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PubMed2004

Prevalence of HIV, syphilis, Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis and candidiasis among pregnant women attending an antenatal clinic in Khartoum, Sudan.

Antenatal screening and treatment for sexually transmitted infections (STIs) has shown some benefits in countries where the practice is adopted. To date the prevalence of STIs in the Sudan is unknown. Our aims were to establish the prevalence of STIs among pregnant women in Khartoum (Sudan), to identify any risk factors and to suggest management. One hundred and fifty-one pregnant women were recruited for the study in an antenatal clinic in Khartoum in 1999. The prevalence of Chlamydia trachomatis, HIV, Trichomonas vaginalis, syphilis, Neisseria gonorrhoea and vulvo-vaginal candidiasis among the study population was established; 7.3% of patients suffered multiple infections. No risk factors for acquiring an STI were identified apart from genital ulcer disease. These findings suggest that a syndromic approach for treating STIs during pregnancy might not be possible. We conclude that STIs have a high prevalence among pregnant Sudanese women in Khartoum. The providers of health care in the Sudan need to revise their priority list.

Adult↗
PubMed2001

Laparoscopic vaginoplasty: using a sliding peritoneal flap for correction of complete vaginal agenesis.

In this technique of peritoneal neo-vaginoplasty, the recto-vesical space is dissected through the vulva under synchronous laparoscopic monitoring. Then the cranial limit of the pelvic peritoneum is incised circumferentially by laparoscopic approach and the two circular edges sutured sequentially. The isolated pelvic peritoneal sleeve is opened inferiorly and sutured to introital mucosal flaps.

Adult↗
PubMed1979

A clinical approach to urinary incontinence in the female.

Five hundred and twenty-eight female patients with urinary incontinence were studied and treated over a 10-year period. Details of management are given, including a description of a vaginal method of reconstruction of the anatomically incompetent bladder neck. The results of treatment of each group are discussed, and the importance of initial clinical recognition of the urinary outflow obstruction syndrome is stressed in order to institute correct treatment.

Dilatation↗
PubMed1995

Four-contrast defecography: pelvic "floor-oscopy".

PURPOSE: This study was designed to determine the accuracy of physical examination (as judged by four-contrast defecography) for women with pelvic floor relaxation disorders. METHODS: Sixty-two women (mean age, 59 years) who had obstructed defecation or constipation, vaginal prolapse, urinary difficulty, or pelvic pain underwent four-contrast defecography. Oral, vaginal, bladder, and rectal contrast were administered selectively and fluoroscopy was performed. Radiographic findings were compared with physical examination diagnosis. RESULTS: Four-contrast defecography changed the diagnosis in 46 patients (75 percent); 26 percent of presumed cystoceles, 36 percent of enteroceles, and 25 percent of rectoceles were not present on defecography. Defecography also revealed unsuspected coexisting defects in addition to known abnormalities detected on physical examination. In contrast, when physical examination was negative for these defects, 63 percent of patients were found to have cystoceles, 46 percent to have enteroceles, and 73 percent to have rectoceles on four-contrast defecography. The discovery of Grade 2 or 3 unsuspected abnormalities was significant, especially so for enteroceles. For posterior vaginal eversions extending to or past the introitus, physical examination was accurate in only 61 percent. Physical examination of large anterior defects was more accurate, with 74 percent of patients being correctly diagnosed. CONCLUSIONS: Physical examination diagnosis of pelvic floor relaxation disorders is frequently inaccurate, especially for large vaginal eversions. Four-contrast defecography improves diagnostic accuracy, helps to identify all pelvic floor defects before surgery, and can assist with planning the correct operative approach.

Defecation↗
PubMed1995

Different tissue responses for iodine and iodide in rat thyroid and mammary glands.

This research describes the effects of short-term elemental iodine (I2) and iodide (I-) replacement on thyroid glands and mammary glands of iodine-deficient (ID) Sprague-Dawley female rats. Iodine deficiency causes atypical tissue and physiologic changes in both glands. Tissue histopathology and the endocrine metabolic parameters, such as serum TT4, tissue and body weights, and vaginal smears, are compared. A moderate reduction in thyroid size from the ID control (IDC) was noted with both I- and I2, whereas serum total thyroxine approached the normal control with both I- and I2, but was lower in IDC. Thyroid gland IDC hyperplasia was reduced modestly with I2, but eliminated with I-. Lobular hyperplasia of the mammary glands decreased with I2 and increased with I- when compared with the IDC; extraductal secretions remained the same as IDC with I2, but increased with I-; and periductal fibrosis was markedly reduced with I2, but remained severe with I-. Thus, orally administered I2 or I- in trace doses with similar iodine availability caused different histopathological and endocrine patterns in thyroid and mammary glands of ID rats. The significance of this is that replacement therapy with various forms of iodine are tissue-specific.

Animals↗
PubMed1985

The management of fetal hydrocephalus.

The management of 53 consecutive documented cases of fetal hydrocephalus is presented. Hydrocephalus was isolated in nine cases (17%) and associated with other abnormalities in 44 (83%). Our success in diagnosing abnormalities associated with hydrocephalus improved from the time period 1977 through 1981 to that of 1982 through 1983. In this series, management consisted of termination of pregnancy, 14 (26%); ventriculoamniotic shunt placement and cesarean section, two (4%); cephalocentesis and cesarean section, two (4%); cesarean section without cephalocentesis or ventriculoamniotic shunt placement, 18 (34%); cephalocentesis and vaginal delivery, nine (17%); and vaginal delivery without cephalocentesis, eight (15%). The outcomes were spontaneous abortion, 14 (26%); intrapartum death, eight (15%); postnatal death, 16 (30%); currently alive, 15 (28%). Current approaches to the management of fetal hydrocephalus are discussed, and areas of therapeutic uncertainty are delineated.

Abnormalities, Multiple↗
PubMed1994

Foetal heart rate in early pregnancy by detection of optimally estimated displacements with pulsed Doppler signals.

Foetal heart rate (FHR) in the early stage of pregnancy can be optimally estimated by a simple system combining a conventional pulsed Doppler device with a microcomputer (CPU). The input signals for FHR have been obtained as low frequency components of foetal Doppler signals. These components are less than 50 Hz and are directly transferred from the conventional pulsed Doppler device to a microcomputer as radio-frequency signals by a specially designed I/O unit. The low frequency components have been converted into displacement signals by the continuous calculation of an arc-tangent function combined with five channel recordings from the foetal cardiac area, each separated by 2 mm on the same echo line. After selecting the optimal displacement data line, the FHR is measured by the proposed algorithm of non-parametric frequency estimation and/or the conventional autocorrelation method. The algorithm draws attention to the improved frequency selectivity by multiplication with reference signals, whose frequency is automatically optimized by the standard FHR rate determined by the length of pregnancy. The FHR determined from the displacement signals by this algorithm has provided a more optimally controlled selectivity than with the presently used autocorrelation method, especially in those pregnancies of less than 8 weeks gestation. Clinical application of this system allowed a complete determination of foetal heart rate from 6 weeks of gestation by a transvaginal approach and from 7 weeks by transabdominal procedures. In some specific cases, with prominent foetal components, it was possible from 5 weeks 2 days by a vaginal, and 6 weeks by an abdominal procedure.

Algorithms↗
PubMed1988

A test for the relative potency of herpes simplex virus vaccines based upon the female guinea-pig model of HSV 2 genital infection.

An ELISA for total herpes simplex virus (HSV) 1 antigen content and a test of immunogenicity based upon the female guinea-pig model of HSV 2 genital infection were applied to two samples from batches of HSV 1 subunit ('Skinner') vaccine. The ELISA was reproducible within an approximately threefold limit of error and batches 1 and 2 were indistinguishable in antigen content. The effects of vaccination in the guinea-pig model were assessed by a statistical analysis of scores derived from the principal clinical signs, vaginal oedema and lesions on the external genitalia. The statistical power of the guinea-pig assay was such that reductions in the severity of illness approaching 40% would be significant (P less than 0.05) on 90% of occasions. The ability to make quantitative estimates of immunogenicity will prove useful in the quality control of HSV vaccine batches which are destined for clinical trials in man.

Animals↗
PubMed2004

Iatrogenic bladder perforations: longterm followup of 65 patients.

BACKGROUND: We reviewed our experience with bladder perforations to better understand the causes of these injuries and to describe their management and its effect on longterm outcomes. STUDY DESIGN: Our bladder trauma database yielded 65 patients during a 12-year period, followed for a mean of 36 months, who had sustained iatrogenic bladder perforations. Endourologic procedures were excluded. Demographic data, surgical details, mechanism of injury, anatomic location, grading, diagnosis, management, and outcomes were assessed. RESULTS: Gynecologic procedures accounted for 40 perforations (61.5%), general surgical procedures for 17 (26.2%), and urologic procedures for 8 (12.3%). The type of gynecologic surgery included abdominal hysterectomy in 16 (40%), resection of a pelvic mass in 12 (30%), cesarean section in 10 (25%), and diagnostic laparoscopy in 2 (5%). Of the general surgical procedures, eight were for colon cancer (47.1%), six for diverticulitis (35.3%), and three for inflammatory bowel disease (17.6%); of the urologic injuries, six occurred during vaginal surgery and two during laparoscopy. Predisposing factors were identified in 52 patients (80%). Intraoperative urologic consultation was obtained in 63 of 65 patients, with prompt identification and repair. In two cases a concurrent left ureteral injury was identified and managed by reimplantation. The sole complication was a vesicovaginal fistula 2 months postoperatively, so the success rate for repair was 98.4%. CONCLUSIONS: Although infrequent, iatrogenic bladder perforations can occur during any pelvic, abdominal, or vaginal procedure. Prompt intraoperative recognition is paramount to ensure satisfactory outcomes. Adequate repair usually can be achieved simply by vesicorrhaphy, limiting unnecessary extravesical dissection. With this approach, morbidity can be minimized.

Colon↗
PubMed1989

Congenital absence of the vagina. Surgical treatment and perioperative care.

A simple surgical technique is described for the correction of an absent vagina. It combines the positive features of the traditional approach of using a split-thickness skin graft from the thigh or buttock applied on a plastic mold with the intermittent-pressure method of vaginal development. Since 1975, the new isograft technique has been performed on 15 patients at the Royal Women's Hospital, Melbourne, with excellent results and no complications. With one exception, satisfactory coitus productive of orgasm has occurred following the procedure.

Adult↗
PubMed2000

Women's experiences of maternity care: satisfaction or passivity?

This study is a first attempt to describe Lebanese women's responses to the medical management of their pregnancy and delivery. A qualitative approach in data collection and analysis was adopted to gain an in-depth view of women's perceptions. Women of any parity undergoing a normal vaginal delivery during the three months preceding the interview were interviewed in different areas in Lebanon: one urban, one semi-rural and two remote rural. Childbirth for all the women interviewed was managed within the medical system. Findings show that women accord total trust to their physicians, and very rarely question the usefulness of many routinely applied procedures, even those which the literature shows are unnecessary. When probed, women report that many aspects of the technical care are intimidating and that they experience discomfort with these procedures. Women are more vocal about patient-provider communication and value good interaction with their provider. The extent of passivity and feelings of discontent women have varies according to their social class and the amount of psychosocial support they receive throughout the process of childbirth.

Adult↗
PubMed1997

Laparoscopically assisted vaginal hysterectomy: report of 190 cases.

We report 190 cases where laparoscopy assisted vaginal hysterectomy (LAVH) was used as a primary procedure when the patients were not suitable candidates for a vaginal hysterectomy (VH) either because of lack of prolapse or multiple abdominal surgeries. All the surgeries were done by the same gynecologist. A total of 209 cases were performed, but 8 cases (3.8%) have been converted to TAH because of intraoperative bleeding or severe adhesions. The remaining 201 (96.2%) cases have been completed as LAVH. In this study we have evaluated only 190 cases as 19 cases had additional associated surgeries or incomplete records. The average operating time was 117+/-25.9 min, the intraoperative blood loss was 242.3+/-213.3 mL, and the average hospitalization was 0.7+/-0.7 days. Although the operating time and intraoperative blood loss over a span of time showed significant reduction, the hospitalization did not show any significant change. The complication rate was 6.6%. The average hospitalization cost excluding the surgeons and anesthesiologist charges was $3936.00. With these findings we have concluded that regardless of preoperative diagnosis and findings when vaginal hysterectomy is not suitable, LAVH is a viable alternative to TAH. To the best of our knowledge this is the first article discussing this particular approach.

Adult↗
PubMed1988

Immediate and late outcome of vaginal myomectomy for prolapsed pedunculated submucous myoma.

During a 10-year period, vaginal myomectomy was attempted in 46 women with a symptomatic prolapsed pedunculated submucous myoma. The procedure was successful in 43 and failed in three patients, necessitating an abdominal operation. Vaginal myomectomy for this condition was simple and quick, and the postoperative course was usually uneventful. Only 8.8% of 34 patients with a median follow-up of 5.5 years required a repeat vaginal myomectomy, and only 5.9% needed a hysterectomy. Vaginal myomectomy is recommended as the initial treatment of choice for prolapsed pedunculated submucous myoma, except in those cases in which other indications necessitate an abdominal approach.

Adult↗
PubMed2003

Older partners and STD prevalence among pregnant African American teens.

BACKGROUND: Several recent studies have addressed the question of whether adolescent females who have sex with older partners have a greater risk of sexually transmitted disease (STD) acquisition. GOAL: The goal was to identify differences in STD prevalence and selected measures of behavioral risk between unmarried pregnant African American adolescent females reporting sex with older partners and those reporting sex with similar-age partners. STUDY DESIGN: Adolescents (n = 169) were recruited during their first prenatal visit. Adolescents completed a self-administered survey and a face-to-face interview and provided urine specimens for nucleic acid amplification assays. RESULTS: Approximately 65% of adolescents reported that their male sex partners were >/=2 years older, while 35% reported having similar-age male sex partners. In age-adjusted analyses, adolescents with older partners were four times more likely to test positive for chlamydia (P < 0.04) and were more than twice as likely to report that their partner was also having sex with other women (P < 0.04). With use of a 30-day recall period, the mean number of unprotected vaginal sexual encounters among adolescents with older partners was 4.1, as compared to a mean of 6.9 among those reporting similar-age partners; this difference approached significance (P = 0.051). Prevalence of trichomoniasis as well as scale measures of adolescents' self-efficacy for condom negotiation and frequency of sexual communication with partners did not differ between those adolescents with older or similar-age male sex partners. CONCLUSION: In resource-constrained clinical settings, one implication of these findings is that pregnant adolescents reporting older partners may be a priority for targeted delivery of partner services. More frequent screening for chlamydia may also be cost-effective for pregnant adolescents with older partners.

Adolescent↗
PubMed2006

Using cervical mucus and other easily observed biomarkers to identify ovulation in prospective pregnancy trials.

To help fulfil the objectives of prospective studies of pregnancy and human development, such as the National Children's Study, there is a need to pinpoint ovulation and conception in a cohort of women. This paper discusses the suitability of using natural and easily observed markers of ovulation for detection of the most likely day of ovulation and conception. Of the biomarkers supported by clinical data, the use of cervical mucus is emphasised as it appears most promising. A considerable amount of data suggests that observation of changes in vaginal discharge from cervical mucus can closely approximate the day of ovulation, is easy to learn and suitable for a large group of women. While this approach could also be cost-effective, a significant drawback may be the learning phase which may take 2-3 instructional sessions for women to fully identify recurring changes across the menstrual cycle.

Biomarkers↗
PubMed2006

Immunohistochemical staining as a potential method for the identification of vaginal epithelial cells in forensic casework.

There is currently no accurate method to identify vaginal epithelial cells uniquely. This study aimed to use a cell extraction procedure compatible with routine forensic sampling methods, and to investigate the expression of cytokeratin (CK), estrogen receptor-alpha (ERalpha), and phosphodiesterase 5 (PDE5) in order to distinguish between skin, buccal, vaginal, and external penile epithelial cells. Seminal fluid samples were also examined. Epithelial cell samples were fixed in formalin, embedded in agarose, and processed using histological methods. Antigen-antibody reactions were detected using the DAKO Envision+ detection system. CK was present in all cells from all five sources confirming the origin of cells as epithelial. Both ERalpha and PDE5 positively labeled vaginal, buccal, and skin epithelial cells. Although an antigen unique to vaginal epithelial cells was not identified, we have described a cell extraction procedure for use in the immunohistochemical detection of a wide range of antigens, an approach compatible with forensic diagnostics.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMedDate not supplied

Gonadal steroids in athletic women contraception, complications and performance.

Gonadal steroids are altered by the reproductive system's adaptation to conditioning exercise. Contraceptive options for the athletic woman include all measures appropriate for the sedentary woman. Barrier methods (always with spermicidal jelly) are the preferred choice. The cardiovascular risks, decreased aerobic performance, and shorter time to muscular exhaustion related to oral contraceptives make this a less desirable option. Potential complications from the steroid changes of intense exercise include: low oestrogen and progesterone with risk of loss of trabecular bone and early osteoporosis, and absent progesterone with low normal oestrogen levels associated with risk of endometrial or breast cancer. Therapeutic options for the amenorrhoeic or young athlete include supplemental oral calcium, cyclic oral progesterone, or possibly cyclic physiological oestrogen and progesterone. The anovulatory (usually older) athlete with regular menses needs cyclic progesterone. Medroxyprogesterone 10mg on days 16 to 25 of the cycle or for 10 days monthly can potentially prevent endometrial and breast cancer, give predictable cycles, improve trabecular bone balance and stimulate the return of ovulatory cycles. A practical approach to anovulatory infertility in the athlete includes a 10% reduction in exercise intensity and/or an increase in percentage body fat to 18 to 20%. Cyclic vaginal progesterone (25mg bid) can then treat short luteal phase cycles. With improved understanding of the hormonal adaptations to conditioning exercise, we will be better able to outline contraceptive and therapeutic options in the future.

Contraceptives, Oral↗
PubMed2003

Psychological profiles among women with vulvar vestibulitis syndrome: a chart review.

The purpose of this study was to assess the prevalence and type of psychological distress in women with vulvar vestibulitis syndrome (VVS). A retrospective chart review was conducted of all women receiving a diagnosis of VVS referred to a tertiary care facility during a two-year period. Brief psychological questionnaires, including the Personality Assessment Screener, Fear of Negative Evaluation Scale, Golombok-Rust Inventory of Sexual Satisfaction, and the Phobia Rating Scale were administered. Fifty-consecutive cases were reviewed along with 12-15 month follow-up data for 41 cases. Phobic anxiety to vaginal touch or entry was significantly higher in women with VVS than normative data. Fear of Negative Evaluation was a strong associated feature, and for 30% approached clinically significant levels. Twenty-six percent showed a moderate, while another 26% showed a mild clinically distressed profile. Negative affect and social withdrawal were among the most frequently endorsed variables. Improvement in allodynia and intercourse were both related to these psychological variables, and a multiple regression analysis supported the use of psychological instruments in addition to standard medical assessment. A subgroup of women with VVS display clinically significant broad based psychological distress that warrants additional assessment. The use of psychological questionnaires in addition to medical assessment of women with VVS may provide valuable information predictive of treatment needs and response.

Adult↗