Clinical study of hyaluronic acid gel in dyspareunia caused by vaginal dryness / Estudio clínico con un gel de ácido hialurónico en la dispareunia por sequedad vaginal

Objective: Hyaluronic acid plays a key role in the hydration, elasticity, and lubrication of the vagina. We evaluated the efficacy of a hyaluronic acid gel (Hyaluron mucus(R)) in the treatment of dyspareunia due to vaginal dryness. Material and methods: A total of 150 women applied the gel using their fingers before intercourse. The gel could also be applied simultaneously by the partner. We assessed the intensity of pain, discomfort during intercourse, and degree of vaginal dryness; we also recorded overall opinion (physician and/or patient) on the efficacy and tolerability of the gel and on its cosmetic and medical properties. Adverse effects and their causality were also recorded. Results: An improvement in pain, discomfort during intercourse, and vaginal dryness was reported by 91%, 84%, and 92% of patients, respectively. Medical opinion was favorable in 81% of cases and moderate in the remaining 19%. Patient opinion was favorable in 82%, moderate in 15%, and poor in 3%. Tolerability was good (2 cases of pruritus, 3 of stinging, and 1 of burning sensation). Compared with the previous treatment, the new gel was considered better by 64% of the women, equal or similar by 33%, and worse by 4%. Conclusions: The hyaluronic acid gel studied (Hyaluron mucus(R)) significantly improved vaginal dryness and dyspareunia with good tolerability and favorable cosmetic-medical properties in around 90% of cases

Objetivo: el ácido hialurónico es clave en la hidratación, elasticidad y lubricación vaginal. Hemos valorado la eficacia de un gel de ácido hialurónico (Hyaluron mucus(R)) en el tratamiento de la dispareunia asociada a sequedad vaginal. Material y métodos: 150 mujeres se aplicaron el gel en la vagina digitalmente antes de cada relación sexual, y se dejó abierta la posibilidad de que se aplicara simultáneamente por la pareja. Se valoraron la intensidad del dolor, la dificultad en la relación y el grado de sequedad vaginal; se registró la opinión global (del médico y/o del paciente) sobre la eficacia, la tolerabilidad y las características cosmético-galénicas del gel. También se recogieron los efectos adversos y su imputabilidad. Resultados: el dolor, la dificultad en la relación y la sequedad vaginal mejoraron en el 91%, el 84% y el 92%, respectivamente. El juicio médico global fue bueno para el 81% de los casos y moderado en el 19% restante, para las pacientes fue bueno en el 82%, moderado en el 15% y malo en un 3%. La tolerabilidad ha sido buena (2 casos de prurito, 3 de escozor y 1 de quemazón). El gel en estudio fue considerado mejor por el 64% de las mujeres, igual o semejante por el 33% y peor por el 4%, respecto al tratamiento previo. Conclusiones: el gel de ácido hialurónico estudiado mejora de forma relevante en torno al 90% de los casos la sequedad vaginal y la dispareunia con una buena tolerabilidad y aceptabilidad cosmeto-galénica

[Contraception and bioethics: between the conscience objection and the autonomy principle]. / Anticoncepción y bioética: entre la objeción de conciencia y el principio de autonomía.

In recent years, in all Western societies has changed the paradigm of the physician-patient relationship. It has passed from the principle of beneficence and abscence of malificence to the patients autonomy, recognizing their sovereignty in making clinical decisions that directly affect them. Occasionally, this principle can clash with certain bioethical aspects of conscientious objection for health professionals and providers, primarily in the areas of contraception and abortion. We discussed aspects that support one or another attitude emphasizing issues relating to contraception and induced abortion and the access and use of contraceptive methods by adolescents recognized as "mature minors" to issues of sexuality, particularly in Spain and Mexico.

Tratamiento adyuvante de la vaginitis con probióticos. Grado de acuerdo basado en el método Delphi / Probiotics as adjuvant therapy for vaginitis. Agreement based on the Delphi method

Objetivo: Reconocer el grado de acuerdo/desacuerdo entre un grupo de ginecólogos españoles sobre el papel de los probióticos como tratamiento adyuvante en la vaginitis. Material y métodos: Estudio prospectivo de metodología Delphi, multicéntrico, con 123 ginecólogos de España, sobre 55 cuestiones, estructuradas en 3 bloques (vaginitis/vaginosis, uso clínico de los probióticos y microbiota vaginal). Resultados: Acuerdo muy consistente en la relación entre vaginitis y edad reproductiva, hormonas y uso de antibióticos como factores favorecedores; alta tasa de recurrencias y complicaciones asociadas a la infección, así como sobre el papel beneficioso de los probióticos. Acuerdo en que los probióticos modulan la proliferación de patógenos vaginales cuando son utilizados principalmente por vía vaginal (cápsulas o tampones). Menor acuerdo con el papel de los probióticos en reducir la transmisión de otras infecciones distintas a candidiasis y vaginosis bacteriana. Conclusiones: Existe un acuerdo muy consistente entre los ginecólogos españoles participantes, sobre el beneficio del uso de probióticos, asociado al antibiótico, para el tratamiento de la vaginitis en la prevención de recurrencias y posibles complicaciones (AU)

Objective: To determine the degree of agreement/disagreement among a group of Spanish gynecologists on the role of probiotics as adjuvant therapy for vaginitis. Material and methods: A prospective, multicenter study with Delphi methodology was performed with 123 Spanish gynecologists on 55 structured issues in 3 blocks (vaginitis/vaginosis, clinical use of probiotics, and vaginal microbiota). Results: There was highly consistent agreement on the relationship between vaginitis and reproductive age, hormones and antibiotics as predisposing factors, on the high rate of recurrence and complications associated with the infection, and on the beneficial role of probiotics. There was agreement that probiotics modulate the growth of vaginal pathogens when used mainly vaginally (capsules or tampons). There was less agreement on the role of probiotics in reducing the transmission of infections other than candidiasis and bacterial vaginosis. Conclusions: There was highly consistent agreement among the participating Spani h gynecologists on the benefits of probiotics associated with antibiotics for the treatment of vaginitis in preventing recurrences and complications (AU)

Protocolo Sociedad Española de Ginecología y Obstetricia de diagnóstico y tratamiento de las infecciones vulvovaginales. Protocolo actualizado en 2012 / The protocol of the Spanish Society of Obstetrics and Gynecology for the diagnosis and treatment of vulvovaginal infection. Update 2012

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Low calcium intake and inadequate vitamin D status in postmenopausal osteoporotic women.

UNLABELLED: An observational cross-sectional study was conducted to assess calcium intake and vitamin D status by measurement of 25-hydroxyvitamin D (25(OH)D), in postmenopausal osteoporotic women (PMOW) treated and untreated for osteoporosis. To assess the influence of sunlight exposure on vitamin D status, the study group was categorized on the basis of sunlight exposure (above or below 2500 sunlight h/year). A group of 336 PMOW older than 65 years was identified (190 [56.5%] treated and 146 [43.5%] untreated for osteoporosis). The demographic and clinical data of the PMO women included history of prior fractures, pharmacological treatments and dietary calcium intake. BMD was measured by DEXA and 25(OH)D was determined by an HPLC method. RESULTS: vitamin D serum levels were lower in the untreated group as compared with the treated group (58±27 vs. 67±27nmol/l; p=0.006). Prevalence of vitamin D deficiency (cut-off point set at <50nmol/l) was higher in the non-treated group (43.8% vs. 29.5%; p=0.009). Nearly all PMOW, whether treated or not for osteoporosis had a total calcium intake of less than 1200mg. Sunlight exposure did not influence the vitamin D status. CONCLUSIONS: vitamin D deficiency and an insufficient calcium intake are highly prevalent in both treated and untreated Spanish PMOW older than 65 years. This can be related to low therapeutic adherence and/or insufficient prescription. Therefore physician's and patient's knowledge regarding the optimization of vitamin D status and calcium intake should be improved and implemented. This article is part of a Special Issue entitled 'Vitamin D workshop'.

Crecimiento paradójico y complicaciones de la embolización arterial de miomas uterinos. Presentación de 2 casos / Paradoxic growth and complications of uterine myoma arterial embolization. Report of 2 cases

El mioma uterino es el crecimiento pélvico anormalmás frecuente; se presenta en el 30% de lasmujeres. El sangrado anómalo, el dolor, lasmolestias hipogástricas, la interferencia con lafertilidad y el crecimiento rápido son indicacionespara su tratamiento. La embolización de las arteriasuterinas se ha propuesto como alternativaterapéutica para la hemorragia anómala producidapor el mioma.Se presentan 2 casos en los que el crecimientoparadójico de los miomas hizo necesaria la prácticade una histerectomía. Se comentan en el textootras complicaciones derivadas de la técnicaseñaladas en la revisión bibliográfica realizada

Uterine myoma is the most common nonmalignantpelvic tumor in women, occurring in 30%.Menorrhagia, pelvic pain, hypogastric distress,infertility and rapid growth are indications forhysterectomy. Uterine artery embolization has beenproposed as a therapeutic alternative formenorrhagia caused by uterine myoma.We report the cases of two patients, both of whomdeveloped severe complications after uterineembolization: paradoxic uterus and myomagrowth and premature ovarian failure respectively,requiring hysterectomy as definitive treatment. Wedescribe other complications of this therapeuticapproach to uterine myoma