Fractional and Microablative CO2 LASER and Radiofrequency in the Treatment of Genitourinary Syndrome of Menopause: A Descriptive Study.

Objectives: This study aimed to evaluate the vagina clinically, cytologically, and histologically before and after treating genitourinary syndrome of menopause (GSM) with fractional microablative carbon dioxide LASER (CO2L), radiofrequency (RF), and estrogen vaginal cream (CT). Methods: Women with moderate-to-severe symptoms of GSM, denoted by a GSM Visual analog scale (VAS) score of >4, were eligible for this study. The patients were randomized into treatment groups. In the energy groups, three vulvovaginal applications were administered monthly. The CT group used 0.5 mg vaginal estriol cream for 14 consecutive days, followed by twice a week for 4 months. The follow-up visits occurred 120 days after the beginning of the treatments. The same parameters obtained at the first visit were re-evaluated: GSM VAS score, Incontinence Quality of Life Questionnaire (I-QOL), gynecological examination determining Vaginal Health Index (VHI), vaginal smear for Vaginal Maturation Value (VMV), and vaginal biopsy. Results: Seventy-one women were included, 48 completed the study and provided adequate samples for analysis (CO2L [21 patients], RF [15 patients], and CT [12 patients]). GSM symptoms, I-QOL, and VHI significantly improved after all proposed treatments, with no significant differences between them. VMV did not change after any treatment; however, only 22.9% of the patients presented with cytological atrophy before treatment. Histological vaginal atrophy was identified in 6 (12.5%) pretreated vaginal samples. After the intervention, all histological parameters were normalized, no tissue damage was observed, and no major clinical complications were observed. Conclusion: CO2L and RF seem to be good alternatives to CT for GSM treatment, with no tissue damage.

Simulated operations (SOs) apply mechanical support to structures to confirm symptom causation.

Simulated operations (SOs) are a direct application of the Integral Theory (IT) mantras, "structure and function are related" and "restore the structure and you will improve the function". SOs performed in a clinic setting, are the most effective way possible to test the validity of the IT predictions: stress urinary incontinence (SUI) and urge are mainly caused by laxity in the vagina or its supporting ligaments. The SUI prediction of the IT is validated if a hemostat applied vaginally in the position of the midurethra to mechanically support the pubourethral ligament (PUL) immediately stops urine loss on coughing. The urge and chronic pelvic pain (CPP) predictions of the IT are similarly validated if a patient states her urge and pain symptoms are relieved by insertion of the bottom blade of a bivalve speculum which supports the uterosacral ligaments (USLs). An important use of SOs is to preoperatively assess (by the hemostat test) whether sling surgery for SUI is likely to cure the patient. Similarly, the speculum is very useful for diagnosing whether severe urge or pain symptoms in a woman with minimal prolapse are originating from weak USLs. If digital support of a cystocele relieves urge symptoms, the patient can reasonably be informed that a cystocele repair should improve the urge as well her cystocele prolapse. Used intraoperatively under spinal anesthesia, SOs can determine whether a sling is sufficiently tight to reverse the loose PUL which is causing the SUI. Approximating both cardinal ligaments (CLs) intraoperatively can result in a remarkable disappearance of a transverese defect cystocele; approximating USLs intraoperatively can give an indication of how effective a USL plication would be surgically.

Punto G: enfoque anatómico y seguridad del paciente / G-spot: anatomical approach and patient safety

Se investiga la región uretro-vaginal (pared posterior de la uretra ­ pared anterior de la vagina), en el área que corresponde a la descripción del "punto G", con el fin de colaborar a la discusión respecto de si existe una estructura morfológica que lo identifique. Se destaca una mayor y ocasional distribución venosa en esta zona, que puede explicar el fenómeno fisiológico descrito por Gräfenberg. Para los ginecólogos, urólogos y sexólogos, el conocimiento de la anatomía funcional de esa región tiene importancia para tratar las disfunciones orgásmicas además de la incontinencia urinaria. Esta situación controvertida influye en el marco actual de la seguridad del paciente

The urethro-vaginal region (posterior wall of the urethra ­ anterior wall of the vagina) is investigated, in the area that corresponds to the description of the "G-spot", in order to contribute to the discussion regarding whether there is a morphological structure that identifies it. A greater and occasional venous distribution in this area stands out, which may explain the physiological phenomenon described by Gräfenberg. For gynecologists, urologists and sexologists, knowledge of the functional anatomy of that region is important to treat orgasmic dysfunctions in addition to urinary incontinence. This controversial situation influences the current framework of patient safety

Vaginal Microbiota and HPV in Latin America: A Narrative Review.

With the expansion of human microbiome studies in the last 15 years, we have realized the immense implications of microbes in human health. The human holobiont is now accepted, given the commensal relationships with bacteria, fungi, parasites, viruses, and human cells. The cervicovaginal microbiota is a specific case within the human microbiome where diversity is lower to maintain a chemical barrier of protection against infections. This narrative review focuses on the vaginal microbiome. It summarizes key findings on how native bacteria protect women from disease or predispose them to damaging inflammatory processes with an emphasis on the role of HPV infections in Latin America, one of the world's regions with the highest cervical cancer prevalence.

E-cadherin and NF-κB expression in the vagina after ovarian ischemia and reperfusion

Purpose: To investigate inflammation and cell adhesion molecules in the vagina after ovarian ischemia-reperfusion (IR) injury. Methods: 20 Wistar albino female rats were divided into two groups: control, and IR groups. In IR group, blood flow was restricted for 2 hours for ovarian ischemia. Then, tissues were re-blood 2 hours for reperfusion. Vagina tissues were excised and processed for histopathological analysis. Histopathological and biochemical follow-ups were performed. Results: Both malondialdehyde and myeloperoxidase values were increased in IR group compared to control group. Glutathione content was decreased in IR group compared to control group. Epithelial degeneration, inflammation, dilatation, and nuclear factor-κB (NF-κB) expression were increased in IR group compared to control group. E-cadherin expression was significantly decreased in IR group. In the IR group, E-cadherin showed a positive reaction in adenomas, gland-like cryptic structures, cellular junctions with clustered inflammatory cells. In the IR group, NF-κB expression was increased in basement membrane, inflammatory cells, in blood vessels. Conclusions: Ovarian ischemia caused degeneration of epithelial cells in the vaginal region and disruptions in the cell junction complex, which leads to activation of E-cadherin and NF-κB signaling pathway and alterations in reproductive and embryonal development in the vaginal region.

Variante incomum da síndrome de Herlyn- -Werner-Wunderlich: relato de caso / Unsual Herlyn-Werner-Wunderlich syndrome: case report

Malformações müllerianas correspondem a variações anatômicas do trato repro- dutor feminino. Comumente assintomáticas, o diagnóstico e a verdadeira incidên- cia são difíceis de determinar. A síndrome de Herlyn-Werner-Wunderlich, clas- sicamente descrita pela tríade útero didelfo, hemivagina cega e agenesia renal ipsilateral também pode ter variações diferentes. Em virtude da mesma origem embrionária dos tratos genital e urinário, anomalias renais devem ser investigadas nesses casos, sendo a mais comum a agenesia renal. Este artigo relata o caso de uma paciente de 18 anos, do sexo feminino, com história de piocolpo por cinco anos. Em propedêutica complementar, foi identificado útero com septação com- pleta associado a hemissepto de terço superior de vagina, formação de piocolpo e agenesia renal à direita. Apesar de não ser a definição clássica, o quadro está incluído nos casos de síndrome de Herlyn-Werner-Wunderlich.

Mullerian malformations correspond to anatomical variations of the female repro- ductive tract. Commonly asymptomatic, the diagnosis and true incidence are difficult to determine. The Herlyn-Werner-Wunderlich syndrome, classically described by the triad: uterus didelphus, blind hemivagina and ipsilateral renal agenesis, can also have different variations. Due to the same embryonic origin of the genital and urinary tracts, renal anomalies must be investigated in these cases, the most common being renal agenesis. This article reports the case of an 18-year-old female patient with a 5-year history of pyocolpus. In complementary exams, a uterus with complete septa- tion was identified, associated with a hemiseptum in the upper third of the vagina, formation of pyocolpus and renal agenesis on the right side. Despite not being the classic definition, it is included in the cases of Herlyn-Werner-Wunderlich syndrome.

The marked dextro-dominance causes accentuated morphophysiological variations in the female reproductive organs of the bat Molossus molossus.

Molossus molossus is an insectivorous molossid bat that is important in the control of nocturnal insects. It is the nominal and the most representative species of the family. However, there are few studies about its reproduction. Thus, this study aimed to evaluate variations of its female reproductive organs during the different reproductive phases. Twenty adult females, divided into four sample groups (non-reproductive, early and advanced pregnancy and lactation), were submitted to morphological and morphometric analyses. Results show that the female reproductive system of M. molossus is composed of ovaries, a short bicornuate uterus, slightly convoluted uterine tubes and vagina. The system presents a distinct morphofunctional asymmetry, with a marked dextro-dominance. The right ovaries of all analyzed groups (NON, P1, P2, and LAC) showed follicles at different stages of development, a large number of interstitial glands and a small, but persistent corpus luteum. Ovulation is simple, unilateral and preferential, occurring exclusively in the right ovary. Follicular development in the left ovary usually does not pass the secondary stage. Implantation is fundic and preferential, occurring exclusively in the right uterine horn. The placenta is formed with two distinct chorioallantoic portions, one diffuse endotheliochorial, which covers the entire uterine cavity and regresses in the final stages of pregnancy, and the principal discoidal hemochorial portion, formed in the implantation site. The uterine cervix presents a pseudostratified epithelium, while the vagina has a little keratinized stratified epithelium, which does not accentually vary in the different reproductive stages, but can disrupt and shed in some cases.

Hidrocele del canal de Nuck / Hydrocele of the canal of Nuck

RESUMEN El hidrocele del canal de Nuck es una condición poco frecuente en mujeres adultas, a quienes puede causar tumefacción inguinal-vulvar. Ocurre debido al fallo de obliteración del proceso vaginal, que es la extensión del peritoneo parietal que acompaña al ligamento redondo del útero a través del canal inguinal hasta los labios mayores. La acumulación de líquido seroso en el saco provoca su aparición. Los hallazgos clínicos inespecíficos, como tumefacción indolora y fluctuante que se extiende desde el canal inguinal superficial hasta los labios mayores, no permiten realizar un diagnóstico preoperatorio de esta condición. La ecografía y la resonancia magnética pueden contribuir al diagnóstico. El diagnóstico definitivo solo puede hacerse durante la cirugía y con los hallazgos anatomopatológicos. El tratamiento consiste en la resección quirúrgica de la lesión por vía local o laparoscópica. Se presenta un caso de hidrocele del canal de Nuck.

ABSTRACT Hydrocele of canal of Nuck is a rare condition in adult women which can cause inguinal-vulvar swelling. It occurs due to failure of obliteration of the vaginal process, which is the extension of the parietal peritoneum accompanying the round ligament of the uterus through the inguinal canal to the labia majora. Accumulation of serous fluid in the sac causes its appearance. Nonspecific clinical findings such as painless, fluctuating swelling extending from the superficial inguinal canal to the labia majora do not allow a preoperative diagnosis of this condition. Ultrasonography and magnetic resonance imaging can contribute to the diagnosis. The definitive diagnosis can only be made during surgery and with anatomopathological findings. Treatment consists of surgical resection of the lesion locally or laparoscopically. A case of hydrocele of canal of Nuck is presented.

Endometrial and vaginal microbiomes influence assisted reproductive technology outcomes.

OBJECTIVE: The role of Lactobacillus-dominant microbiota in the endometrium in reproductive function is unclear. We therefore aimed to explore the impact of the balance of Lactobacillus and pathological bacteria in the endometrial and vaginal microbiomes on the pregnancy outcomes of women treated with assisted reproductive technology (ART). METHODS: This study included 35 women with infertility submitted to good-quality embryo transfers. The cutoff values for abundance of Lactobacillus species (spp.) and pathological bacteria in the endometrium and vagina were calculated. Women with Lactobacillus spp. and pathological bacteria abundance above the cutoff values were categorized in the high-abundance group, whereas those with abundance below cutoff values were categorized in the low abundance group. We divided the patients into four groups based on the combination of high/low abundance of Lactobacillus spp. and pathological bacteria. RESULTS: The 35 cases of good-quality embryo transfer resulted in 21 pregnancies. Pregnant women were present in significantly higher proportions in the high Lactobacillus spp. abundance and low pathological bacteria abundance group, whereas the opposite combination (i.e., low Lactobacillus spp. abundance and high pathological bacteria abundance) saw a significantly higher proportion of nonpregnant women (p=0.022). CONCLUSIONS: The balance between Lactobacillus and pathological bacterial abundance in the endometrial and vaginal microbiomes is associated with pregnancy from ART.

Síndrome de Hamman (neumomediastino) posparto. Síntesis de la bibliografía y reporte de caso / Postpartum Hamman (pneumomediastinal) syndrome. Synthesis of the literature and case report

Resumen ANTECEDENTES: El síndrome de Hamman se caracteriza por la coexistencia de aire libre en el mediastino sin una causa identificable; también puede ser secundario a traumatismos, infecciones intratorácicas, procedimientos médicos como la esofagoscopia y broncoscopia. Su incidencia se estima entre 1 en 2000 y 1 en 100,000 embarazos. CASO CLÍNICO: Paciente de 18 años, con 65 kg de peso, 1.56 m de talla e IMC 26.74, correspondiente a sobrepeso, primigesta, sin antecedentes patológicos ni heredofamiliares relevantes, con evolución normal del embarazo. A las 39 semanas acudió a urgencias ginecológicas debido a contractilidad uterina y salida de líquido por la vagina. La finalización del embarazo fue por parto, con recién nacido vivo. En el puerperio mediato (30 horas después del parto) súbitamente tuvo disnea, ortopnea y dolor en la región infraclavicular, sensación de "burbujeo" en la parte anterior del tórax. La radiografía simple de tórax mostró aire libre en el mediastino y enfisema subcutáneo. La TAC de tórax evidenció múltiples burbujas de aire, con extensión del espacio perivertebral de predominio derecho. La conclusión diagnóstica fue: enfisema extenso subcutáneo en los espacios del cuello, con alcance al mediastino anterior, con extenso neumomediastino y cardiomegalia global. CONCLUSIONES: El síndrome de Hamman prevalece en primigestas jóvenes y tiene un curso benigno. El tratamiento debe ser conservador, con oxígeno y analgésicos.

Abstract BACKGROUND: Hamman's syndrome is characterized by the coexistence of free air in the mediastinum without an identifiable cause; it may also be secondary to trauma, intrathoracic infections, medical procedures such as oesophagoscopy and bronchoscopy. Its incidence is estimated to be between 1 in 2000 and 1 in 100,000 pregnancies. CLINICAL CASE: 18-year-old female patient, weight 65 kg, height 1.56 m and BMI 26.74, corresponding to overweight, primigravida, with no relevant pathological or heredofamilial history, with normal evolution of pregnancy. At 39 weeks, she attended the gynaecological emergency department due to uterine contractility and leakage of fluid from the vagina. The pregnancy was terminated by delivery, with a live newborn. In the immediate postpartum period (30 hours after delivery) she suddenly experienced dyspnoea, orthopnoea and pain in the infraclavicular region, with a sensation of "bubbling" in the anterior chest. Plain chest X-ray showed free air in the mediastinum and subcutaneous emphysema. Chest CT showed multiple air bubbles, with extension of the perivertebral space predominantly on the right. The diagnostic conclusion was: extensive subcutaneous emphysema in the neck spaces extending into the anterior mediastinum, with extensive pneumomediastinum and global cardiomegaly. CONCLUSIONS: Hamman syndrome is prevalent in young primigravidae and has a benign course. Treatment should be conservative, with oxygen and analgesics.

Quemadura genital por producto químico: reporte de caso / Genital burn by chemical product: case report

Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.

Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.

Evisceración intestinal transvaginal incarcerada con perforación intestinal después de una colporrafia con malla. Reporte de un caso / Incarcerated transvaginal bowel evisceration with intestinal perforation after a mesh colporraphy. A case report

Introducción. La evisceración intestinal transvaginal es consecuencia, en la gran mayoría de casos, de dehiscencia del muñón vaginal posterior a histerectomía en pacientes postmenopáusicas. A través de la dehiscencia vaginal se produce la salida del contenido abdominopélvico, que puede presentarse como una evisceración simple, incarceración, obstrucción, estrangulamiento y perforación de un asa intestinal. Caso clínico. Mujer de 78 años, con antecedente inmediato de colpocleisis y colporrafia con malla de polipropileno por prolapso vaginal, que presentó dehiscencia del muñón vaginal debido a rechazo de la malla, que condicionó la solución de continuidad de la pared vaginal, con prolapso, incarceración, obstrucción y perforación de íleon. Con el diagnóstico de evisceración intestinal transvaginal incarcerada con perforación intestinal se llevó a tratamiento quirúrgico, con abordaje inicial por vía vaginal para liberar el asa intestinal, luego por laparotomía se realizó resección y anastomosis de íleon, sacrocolpopexia con malla y plastia de Douglas. Presentó buena evolución postoperatoria.Conclusión. La evisceración intestinal transvaginal con perforación intestinal es una entidad de muy rara presentación. El órgano más frecuentemente comprometido es el intestino delgado, especialmente el íleon. Puede complicarse con incarceración, obstrucción intestinal, isquemia y perforación. El manejo quirúrgico involucra resección intestinal, cuando hay signos de necrosis, con reparación y fijación del muñón vaginal.

Introduction. Transvaginal intestinal evisceration is a consequence, in the vast majority of cases, of dehiscence of the vaginal stump after hysterectomy in postmenopausal patients. Through vaginal dehiscence, the exit of the abdominopelvic content occurs, which can present as a simple evisceration, incarceration, obstruction, strangulation and perforation of an intestinal loop. Clinical case. A 78-year-old woman with an immediate history of colpocleisis and polypropylene mesh colporrhaphy due to vaginal prolapse, presents dehiscence of the vaginal stump caused by rejection of the mesh that conditioned the solution of continuity of the vaginal wall, prolapse, incarceration, obstruction and perforation of the ileum. Surgical treatment was performed with the diagnosis of incarcerated transvaginal intestinal evisceration with intestinal perforation. The initial approach was to free the intestinal loop vaginally, followed by laparotomy, ileal resection and anastomosis, mesh sacrocolpopexy, and Douglas plasty were performed. He presented good postoperative evolution.Conclussion. Transvaginal intestinal evisceration with intestinal perforation is a very rare entity. The most common organ involved is the small intestine, especially the ileum. It can be complicated by incarceration, intestinal obstruction, ischemia, and perforation. Surgical management involves intestinal resection, when there are signs of necrosis, with repair and fixation of the vaginal stump.

Epidemiología del virus del papiloma humano / Epidemiology of human papillomavirus

Resumen La presente revisión narrativa fue realizada con el objeto de investigar y recopilar la información más reciente y relevante sobre la epidemiología del Virus del Papiloma Humano y su relación con las patologías asociadas a él, en especial la patología maligna del área genital femenina. La revisión de la literatura fue realizada electrónicamente en PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, y Google Scholar para los artículos escritos en el idioma inglés. Los portales Scielo, Latindex, Imbiomed-L, Redalyc y Google Scholar fueron revisados en búsqueda de artículos escritos en el idioma español. La búsqueda incluyó las palabras claves: epidemiología del virus del papiloma humano, taxonomía viral, estructura del virus del papiloma humano, clasificación del virus del papiloma, nomenclatura del virus del papiloma humano, patologías asociadas al virus del papiloma humano, virus papiloma humano y cáncer del cuello uterino, virus del papiloma humano y cáncer de vulva, y virus del papiloma humano y cáncer de vagina. Se buscaron, revisaron y analizaron las publicaciones desde enero de 1987 hasta agosto de 2021. Esta revisión narrativa investigó la epidemiología del virus del papiloma humano y sus patologías asociadas, en especial las malignas del área genital femenina.

Abstract The present narrative review was conducted to investigate and to compile the most recent and relevant information about the epidemiology of the Human Papilloma Virus and its relationship with the pathologies associated with it. Literature searches were performed electronically in PubMed, Medline, ISI, DOAJ, Springer, Embase. Web of Knowledge, DOAJ, and Google Scholar for original articles written in the English language and Scielo, Latindex, Imbiomed-L, Redalyc, and Google Scholar for original articles written in the Spanish language. The searches included the keywords: epidemiology of human papillomavirus, viral taxonomy, the structure of human papillomavirus, classification of human papillomavirus, the nomenclature of human papillomavirus, pathologies associated to human papillomavirus, human papillomavirus and cervical, human papillomavirus and vulvar cancer and human papillomavirus and vaginal cancer Publications from January 1987 to August 2021 reviewed. This narrative review researched the epidemiology of the human papillomavirus and its pathologies associated especially the female genital area.

Vaginal cytology in mares in the different stages of the estral cycle associated with the seasons of the year / Citologia vaginal em éguas nas diferentes fases do ciclo estral associadas as estações do ano

The reproductive biotechnologies directly assist in the development of different methods of reproductive evaluation. The objective of this study was to develop a new method to determine the estrous cycle phase in equine females through vaginal cytology throughout the seasons, as well as to establish an estimate of inflammatory cells present in the vagina. Six mares were evaluated at different ages without a defined breed and reproductive activity and were subjected to ultrasound evaluation of the reproductive system and cytological analysis of the vaginal region. In the summer, there was a predominance of keratinized epithelial cells in the estrus and intermediate in the diestrus. In the autumn, there was a predominance of keratinized cells in estrus and parabasal cells in estrus and diestrus. In anestrus (winter), a greater number of parabasal cells was identified in relation to the other cell types. In estrus (spring), there was a predominance of parabasal and intermediate cells. Conversely, in diestrus, parabasals were found in greater numbers. The evaluation of inflammatory cells of the vaginal epithelium of mares showed greater activity in the summer; however, there are no reference values for healthy animals in the literature, and it is necessary to conduct studies on the subject. It is concluded that there is an influence of cyclicity on the vaginal epithelium of the equine species, varying according to the season. Additionally, vaginal cytological evaluation is an important complementary tool in the diagnosis of vaginitis in mares, requiring further research on the subject.(AU)

As biotecnologias reprodutivas auxiliam diretamente no desenvolvimento de diferentes métodos de avaliação repro-dutiva. O objetivo deste estudo foi desenvolver um novo método para determinar a fase do ciclo estral em fêmeas equinas através da citologia vaginal ao longo das estações, bem como estabelecer uma estimativa das células inflamatórias presentes na vagina. Seis éguas foram avaliadas em diferentes idades, sem raça definida e em atividade reprodutiva, e foram submetidas à avaliação ultrassonográfica do aparelho reprodutor e análise citológica da região vaginal. No verão, houve predomínio de células epiteliais queratinizadas no estro e intermediárias no diestro. No outono, houve predomínio de células queratinizadas no estro e células parabasais no estro e diestro. No anestro (inverno), foi identificado maior número de células parabasais em relação aos demais tipos celulares. No estro (primavera), houve predomínio de células parabasais e intermediárias. Por outro lado, no diestro, os parabasais foram encontrados em maior número. A avaliação das células inflamatórias do epitélio vaginal de éguas mostrou maior atividade no verão; entretanto, não há valores de referência para animais saudáveis na literatura, sendo necessário a rea-lização de estudos sobre o assunto. Conclui-se que há influência da ciclicidade no epitélio vaginal da espécie equina, variando de acordo com a estação do ano. Além disso, a avaliação citológica vaginal é uma importante ferramenta complementar no diagnóstico da vaginite em éguas, necessitando de mais pesquisas sobre o assunto.(AU)

Vaginal cancer: Why should we care? Anatomy, staging and in-depth imaging-based review of vaginal malignancies focusing on MRI and PET/CT.

Vaginal cancer often poses a challenge for clinical and radiological diagnosis, and its risk factors, progression, and treatment are still poorly established. Although vaginal malignancies are rare, even globally, their rates have increased due to the increased access to healthcare and the evolution of screening measures and diagnostic methods. Because the vaginal cavity is a virtual space, it can harbor lesions that often go unnoticed and, not infrequently, diagnosed belatedly. MRI and, more recently, PET/CT are part of the imaging armamentarium that have already been incorporated into the clinical staging and management of gynecological tumors, allowing excellent morphological characterization of the lesion, its topography and relationship with adjacent structures for the investigation of disease dissemination, overcoming limitations of clinical methods, such as speculum examination, usually restricted to observation only of the superficial characteristics of these lesions. Some vaginal neoplasms have characteristic MRI patterns, which, combined with expert knowledge of anatomy, allow identification of local macroscopic details (such as the mucosal, submucosal, and muscle layers). Furthermore, the application of PET/CT, already well established for identifying systemic disease, has a large impact on patient prognosis. The objective of this work is to review the epidemiological aspects of primary vaginal cancers and the imaging patterns of their main histological subtypes based on MRI and PET/CT, with a brief discussion of the local anatomy, oncological staging, and treatment.

Vaginal development during 2nd gestational trimester: translational study in human female fetuses with disorders of the neural tube.

PURPOSE: One of the most common malformations of the central nervous system is related to embryonic neural tube alterations. We hypothesized that anencephaly affects the development of the vagina during the human second trimester of pregnancy. Our study compared the biometric parameters of the vagina in human female fetuses with neural tube defects. METHODS: In our study, 34 female fetuses were analyzed, 22 normal and 12 anencephalic, aged between 12 and 22 weeks post conception (WPC). After dissection of the pelvis and individualization of the genital tract, we evaluated the length and width of the vagina using the Image J software. We compared the means statistically using the Wilcoxon-Mann-Whitney test and performed linear regression. RESULTS: We do not identify statistical significance between the groups for the measurements of vaginal length (Control 3.12-18.33 mm/mean = 9.08 mm/SD +  - 3.77 vs. Anencephalic 2.91-13.10 mm/mean = 7.24 mm/SD +  - 2.28, p = 0.3469) and vaginal width (Control 1.04-4.86 mm/mean = 2.71 mm/SD + - 0.94 vs. Anencephalic 1.35-3.17 mm/mean = 2.13 mm/SD + - 0.65; p = 0.2503). The linear regression analysis indicated that 78.57% significance was found in the correlations in normocephalic fetuses and 57.14% significance in anencephalic fetuses (12.3-18.6 WPC). CONCLUSIONS: We do not find differences in the length and width of the vagina in anencephalic fetuses but the vaginal length and width shows a lesser tendency of growth in the anencephalic fetuses during the second trimester suggesting that anencephaly can impact the development of the vagina.

Fibrous components of extracellular matrix and smooth muscle of the vaginal wall in young and postmenopausal women: Stereological analysis.

The anterior vaginal wall is subject to many diseases, such as pelvic organ prolapse. The pathophysiology of this illness is multifactorial, and as such, structural components of the vagina are involved. Furthermore, it is more prevalent in older women. There is a lack of data in the literature regarding the extracellular matrix components of the vaginal wall and its changes with aging. The work presented herein aims to perform a stereological study of the extracellular matrix in young and old women. It was observed a decrease of the volumetric density of smooth muscle (45.5 ± 3.2 % and 32.8 ± 5.8 % for the G1 and G2 samples, respectively) and an increase of collagen and elastic fibers with age (35.9 ± 2.1 % and 54.1 ± 5.9 % for the G1 and G2, respectively) in the mucosa of the vaginal wall. These results could help to better understand the pathophysiology of pelvic organ prolapse concerning the aging process.

Comparative measurement of D- and L-lactic acid isomers in vaginal secretions: association with high-grade cervical squamous intraepithelial lesions.

PURPOSE: Identification of low-cost protocols to identify women at elevated susceptibility to develop cervical intra-epithelial abnormalities would aid in more individualized monitoring. We evaluated whether quantitation of the D- and L-lactic acid isomers in vaginal secretions could differentiate women with normal cervical epithelia from those with a low (LSIL) or high (HSIL) grade squamous intraepithelial lesion or with cervical cancer. METHODS: Vaginal samples, collected from 78 women undetgoing cervical colposcopy and biopsy, were tested for pH, bacterial composition by Gram stain (Nugent score) and concentrations of D- and L-lactic acid by a colorimetric assay. RESULTS: Subsequent diagnosis was 23 women with normal cervical epithelium, 10 with LSIL, 43 with HSIL and 2 with cervical cancer. Vaginal pH and Nugent score were comparable in all subject groups. The concentration of L-lactic acid, but not D-lactic acid, as well as the L/D-lactic acid ratio, were significantly elevated (p < 0.01) in women with HSIL and cervical cancer. CONCLUSION: Comparative measurement of vaginal D- and L-lactic acid isomers may provide a low-cost alternative to identification of women with an elevated susceptibility to cervical abnormalities.

Importance of Doppler ultrasound in vaginal foreign body: case report and review of the literature.

The aim of this paper is to describe the distinctive ultrasound findings of a case of vaginal bleeding caused by the presence of a foreign body. We present the case of an infant who consulted for vaginal bleeding and foul-smelling discharge. The ultrasound revealed signs of vaginal distension due to heterogeneous-hematic contents and parietal thickening. At Doppler examination, a striking finding of increased vascularization limited to the upper two-thirds of the vaginal wall was found, which was initially interpreted as a sign of local inflammation suggesting the presence of an underlying foreign body. At direct vaginoscopic examination remains of toilet paper in the vaginal fundus were found. The presence of a foreign body in the vagina is an uncommon cause of discharge and vaginal bleeding in pediatrics, therefore, this etiology should be kept in mind when the adequate clinical context arises. Doppler ultrasound represents a first-line complementary method when this entity is suspected.