Vaginitis citolítica y los errores terapéuticos: Cómo hacer un diagnóstico y tratamiento diferenciado de la vaginitis candidiásica recurrente / Cytolystic vaginitis. How to make a diagnosis and differentiated treatment from recurrent caginitis vaginitis

Introducción: La vaginitis citolítica (VC) se refiere a la lisis de las células del epitelio intermedio de la vagina causado por un aumento de lactobacilos que provocan acidificación extrema de la vagina. Los síntomas pueden llevar a confundir su diagnóstico con vulvovaginitis candidiásica (VVC), por lo que puede ser tratada de manera errónea con antimicóticos sin responder al tratamiento. Objetivo: Realizar una revisión bibliográfica sobre el diagnóstico y tratamiento diferencial de la VC. Métodos: Se realizó una búsqueda bibliográfica en varias bases de datos: Academic Google, Scopus, PubMed, LILACS, ClinicalKey utilizando los términos MeSH y DeCS: "vaginitis citolítica", "cytolitic vaginitis", "vulvovaginitis candidiásica", "vaginitis recurrente". Resultados: Se identificaron 42 artículos de los cuales se seleccionó 34 para la presente revisión. Discusión: En la VC a través de estudios complementarios se puede identificar abundantes lactobacilos, especialmente L. crispatus y pH vaginal inferior a lo normal. El examen lipídico de secreciones vaginales, sugiere la existencia de niveles elevados de lípidos relacionados con apoptosis celular, estrés oxidativo y sobrecrecimiento bacteriano. El objetivo del tratamiento es mejorar la exagerada acidez vaginal para lo cual se recomienda el empleo de baños de asiento o duchas vaginales con bicarbonato de sodio entre otras medidas. Conclusiones: La VC es una entidad frecuente pero poco conocida, comúnmente confundida con VVC. Su tratamiento debe evitar el uso de antimicóticos.

Detection trend of vaginal intraepithelial neoplasia diagnosed by colposcopy guided biopsy from 2013 to 2015 / 中华妇产科杂志

Objective To explore the detection trend of vaginal intraepithelial neoplasia(VaIN)of lower genital tract from 2013 to 2015. Methods A retrospective analysis was undertaken of colposcopy-directed biopsy of cervical, vaginal and vulvar intraepithelial neoplasia lesions include cervical intraepithelial neoplasia (CIN), VaIN and vulvar intraepithelial neoplasia (VIN) in Obstetrics and Gynecology Hospital of Fudan University from January 2013 to December 2015. Results (1) Overall data of CIN, VaIN and VIN:a total of 16732 cases were diagnosed of lower genital intraepithelial neoplasia in 3 years, accounting for 23.20% (16732/72128) of total colposcopy-directed biopsy cases. Among them, CIN, VaIN and VIN accounted for 19.48%(14053/72128), 2.67%(1923/72128), 1.05%(756/72128) of total colposcopy-directed biopsy cases of the lower genital tract, 83.99%(14053/16732), 11.49%(1923/16732), 4.52%(756/16732) of total lower genital intraepithelial neoplasia, respectively. (2) Annual data of CIN, VaIN and VIN from 2013 to 2015. The annual proportion of CIN in all intraepithelial neoplasia of lower gential tract was basically stable, consisting of 86.02%(3955/4598),83.25%(4795/5760) and 83.20%(5303/6374), respectively. The annual proportion of VaIN was gradually increasing, consisting of 8.09% (372/4598), 12.45%(717/5760) and 13.08%(834/6374), respectively. The annual proportion of VIN was gradually decreasing, consisting of 5.89% (271/4598), 4.31% (248/5760) and 3.72% (237/6374), respectively. Conclusion The increasing detection of VaIN from 2013 to 2015 might correlate with the increasing attention to inspection of the entire vaginal wall.

Insights into the role of cervical mucus and vaginal pH in unexplained infertility / Sobre o papel do muco cervical e do PH vaginal na gênese da infertilidade inexplicada

Unexplained infertility diagnosis is made in the presence of a normal semen analysis when tubal patency and normal ovulatory function are established. Among several potential causes, unexplained infertility could be attributed to vaginal pH and cervical mucus abnormalities. Although the vaginal canal and the cervix generally function as effective barriers to sperm, and although the production of mucus is essential to transport them from the vagina to the uterine cavity, these factors receive little attention in the investigation of couples with unexplained infertility. A substantial reduction in sperm number occurs as they transverse the cervix. From an average of 200 to 300 million sperm deposited in the vagina, only a few hundred achieve proximity to the oocyte. Given this expected high spermatozoa loss, a slight modification in cervical mucus may rapidly transform the cervix into a "hostile" environment, which, together with changes in vaginal environment and cervix structure, may prevent natural conception and be a cause of infertility. In this review, we discuss the physiological role of the vaginal pH and cervical mucus in fertility, and describe several conditions that can render the cervical mucus hostile to sperm and therefore be implicated in the pathophysiology of unexplained infertility.

RESUMO O diagnóstico de infertilidade inexplicada baseia-se na presença de espermograma normal, constatadas também permeabilidade tubária e função ovulatória normais. Entre as várias causas potenciais de infertilidade inexplicada, a presença de muco cervical e pH vaginal anormais devem ser consideradas. Embora a produção adequada de muco cervical seja essencial para o transporte dos espermatozóides da vagina para a cavidade uterina, e tanto o canal vaginal quanto o colo do útero desempenham função importante como barreira à passagem dos espermatozóides, estes fatores recebem pouca atenção na investigação de casais com infertilidade inexplicada. Uma redução substancial do número de espermatozoides ocorre à medida que estes percorrem o trato reprodutivo feminino. Partindo de cerca de 200 a 300 milhões de espermatozoides depositados na vagina, apenas algumas centenas alcançam a proximidade do oócito. Alteracões do muco cervical podem rapidamente transformar o colo do útero num ambiente hostil, que em conjunto com alterações no ambiente vaginal e da estrutura de colo do útero, podem apresentar-se condicões impedientes para a concepção natural; desse modo, convertem-se em causa de infertilidade. Nesta revisão, discutimos o papel fisiológico do pH vaginal e do muco cervical na fertilidade, descrever várias condicões que podem tornar o muco cervical hostil aos espermatozoides e, por fim analisamos como estes fatores interferem na fisiopatologia da infertilidade inexplicada.

Diagnostic values of vaginitis five of the joint inspection kit combined with microscopic examination for vaginal disease / 国际检验医学杂志

Objective To investigate the diagnostic values of vaginitis five of the joint inspection kit combined with microscopic examination for common vaginal disease.Methods The vaginal secretions samples from 4 114 outpatients were tested with LTS-V400 vaginitis five of the joint inspection kit and microscopic examination.The examination results of age groups were analyzed and compared.Results In all 4 114 cases of samples,the positive rate of trichomonad(1.95%)was significantly lower than that of fun-gi(4.74%),P 40-50-age group,which were 1.95%,6.10%,14.15%,10.24% and 46.34%,respectively. The positive rates of H2 O2 ,pH >4.5 and pH 50 age group,which were 85.43%,86.09%,and 0.66%,respectively.The positive rates of trichomonad,SNA,LE,H2 O2 ,pH>4.5 and pH<3.8 were statistically different a-mong the age groups(P <0.05 ).Conclusion Vaginitis five of the joint inspection kit combined with microscopic examination is suitable for the diagnosis of trichomonas vaginitis,mouldsex vaginitis,and bacterial vaginal disease .

The clinical study of pelvic floor rehabilitation therapy of vaginal prolapse and bacterial vaginal disease / 中国基层医药

Objective To study the clinical effects of postpartum women with vaginal prolapse and bacterial vaginal disease on biofeedback combined with electrical stimulation used in pelvic muscle recover therapy,and explore the effectiveness of the treatment and the positive role, reduce the incidence of pelvic floor functional disease. Methods 157 cases of postpartum women who had detected pelvic floor Ⅰ,Ⅱ muscle fiber strength and vaginal dynamic pressure were selected for the study in our hospital,and divided into the treatment group (82 cases) and the control group group(75 cases).The treatment group were observed on the basis of biofeedback combined with electri-cal stimulation therapy( use of phenix USB4 treatment) .The control group were observed on the basis of Kegel exer-cise.Two groups had treatment of bacterial vaginal disease.Results The treatment group after treatment,total effec-tive rate was 93.90%,better than that of the control group.At the same time Aa point,Ap point and POP-Q was bet-ter,Vaginal prolapse was improved,pelvic floorⅠ,Ⅱmuscle fiber strength and vaginal dynamic pressure was signifi-cantly different compared the control group (χ2 =11.19,P<0.05) .Conclusion The pelvic floor rehabilitation ther-apy can improve the pelvic floor muscle strength of postpartum women,and improve the symptoms of pelvic organ pro-lapse.There was no pain and no damage.The treatment effect is not affected by vaginitis,and which is worthy of clini-cal application.