex-dimorphic brain structures and subsequent behavior. To test for corresponding behavioral effects in humans, 30 women with a history of prenatal DES exposure were contrasted with 30 unexposed women who had been referred to the same clinic for a colposcopic examination because of an abnormal Pap smear. Gender-role behavior of childhood, adolescence, and adulthood was assessed by means of a semistructured interview, the Gender Role Assessment Schedule-Adult, and the Bem Sex Role Inventory. The mothers of these women were interviewed about their daughters with the "mother form" of the same interview schedule. The results suggest that DES women show less orientation toward parenting than the controls. There were no consistent group differences in other domains of gender-role behavior.

Adolescent↗
PubMed1995

Building up a computerized follow-up register and information system for cervical cytology.

It is well known that cervical intraepithelial neoplasia (CIN) and human papilloma virus (HPV) infection are closely related to cervical cancer. The cervical cytology examination (pap-test), followed by a colposcopic examination and a biopsy are the common tools for the early detection and the establishment of diagnosis of the cervical precancerous lesions. The monitoring and surveillance of those precancerous lesions is essential for the prevention of cervical cancer and for effective patient management. Nowadays, the long-term care of patients with a chronic and/or serious disease is feasible with the use of computerized follow-up registers or through more complex information systems. Nevertheless, manual recording is still the predominant method of data collection in 'Alexandra' University Hospital and this is the case in most health services in Greece due to scarcity of resources. A 'circulating' outpatient card, where information on gynecologic cytology, colposcopy and biopsy examinations is recorded, was the basis for the development of a computerised follow-up register and information system for cervical cytology in the Department of Cytopathology.

Biopsy↗
PubMed1984

IUD induced bleeding and the way of therapy.

In a retrospective study containing 2404 cases of IUD induced bleeding problems, the type and timing of bleeding as well as the types of conservative therapy were evaluated. The non-hormonal treatment (uterotonics, calcium, C- and K-vitamin etc.) proved to be significantly less effective (P less than 0.05) than the hormonal therapy (estrogen, gestagen and combined preparations). The rate of effectiveness was 80.1% and 86.7%, respectively. Because the effectiveness of the conservative therapy is 80%, even in the non-hormonal group, the IUD should be removed only if this treatment proves to be ineffective. Attention is drawn to the importance of routine colposcopic and cytological screening.

Ascorbic Acid↗
PubMed1984

Ambulatory removal of cervical polyps under colposcopy.

Hospitalization, polypectomy, and D&C under general anesthesia, are the usual way to treat a cervical polyp. This article describes a simple, ambulatory way of performing polypectomy under colposcopic vision, with no need for hospitalization and general anesthesia. The paper summarizes our experience with this method in 96 patients. Our conclusion is that this simple procedure spares the patient general anesthesia, D&C, and unnecessary hospitalization with attendant expense.

Adult↗
PubMed1989

Topical testosterone for lichen sclerosus.

Twenty-three patients diagnosed as lichen sclerosus with colposcopic directed biopsy were given topical testosterone as a first line therapy. The overall remission rate was found to be 87.7%; 8.7% of the patients experienced undesirable androgenic side effects. Of the three patients who did not respond satisfactorily to testosterone treatment, two had alcohol injection to the vulva and one had vulvar denervation.

Administration, Topical↗
PubMed1991

Cervical dysplasia in the postmenopausal female: diagnosis and treatment.

Thirty-two postmenopausal women, age 50 years or older, were colposcoped for abnormal Papanicolaou (PAP) smears. Sixteen had mild to moderate dysplasia, six severe dysplasia and the remainder had no dysplasia. Treatment included observation, topical estrogen, cryotherapy, conization or hysterectomy. Based upon our observations, satisfactory colposcopy can be performed in the majority of postmenopausal women. Oral or topical estrogen is a valuable adjunct in the initial evaluation and treatment of abnormal PAP smears in postmenopausal women. Criteria for adequate colposcopy in postmenopausal women are discussed and a management scheme is proposed.

Aged↗
PubMed1986

Stress and hopelessness in the promotion of cervical intraepithelial neoplasia to invasive squamous cell carcinoma of the cervix.

Stress and hopelessness have been associated with the development of invasive cervical cancer by previous research. Subjects in this study were recruited from a colposcopy clinic awaiting work-up of an abnormal pap smear and from those admitted to an in-patient gynecology ward for cone biopsy of the cervix or hysterectomy to treat a symptomatic pelvic mass thought to be uterine leiomyomas. After data collection, pathology reports and colposcopic findings were used to determine group assignment independent of subjects' knowledge of their diagnosis. A modest stress-promotion correlation was derived, which was greatly enhanced by significant interactions with low levels of cooperative coping style and for high levels of premorbid pessimism, future despair, somatic anxiety, and life threat reactivity. These stress-moderator interactions are discussed in terms of immune system deficit with concomitant enhancement of promotion of CIN to invasive squamous cell cervical cancer.

Adaptation, Psychological↗
PubMed1989

Host moderator variables in the promotion of cervical neoplasia--II. Dimensions of life stress.

Controllability and predictability have been shown to mediate the aversive impact of life events on health. This study examined the relationship of these parameters (along with coping style) to the promotion of cervical intraepithelial neoplasia (CIN) to invasive squamous cell carcinoma of the cervix. Seventy-five female patients participated while awaiting the results of colposcopically directed biopsy performed during work-up of an abnormal Pap smear. The Million Behavioral Health Inventory, a modified form of the Life Experience Survey, and a semi-structured interview were administered before subjects learned of their biopsy results. Subjects defined as susceptible by previous research had positive (through generally nonsignificant) correlations between life events and promotion while resilient subjects had negative correlations. The relationship between controllability of life events and CIN was moderated beneficially by a sociable and confident style and detrimentally by an inhibited style and a pessimistic attitude. Life event predictability did not contribute to CIN promotion beyond the effects of controllability.

Adaptation, Psychological↗