Cambios histológicos del tracto genital y riesgo de malignidad, en hombres transgénero sometidos a tratamiento androgénico / Histological changes of the genital tract and risk of malignancy in transgender men undergoing androgenic treatment

RESUMEN Introducción y objetivos: La identidad de género es la vivencia interna e individual del género tal como cada persona la siente. En algunos casos, la adquisición de los caracteres sexuales secundarios del otro género es importante en el proceso de reasignación de género, siendo importante el tratamiento endocrinológico. La cuestión es si la administración prolongada de andrógenos es segura en los casos de pacientes transexuales mujer a hombre, ya que es poca la evidencia científica a largo plazo. El objetivo de este estudio es analizar las características clínicas de los pacientes trans de nuestra unidad, y los hallazgos anatomopatológicos de las piezas quirúrgicas de histerectomía y doble anexectomía, para ver la influencia de la androgenoterapia en los genitales internos femeninos. Métodos: Se trata de un estudio descriptivo donde se analizaron datos demográficos y clínicos de los pacientes remitidos para cirugía genital, así como se analizaron los resultados del estudio anatomopatológico de las piezas de histerectomía y anexectomía. Resultados: Se incluyeron 66 pacientes, de los que 59 se intervinieron. No se halló malignidad en ninguna de las piezas quirúrgicas, sí diversos hallazgos benignos como miomas, atrofia/proliferación endometrial, actividad folicular en ovarios u ovarios tipo síndrome de ovario poliquístico. Conclusiones: La exposición a andrógenos a largo plazo no parece producir cambios malignos en la histología uterina ni ovárica, sin embargo, a menudo lleva a cambios en la actividad y la arquitectura ovárica, apreciándose en la mayoría de los casos ovarios funcionales e incluso semejantes a los observados en mujeres con ovario poliquístico.

ABSTRACT Introduction and objectives: Gender identity is the internal and individual experience of the gender as each person feels it. In some cases, the acquisition of secondary sexual characteristics of the other gender is important in the process of gender reassignment, with endocrinological treatment being important. The question is whether prolonged administration of androgens is safe in cases of transsexual women to men, since there is little scientific evidence in the long term. The aim of this study is to analyze the clinical characteristics of trans patients in our unit, and the anatomopathological findings of the surgical pieces of hysterectomy and double adnexectomy, to see the influence of androgen therapy on the female internal genitalia. Methods: This is a descriptive study where demographic and clinical data of the patients referred for genital surgery were analyzed, as well as the results of the anatomopathological study of the hysterectomy and adnexectomy pieces were analyzed. Results: 66 patients were included, of which 59 were intervened. No malignancy was found in any of the surgical pieces, but several benign findings such as myomas, endometrial atrophy / proliferation, follicular activity in ovaries or ovaries like polycystic ovary syndrome. Conclusions: Long-term exposure to androgens does not seem to produce malignant changes in uterine or ovarian histology, however, it often leads to changes in ovarian activity and architecture, with functional ovaries being seen in most cases and even similar ones. those observed in women with polycystic ovary.

Effects on the female reproductive system of air pollution produced by the use of wood combustion for residential heating: challenges and perspectives of morphological studies / Efectos sobre el sistema reproductivo femenino de la contaminación del aire producido por el uso de la combustión de madera para calefacción residencial: retos y perspectivas de los estudios morfológicos

Previous studies have shown that air pollution affects cardio-respiratory function, but its role regarding reproductive processes is unknown. There are few experimental background studies on its effects on the morpho-function in the reproductive system. The use of wood combustion for residential heating (WCRH) in the cities of south-central Chile has increased significantly. As a result, it has become a source of significant emissions of particulate matter suspended (PM) in the air. The possible association between exposure to PM and reproductive problems has been suggested only on the basis of epidemiological studies, most of them carried out in environments where the main source of PM emission is the combustion of oil by motorized vehicles and industries, ignoring the effects produced by the smoke of WCRH. For example, in the city of Temuco-Padre Las Casas, Chile, 93 % of PM emissions correspond to WCRH smoke, thus being considered an urban area with a single PM emission source and the factors that contribute to this type of contamination are reasonably representative of most of the cities in south-central Chile. We therefore suggest this as an adequate setting to evaluate the real effect of the environmental contamination produced by the smoke of WCRH in the reproductive system. The limited number of studies reported on the effects of this type of emission on the female reproductive system, present a challenge for the morphological sciences and also for those who make decisions that affect public health.

Estudios previos han demostrado que la polución del aire afecta la función cardio-respiratoria, pero el rol que tiene ésta respecto a los procesos reproductivos es desconocida. Existen escasos antecedentes experimentales sobre sus efectos sobre la morfo-función en el sistema reproductivo. El uso de la combustión de madera para calefacción residencial (WCRH) en las ciudades del centro-sur de Chile ha aumentado significativamente. Como resultado, se ha convertido en una fuente de emisión importante de material particulado en suspensión (PM) en el aire ambiental. La posible asociación entre exposición a PM y problemas reproductivos ha sido sugerida solo en base a estudios epidemiológicos, la mayoría de ellos realizados en ambientes donde la principal fuente de emisión de PM es la combustión del petróleo por vehículos motorizados e industrias, ignorando los efectos producidos por el humo de WCRH. Por ejemplo, en la ciudad de Temuco-Padre Las Casas, Chile, el 93 % de las emisiones de PM corresponden al humo de WCRH, por lo tanto, es considerada como un área urbana con una fuente de emisión de PM única y los factores que contribuyen a este tipo de contaminación son razonablemente representativos a la mayoría de las ciudades en el centro-sur de Chile, lo que permite sugerirla como un ambiente adecuado para evaluar el efecto de la contaminación ambiental producida por el humo de la WCRH en el sistema reproductivo. Los escasos estudios reportados sobre los efectos de este tipo de emisión sobre el sistema reproductivo femenino constituyen un desafío no tan solo para las ciencias morfológicas, sino que además, para quienes toman decisiones que afectan la salud pública.

Histopatology of the reproductive tract of Nellore pubertal heifers with genital ureaplasmosis

ABSTRACT In order to study and characterize the lesions in the reproductive tract of Nellore heifers naturally infected with Ureaplasma diversum and presenting granular vulvovaginitis syndrome (GVS), fragments of uterine tube, uterus, cervix, vagina and vulva of 20 animals were evaluated. The macroscopic lesions of the vulvovaginal mucosa were classified in scores of "1" mild, until "4", severe inflammation and pustular or necrotic lesions. The histopathological evaluation was performed using scores of "1" to "4", according to the inflammatory alterations. The fragments with severe microscopic lesions (3 and 4) were from the uterine tubes and uterus, which showed leukocytes infiltration and destruction and/or necrosis of epithelium. Alterations in the lower reproductive tract fragments were mild, but characteristics of acute inflammatory processes. The histopathological findings of the reproductive tract of females naturally infected with Ureaplasma diversum are consistent with injuries that compromise the environment from the local where spermatozoa acquires ability to fertilize an oocyte until those where the oocyte is fertilized. Therefore, animals with GVS should be identified early in the herd, because, besides the reduction in the fertility rates caused by tissue damages, they can contribute to disseminate the microorganism. Key words: bovine, tissue evaluation, reproduction, Ureaplasma diversum.

Ninfoplastia em estrela: técnica para redução dos pequenos lábios vulvares / Star nymphoplasty: a surgical technique for labia minora hypertrophy

Introdução: O cirurgião plástico tem sido consultado com frequência, nos últimos anos, sobre a forma e as dimensões dos pequenos lábios vulvares e outras estruturas circunvizinhas, não só pela questão estética, mas também pela funcional, da dispareunia. Os autores apresentam uma técnica de tratamento estético e funcional da genitália externa feminina, a vulva, com o intuito de corrigir a hipertrofia dos pequenos lábios (ninfas), sem alterar­lhes a forma. Método: A técnica consiste na abordagem do pequeno lábio vulvar, com uma incisão em forma de estrela, produzindo um encurtamento das ninfas tanto ântero-posteriormente como crânio-caudalmente. O estudo é de tipo retrospectivo de um período de 15 anos, com seguimento clínico e cirúrgico de 64 pacientes de sexo feminino, com uma faixa etária entre 14 e 58 anos, todas submetidas à ninfoplastia em estrela, técnica proposta neste estudo. Resultados: Os resultados foram obtidos da ficha dos pacientes operados no período compreendido entre janeiro de 1996 e dezembro de 2011, no Hospital da Lagoa e na Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro-RJ. Alto índice de satisfação das pacientes com o tamanho e o formato estético da genitália. Houve uma baixa taxa de complicações e queixas residuais. Conclusão: Este ato cirúrgico é feito com o objetivo de remanejar a estrutura tecidual hipertrófica dos pequenos lábios vulvares. De um ponto de vista técnico, pode-se considerar como um procedimento simples e eficaz no tratamento tanto funcional como estético da genitália feminina.

Introduction: In recent years, women have been frequently consulting the plastic surgeon concerning the shape and dimensions of the labia minora and other surrounding structures, not only for aesthetic but also functional reasons, e.g., dyspareunia. The authors present a technique for the aesthetic and functional treatment of the external female genitalia, the vulva, with the purpose of correcting hypertrophy of the labia minora (nymphs), without changing their form. Method: This technique consists in the incision in the shape of a star leading to a shortening of nymphs both anteroposteriorly and craniocaudally. This is a 15-year retrospective study, with clinical and surgical follow-up of 64 female patients with an age range between 14 and 58 years, all submitted to star nymphoplasty, the technique proposed in this study. Results: The results were obtained from the patients operated from January 1996 to December 2011, at the Hospital da Lagoa and at Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro, RJ. A high rate of patient satisfaction with the size and aesthetic shape of the genitalia was achieved. There was a low rate of complications and remaining complaints. Conclusion: This surgical procedure is done with the objective of reshaping the tissue structure of the hypertrophic labia minora. From a technical point of view, it can be considered as a simple and effective functional and aesthetic treatment of the female genitalia.

Fisiopatología y tratamiento de la atrofia genitourinaria en mujeres / Pathophysiology and therapy of urogenital atrophy in women

La involución del tracto genital femenino refleja su integración con los cambios que sufre el eje hipotálamo-hipofisario-ovárico. El descenso de los niveles de estradiol conlleva una serie de efectos adversos, incluidos los relativos a las vías urinarias inferiores. El cambio más importante es la atrofia vaginal: la mucosa vaginal se vuelve más fina y seca, lo cual puede producir incomodidad vaginal, sequedad, quemazón, prurito y dispareunia. El epitelio vaginal puede presentar cambios inflamatorios y ser un factor que contribuya a los síntomas urinarios, tales como frecuencia, urgencia, disuria, incontinencia, e infecciones recurrentes. Por otra parte, se ha sugerido que los niveles bajos de estrógenos pueden afectar los tejidos periuretrales y contribuir a la laxitud de la pelvis y la incontinencia de esfuerzo. Relacionados con el hipoestrogenismo, los cambios en el pH y la flora vaginal pueden predisponer a las mujeres posmenopáusicas a las infecciones del tracto urinario. La terapia hormonal local en forma de cremas, comprimidos o supositorios es la base del tratamiento de la atrofia genital. Además, otras vías de administración de hormonas, tanto local como sistémica, también han demostrado ser válidas. Sin embargo, a pesar de que los beneficios del reemplazo con estrógenos en la prevención de la atrofia vaginal y la reducción de la incidencia de los síntomas están bien establecidos, este tipo de tratamiento está contraindicado en algunas mujeres y no es una opción aceptable para otras. Pero además, la ruta óptima de administración del tratamiento hormonal, el régimen, las dosis, y las alternativas no hormonales para mejorar los síntomas y la calidad de vida de la población posmenopáusica no han sido completamente estudiados. Esta revisión se centra en los cambios del envejecimiento vaginal e intenta presentar una sinopsis de la fisiopatología y el tratamiento de la atrofia vaginal y la vaginitis atrófica.

Foreign objects in genitalia: Homicide with destruction of identity –A case report.

Sadistic homicides are probably more common than would be expected from reading the literature, where only a few cases are mentioned. In the present case an unclothed dead body of 25 year old female was found in the forest area by the police. On postmortem examination, we found crushed head by heavy hard blunt force (a heavy stone with blood stains recovered near body). After killing her, assailants tried to destroy her identity by burning the face and disfiguring the head. In this case beside common findings of homicide as usually seen in sexual murder cases; there was unique finding of a wine bottle introduced into vagina probably out of frustration. Body also had postmortem abrasions over different parts of the body. Postmortem fractures of multiple ribs were present on both sides of the chest. The death was due to crushed injuries to head caused by hard blunt force, which was sufficient to cause death in ordinary course of nature. We also discuss the possible scenario of psycho-pathology of accused in such cases.

cautionary case of female genital mutilation

We report a case of a tightly circumcised woman who bled irregularly throughout her first year of marriage but failed to conceive. The detection and management of a large but hidden cervical polyp solved her problems. We suggest that such cases, especially in immigrant women, require deeper investigation than might at first appear to be needed

Trombosis de la vena ovárica / Thrombosis of the ovarian vein

Se presenta el caso clínico de una paciente que cursa con trombosis de la vena ovárica izquierda post parto prematuro extremo, secundario a corioamnionitis, con diagnóstico imagenológico confirmatorio y buena evolución a largo plazo.

Doença inflamatória pélvica infecçäo do trato genital superior feminino / Pelvic inflammatory disease superior female genital tract infection

Foi feito uam revisäo sobre o tema doença inflamatória pélvica especialmente dirigida para uma discussäo sobre o próprio título, uma vez que analisando a etiopatogenia, pode-se admitir a nomenclatura de infecçäo do trato genital superior feminino como a opçäo mais correta

Influence of Schistosoma mansoni infection on the reproductive capacity of albino mice

This paper reports reduction on the reproductive capacity of female mice infected with Schistosoma mansoni, either in the acute phase or in the chronic one of the disease. This decrease in the reproductive capacity was highly significant (93.3% and 86.7%, for the acute and chronic phases, respectively).

Este trabalho trata de redução na capacidade reprodutiva de camundongos fêmeas infectados com Schistosoma mansoni, tanto na fase aguda como na fase crônica da doença. Esta diminuição da capacidade reprodutiva foi altamente significativa, com índices de 93,3% e 86,7% nas fases aguda e crônica, respectivamente.

Mycoplasma hominis, ureaplasma urealyticum y mycoplasma fermentans: su relación con patologías del tracto genital humano / Mycoplasma hominis, ureaplasma urealyticum and mycoplasma fermentans: their causal relationship with genital tract human diseases

Los micoplasmas genitales han sido implicados en numerosos cuadros clínicos, como: Uretritis, Enfermedad Inflamatoria Pélvica, Cervitis, Vaginitis, Vaginosis Bacteriana, Prostatitis e infertilidad. No obstante, debido a que pueden formar parte de la flora normal del tracto genital humano, el rol patógeno de estos microorganismos es todavía controversial. Con el propósito de determinar si existe o no relación entre la presencia de micoplasmas genitales y las patologías ya mencionadas, se procesaron 93 muestras de origen uro-genital, provenientes de pacientes sospechosos de infección, que acudieron al Servicio de Microbiología de la Policlínica San Luis de Maracaibo entre marzo y diciembre de 1994. Las muestras fueron resuspendidas en Caldo Urea-Arginina y luego, inoculadas en el Agar Micoplasma, en forma de gotas no confluentes. Los medios fueron incubados a 37ºC por 48 horas en atmósfera microaerofílica. La identificación de especies se orientó por el cambio de color del indicador en el caldo y se confirmó por la morfología de las colonias en el agar. Se obtuvo una proporción de 39.92 por ciento para M.hominis en mujeres y, del 4.30 por ciento y 21.54 por ciento para U.urealyticum en el sexo masculino y femenino, respectivamente. No hubo aislamientos de M.fermentans. No se encontró asociación estadísticamente significativa entre las variables estudiadas

Estudo clínico e histopatológico da genitália de fêmeas bovinas de corte descartadas após a 3ª Inseminação Artificial / Clinical and histopathologic study of genital system of beef cows slaughtered after third artificial insemination

Os exames clínicos, macroscópico e histopatológico post-mortem e de biópsia uterina revelaram em vinte e uma fêmea bovinas de corte descartadas após a terceira Inseminação Artificial que a principal causa de infertilidade fol a infecção uterina. Outras condições associadas ao complexo metrite/endometrite, tais como cisto folicular, hipoplasia ovariana, corpo lúteo cístico e cérvix sinuosa também foram observados. Houve correspondência entre todos os métodos de diagnóstico empregados. O exame clínico dos animais permitiu diagnosticar 76,19% das causas de infertilidade e 71,42% dos casos de infecção uterina, enquanto o exame macroscópico post-mortem demonstrou 95,23% dessas causas. Por outro lado, a biópsia uterina demonstrou a mesma acurácia para o diagnóstico de infecção uterina demonstrada no exame histopatológico post-mortem.

Twenty-one non-pregnant beef cows after third insemination were submitted to clinicai examination of the reproductive tract, including collection of samples for uterina biopsy. Twenty-four hours later they were slaughtered and macroscopic and microscopic examinations of the genital tract were performed. Uterina infections proved to be the major cause of infertility, also associated to others disturbances, such as cystic ovarian disease, ovarian hypoplasia, cystic corpus luteum and sinuosity of the cervix presented in minar cases. Diagnose obtained through rectal palpation of the genital tract, uterina biopsy and post-mortem histopathologyc showed good conformity. Through rectal palpation accurately diagnosed 71,42% of the cows with uterina ifection and 76,19% of ali abnormalities. The post-mortem macroscopic examination of the genital tract found out 95,23% of the pathologic changes presented. Every samples obtained by uterina biopsy showed to uterina infections, which were later confirmed by the post-mortem histopathologic examination. In conclusion, the main cause of infertility in this group of cows was uterina infections.