Reactional changes in short-term levonorgestrel-releasing intrauterine system (lng-ius) use

SUMMARY OBJECTIVE: To evaluate endocervical and vaginal environment changes in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: A quasi-experimental study included sixty women who had an LNG-IUS inserted in the Family Planning Clinic of UNICAMP between April and November of 2016. Women in reproductive age, non-pregnant, without the use of antibiotics and contraceptives seeking for LNG-IUS insertion were selected for this study. All women were evaluated with regard to vaginal and endocervical pH, vaginal and endocervical Gram-stained bacterioscopy, and Pap-smear before and two months after LNG-IUS insertion. Clinical aspects such as cervical mucus, vaginal discharge, and cervical ectopy were also observed. RESULTS: After LNG-IUS insertion, there was an increase in the following parameters: endocervical pH>4.5 (p=0.02), endocervical neutrophil amount (p<0.0001), vaginal cytolysis (p=0.04). There was a decrease in vaginal discharge (p=0.01). No statistically significant changes were found in vaginal pH, neutrophils amount in the vaginal mucosa, vaginal discharge appearance, vaginal candidiasis, bacterial vaginosis, vaginal coccobacillary microbiota, cervical mucus appearance, or cervical ectopy size. CONCLUSIONS: Short-term LNG-IUS use did not increase vulvovaginal candidiasis or bacterial vaginosis, and led to diminished vaginal discharge. Notwithstanding, this device promoted reactional changes in the vaginal and endocervical environment, without modification on cervical ectopy size.

RESUMO OBJETIVO: Avaliar as alterações do ambiente endocervical e vaginal em mulheres usuárias de sistema intrauterino liberador de levonorgestrel (SIU-LNG). MÉTODOS: Um estudo quase-experimental incluiu 60 mulheres que inseriram o SIU-LNG na Clínica de Planejamento Familiar da UNICAMP entre abril e novembro de 2016. Mulheres em idade reprodutiva, não gestantes, sem uso de antibióticos e contraceptivos, em busca pela inserção do SIU-LNG, foram selecionadas para este estudo. Todas as mulheres foram avaliadas quanto ao pH vaginal e endocervical, bacterioscopia vaginal e endocervical por coloração de Gram, exame de Papanicolau antes e dois meses após a inserção de SIU-LNG. Aspectos clínicos como muco cervical, corrimento vaginal e ectopia cervical também foram observados. RESULTADOS: Após a inserção do SIU-LNG houve aumento nos seguintes parâmetros: pH endocervical >4,5 (p=0,02), quantidade de neutrófilos endocervicais (p<0,0001), citolise vaginal (p=0,04). Houve diminuição do conteúdo vaginal (p=0,01). Não foram encontradas alterações estatisticamente significativas no pH vaginal, na quantidade de neutrófilos na mucosa vaginal, apecto do corrimento vaginal, candidíase vaginal, vaginose bacteriana, microbiota cocobacilar vaginal, aparência de muco cervical ou tamanho da ectopia cervical. CONCLUSÃO: O uso do SIU-LNG em curto prazo não aumentou a candidíase vulvovaginal ou a vaginose bacteriana, levou à diminuição do conteúdo vaginal. No entanto, este dispositivo promoveu mudanças reacionais no ambiente vaginal e endocervical, sem modificação no tamanho da ectopia cervical.

Detection of matrix metalloproteinase-11 in menstrual blood by enhanced chemiluminescence method / 法医学杂志

OBJECTIVE@#To explore the forensic application value of detection of matrix metalloproteinase-11 (MMP-11) in menstrual blood by enhanced chemiluminescence method.@*METHODS@#Menstrual blood, vaginal swab, peripheral blood, saliva stain, urine stain and semen stain were collected to detect whether or not there were MMP-11 using enhanced chemiluminescence method. The specificity and reliability of the MMP-11 assay along with its sensitivity were evaluated.@*RESULTS@#The positive detection rate of MMP-11 in menstrual blood was 89.47%, whereas no MMP-11 was found in vaginal swab, peripheral blood, saliva stain, urine stain and semen stain. When 25 microL sample was added, the mass concentration of protein was 1.329 microg/microL, then MMP-11 could be detected. A positive detection rate of 89.58% was observed in MMP-11 positive menstrual blood samples after stored at 4 degrees C for 20 months.@*CONCLUSION@#Enhanced chemiluminescence method is sensitive and specific for detecting MMP-11, and can be applied to distinguish menstrual blood from common stain such as peripheral blood, vaginal fluid.

Comparing serum follicle-stimulating hormone [FSH] level with vaginal PH in women with menopausal symptoms

Despite the important implication for women's health and reproduction, very few studies have focused on vaginal PH for menopausal diagnosis. Recent studies have suggested vaginal PH as a simple, noninvasive and inexpensive method for this purpose. The aim of this study is to compare serum FSH level with vaginal PH in menopause. This is a cross-sectional, descriptive study, conducted on 103 women [aged 31-95 yrs] with menopausal symptoms who were referred to the Menopausal Clinic at Ghaem Hospital during 2006. Vaginal pH was measured using pH meter strips and serum FSH levels were measured using immunoassay methods. The data was analyzed using SPSS software [version 11.5] and results were evaluated statistically by the Chi-square and Kappa tests. P 4.5, and serum FSH as >/= 20 mIU/ml, then the sensitivity of vaginal pH for menopausal diagnosis was 97%. The mean of FSH levels in this population was 80.79mIU/ml. Vaginal pH is a simple, accurate, and cost effective tool that can be suggested as a suitable alternative to serum FSH measurement for the diagnosis of menopause

A study of cervical cancer screening for prevention of carcinoma cervix.

To identify precursor lesions of cancer cervix and early cancer cervix in married women with primary complaint of leucorrhoea in a tertiary referral centre with reference to effectiveness of screening methods, 100 successive women attending colposcopy clinic with primary complaints of leucorrhoea were selected . All women had speculum examination, Pap smear, vaginal pH, Whiff test, visual inspection of cervix after application of acetic acid (VIA), visual inspection of cervix after application of Lugol's iodine (VIL), colposcopy done. Biopsy was taken when indicated. A total of 63 women were referred. There were 93 menstruating women. The mean age was 34.5 years. Whiff test was positive in 6 women. Downstaging showed 74 women with abnormal cervix. VIA was postive in 44 women and VIL in 53 women. The sensitivity and specificity of VIA was 77.7% and 75%, and that of VIL was 69% and 57% respectively. Diagnostic accuracy of VIA was 76%,VIL was 63%. Pap smear showed 87% accuracy. The correlation between colposcopy and histopathological examination was 93-98%. Precursor cancer cervical lesions, were found in 27% of women. Referral women with cancer precursor lesions formed the largest group of 24% (n=24) of total women. Early carcinoma cervix was detected in 3% (n=3) of which one woman was referred. The burden of carcinoma cervix in India can be brought down by screening camps and early referral.

Comparable between rapid one step immunochromatographic assay and ELISA in the detection of prostate specific antigen in vaginal specimens of raped women.

BACKGROUND: Rape is a crime found in Thailand nowadays. The crime is often lacking of eyewitnesses. Therefore, examination for forensic biological evidence becomes quite important, especially investigating sperm and semen in vaginal specimens of the victim. Acid phosphatase test for semen is commonly used in Thailand but is just a presumptive test. Recently, confirmatory kit tests became available in Thailand for detecting the prostate specific antigen (PSA) from semen. This test is simpler and cheaper than ELISA. OBJECTIVE: To compare the rapid one-step immunochromatographic assay with ELISA for the detection of prostate specific antigen in vaginal specimens of raped women. MATERIAL AND METHOD: A diagnostic test was conducted on the vaginal specimens of raped women that were sent to the laboratory of the Pathology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University during April-August 2006. One hundred vaginal specimens were examined for prostate specific antigen by rapid one step immunochromatographic assay and compared with ELISA. RESULTS: There were 85% and 83% of sensitivity, 85% and 85% of specificity, 85% and 85% of accuracy, 89% and 89% of positive predictive value, and 79% and 77% of negative predictive value from rapid one-step test kit and ELISA respectively CONCLUSION: The result showed that there was no difference on specificity, accuracy and positive predictive value between the two methods but sensitivity and negative predictive value of rapid one-step test kit was better than ELISA. The research team recommends that rapid one-step test kit for prostate specific antigen should be routine service in vaginal specimens of raped women.

Vaginal microflora in postmenopausal women on hormone replacement therapy.

To study the spectrum of vaginal microflora in postmenopausal women on hormone replacement therapy (HRT) and to compare the efficacy of Papanicolaou (Pap) smears with other methods for their detection. Eighty postmenopausal women were recruited for the study. These included 40 women who had attained spontaneous and were on HRT (User 1); 20 hysterectomised women on only estrogen therapy (User 2) and 20 controls (Non users). Their clinical data was recorded and specimens were collected for vaginal cultures (for aerobic bacteria and fungi), vaginal pH, Gram stain and Pap stain on cervical-vaginal smears and toluidine blue on wet smears. Vaginal pH was significantly lower in Users as compared to Non users. Lactobacilli and Gardnerella were more frequently isolated from Users while Bacteroides and E. coli were more common in Non users. Cultures were significantly more sensitive than Gram stained direct vaginal smears in detection of aerobic bacteria; however, Candida could be detected on Gram stain alone in all the cases. Frequency of detection of organisms significantly improved by application of Gram stain to the cervico-vaginal smears. However, clinically relevant organisms like Candida, Gardnerella and Mobiluncus could be identified on Pap smears alone in >50% cases. Lactobacilli could be readily identified in Pap smears in 98% cases. Wet mounts could detect cocci more easily as compared to Pap smears. Altered vaginal microbial profile in post menopausal women receiving HRT may cause bacterial and fungal vaginitis. Although culture studies remain the gold standard to detect these microorganisms, Pap and Gram stains and wet smears provide useful supplements and may be used as alternative procedures especially in resource limited settings lacking adequate culture facilities.

Influence of moonlight on the birth of male and female babies.

Effects of full moon and no moon on the birth of male and female offsprings were studied in Indian Couples of the age group 20 to 40 years. It was observed that 42 wives who were conceived within 24 hours of ovulation at full moon gave birth of 40 male and 2 female babies. On the other hand 40 women conceived on the day of ovulation 3 days prior to full moon gave birth of 13 male and 27 female babies. But only 5 women conceived on no moon, all of them gave birth of female babies. It was also observed that vaginal pH of the ovulated women during full moon was alkaline (pH 8.7 +/- 0.4) while pH was weak acidic in women ovulated 3 days prior to full moon and no moon (pH 6.4 +/- 0.5; 6.2 +/- 0.5). The basal body temperature (BBT) was increased 0.7 degrees F to 1.3 degrees F during the ovulation period when compared with women during the absence of ovulation. But there is an increase in temperature 0.5 degrees F more in women ovulated in full moon than no moon. Together, these results indicate that alkaline vaginal fluid medium and more rise of BBT during full moon favour conception of male [corrected] babies. This method gives the couple more chance of having male child if conception occurs in the day of ovulation in full moon and having female child if conception occurs in no moon.

Vulvovaginites: estudo das variaçoes de pH vaginal e microflora associada / Vulvovaginitis: vaginal pH changes and associated microflora

PURPOSE: To establish a correlation between pH vaginal and the microflora associated in carriers of vulvovaginites. METHODS: In the present study, the cytopathological examination and the vaginal flow in a group of 65 sexually active women had been carried through, 20 and 72 years, taken care of in the Laboratório de Citologia Clínica do Departamento de Análises Clínicas e Toxicológicas da Universidade Federal do Rio Grande do Norte, for determination of microorganisms in cervicovaginal sample and of pH in the vaginal flow. RESULTS: Associating pH vaginal with the presence of vulvovaginitis, it was evidenced that the Candida sp. occurred more frequently in pH 4.0, Trichomonas vaginalis in pH 6.0, Gardnerella vaginalis in pH 5.0, coconuts in pH 5.0, bacilli in pH 4.0 and cocos/bacilos in pH 6.0. It was observed that all the patients had presented at least one type of ethiological agent of vulvovaginiti and an associated microflora. CONCLUSION: The joint accomplishment of the cytological examinations and the determination of pH revealed important for directing the microflora associated with the vulvovaginiti, suggesting, of this form, that pH vaginal plays preponderant role how much to the presence of the infectious agents in the vaginal ecosystem.

Intensidade dos receptores de estrogênio em fragmentos dfa mucosa vaginal / Estrogen receptors in biopsy of vaginal mucosa

OBJETIVOS: avaliar a presença e a intensidade dos receptores estrogênicos citoplasmáticos em biópsias da mucosa vaginal.MATERIAL E MÉTODOS: realizadas biópsias em 49 mulheres normais no menacme, atendidas para tratamento de procidências das paredes vaginais ou de prolapso genital. Os fragmentos de epitélio vaginal foram processados por método imunocitoquímico (PAP). As diferentes coloraçoes obtidas foram correlacionadas ao grau de intensidade dos receptores de estrogênio do citoplasma (zero, + a ++++). Os receptores proteicos específicos ao estrogênio foram identificados no citoplasma das células que compoem as três camadas celulares do epitélio vaginal (CP - camada profunda, CI - camada intermediária e CS - camada superficial). RESULTADOS: A CI possui maior intensidade de REc. Em mulheres com citologia esfoliativa vaginal compatível com o perfil endócrino e adequada à faixa etária, a intensidade dos REc das células da CI nao dependem das oscilaçoes hormonais plasmáticas, nem da faixa etária. As pacientes muito jovens (idade entre 11 e 15 anos) tiveram maior incidência de REc nas células da camada intermediária do que as mulheres que cursam o período final da idade reprodutiva (idade entre 40 e 45 anos). A correlaçao entre a intensidade dos REc observados nas células das três camadas do epitélio vaginal de mulheres no menacme e os índices de maturaçao da citologia vaginal nao resultaram em valores estatisticamente significativos. CONCLUSOES: O epitélio vaginal das mulheres, um sensível efetor estrogênico, presta-se para a identificaçao e valorizaçao dos REc, desde que sejam considerados cada um dos fatores endócrinos, as diferentes fases do ciclo biológico da mulher, a faixa etária e as diferentes estruturas celulares que o compoem.