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Background: To compare the vaginal route and laparoscopic suture for vaginal cuff closure (VCC) in patients undergoing a total laparoscopic hysterectomy (TLH)., Methods: A total of 471 women who required hysterectomy were allocated to two groups. 261 women had TLH via VCC by the vaginal route and 210 women had TLH via VCC by laparoscopic suture. All TLHs were performed by the same laparoscopic surgeon., Results: The cuff-related complications included vaginal disruption (3.4%), dehiscence (1.27%), vaginal vault bleeding (1.91%), vaginal spotting (19.32%), granulation (1.27%), cuff infection (1.49%), and yellowish vaginal discharge (6.16%). No difference in vaginal cuff complications was found between the laparoscopic and vaginal approach. The median operation time was significantly shorter for the laparoscopic suture (76.74 min, range 40-220; 95% CI 74.84-83.45) than the vaginal route for VCC (85.77 min, range 45-290; 95% CI 86.87-95.36) after hysterectomy (p < 0.001)., Conclusion: For VCC with TLH, laparoscopic suture was a safe and less time-consuming procedure. The cuff-related complications were similar in the two groups., (Copyright © 2010 S. Karger AG, Basel.)

Introduction: No validated questionnaire that evaluates vaginal symptoms is currently available in the German language. Here, we report the translation and validation process of the German ICIQ-VS., Subjects: Pilot study: 10 patients without any specific disease. MAIN STUDY: 58 Patients (cases) suffering from genital descensus higher than grade 1 pelvic organ prolapse quantification (POPQ) and 51 patients (controls) without vaginal affections., Methods: To establish a cultural-adaptive equivalent in German, recommendations from Guillemin et al. [J Clin Epidemiol 1993;46:1417-1432] were carefully followed. Participants of the main study were asked to fill in the questionnaire at three time points [baseline (T1), 7 days later (T2) and 1 year later (T3)]. Reliability, validity and sensitivity to change were evaluated., Results: In our pilot study, all questionnaire items were correctly interpreted and answered. In the main study, no changes from the original format were observed after translation and cultural adaptation. For the cases, internal consistency was acceptable (Cronbach's alpha 0.72-0.79) and test-retest reliability was moderate to near-perfect for single items (weighted kappa 0.67-0.94). Sensitivity to change and content validity were excellent. Construct validity revealed statistically significant differences between groups., Conclusion: The ICIQ-VS has successfully been translated and validated into the German language., (Copyright (c) 2010 S. Karger AG, Basel.)

Background: Involvement of the female genital tract by Darier's disease, an unusual genodermatosis, is uncommon, and the manifestation of the disease in a cervicovaginal smear is exceptionally rare., Case: A 39-year-old woman had an abnormal Pap smear caused by involvement of the female genital tract by Darier's disease. Cytologic examination showed features consistent with a low grade squamous intraepithelial lesion, but during a biopsy it was found to be vaginal involvement by Darier's disease., Conclusion: The correct interpretation of cytologic findings is not possible when the diagnosis of Darier's disease is not known since a low grade squamous intraepithelial lesion cannot be ruled out. This case underlines the importance of knowing the patient's medical histoiy in any moment of medical attention.

We present an unusual case of condylomata acuminata arising in the transplanted skin of a neovagina in a male-to-female transsexual. The neovagina had been constructed using a penile and a scrotal skin flap. Resection of the larger condylomata was performed; then all visible lesions were ablated by electrovaporization. Microsocpic examination and DNA hybridization revealed condylomata acuminata due to human papillomavirus type 16, 31, and 33 infection., (Copyright 2004 S. Karger AG, Basel)

This manuscript is a review of new ideas regarding the pathogenesis of peritoneal endometriosis, ovarian endometriosis, and retroperitoneal adenomyosis. Peritoneal endometriosis, the different aspects of which (black, red and white) represent distinctive steps in the evolutionary process, can be explained by the transplantation theory. Red lesions are the most active and most highly vascularized lesions and are considered to be the first stage of peritoneal endometriosis. The retroperitoneal nodule is an adenomyotic nodule whose histopathogenesis is not related to the implantation of regurgitated endometrial cells but to metaplasia of Müllerian remnants located in the rectovaginal septum. Metaplastic changes of Müllerian rests into adenomyotic glands involving the rectovaginal septum and the retroperitoneal space are responsible for the striking proliferation of the smooth muscle, creating an adenomyomatous appearance similar to that of adenomyosis in the endometrium., (Copyright 2002 S. Karger AG, Basel)

Primary vaginal stones are extremely rare, particularly in young women. We describe the occurrence of a primary vaginal calculus in a severely retarded 11-year-old girl who was not diagnosed until she was examined using computerized tomography. We postulate that the calculus was formed as a consequence of urinary contamination of the vagina in association with incontinence and prolonged maintenance in a recumbent posture., (Copyright 2000 S. Karger AG, Basel)

Cutaneous disorders can allow the detection of severe systemic disease. We report the case of a woman with vaginal ulcerations. The lesions persisted despite oral antibiotics, antifungal therapy and local care. Biopsy showed an inflammatory ulcerating process with discrete vasculitis. Peripheral blood count showed thrombocytopenia and monocytosis, and bone marrow smears revealed as subacute myelomonocytic leukemia. A review of the literature indicates that genital ulcerations are not known in association with subacute myelomonocytic leukemia. In our case, the persistent vaginal ulcerations were the initial symptom of the subacute myelomonocytic leukemia., (Copyright (R) 2000 S. Karger AG, Basel)

A rare case of primary vaginal calculus is presented. The case is unusual since it occurred after abdominoperineal resection for carcinoma rectum. The mechanism of stone formation in the patient has been discussed.

Congenital arteriovenous malformation (AVM) of the female pelvis is a rare but potentially life-threatening condition. An unusual presentation of AVM involving the vagina, abdominal wall, spleen and thigh, with profuse hemorrhage from a vaginal ulcer is described. Doppler, real time ultrasound and computerized tomography were useful in confirmation and delineation of the extensive AVM in this case. Angiography and embolization were thought risky and possibly unnecessary. Bleeding stopped with bed rest and vaginal packing with gauze soaked in 3% hypertonic saline. The ulcer healed after 3 months with conservative management. The risk of future problems was explained to the patient and follow-up was advised. Undertreatment of AVM may be preferable to overtreatment, and the aim should be 'control' rather than 'cure'.

In two cases the ova of parasitic worms, Ascaris lumbricoides and Enterobius vermicularis, were observed in Papanicolaou-stained vaginal smears. The characteristics of each type of ovum are described.

The clinical picture of candidal vaginitis was described for the first time in 1792. The connection with yeasts was already discovered in the 19th century. Not until the last 35 years, however, have the epidemiologic aspects of genital mycoses and the diagnostic and therapeutic principles been systematically developed. The rise in the incidence of the disease is due to several factors: the administration of corticosteroids, cystostatic agents, and oral contraceptives as well as socioeconomic circumstances. Two serious complications of vaginal yeast infection in pregnant women should be noted: the amniotic infection syndrome and neonatal contamination at the time of delivery. Vulvovaginitis is one of the most common genital diseases in childhood and adolescence. Mycoses can be diagnosed in daily gynecological practice by simple, reliable methods, but only culture on prepared media or by incubation of standardized plates can be depended upon to establish or rule out a mycosis. Effective antimycotics with a broad spectrum of activity have been developed in the last 15 years. We have been primarily concerned with clotrimazole because of our own investigations and impartial comparisons with other fungicidal drugs. Studies of patient compliance have shown that the diseased women accept short-term therapy most readily. However, appropriate control examinations are needed to document the results of treatment.

Pancervicovaginal smears taken from 350 women using an intrauterine contraceptive device (IUD) were screened for the presence of actinomycetes organisms. Of the 12 cases in which actinomycetes-like organisms were seen in Papanicolaou-stained smears, the presence of actinomycetes organisms was confirmed by immunofluorescence in 10 cases. The prevalence of actinomycetes infection was thus 2.8% (10 of 350 cases) in the IUD users. Eight (4.3%) of 173 symptomatic subjects had actinomycetes infections. Two of the positive cases were asymptomatic. Eight of the ten patients with confirmed actinomycetes infection were using the Cu T device while two were wearing the Lippes Loop IUD. Seven of the ten patients had been using an IUD for more than two years. The time of insertion of the IUD (postpuerperal, postmenstrual or after medical termination of pregnancy) did not show any correlation with the presence of actinomycetes infection. Actinomyces israelii was responsible for the infection in eight cases while Arachnia propionica was seen in two cases. The organisms could not be grown in culture.

A case is presented of a large calculus that was formed in the vagina of a 44-year-old woman within less than 4 months. Urinary salts from a vesico-vaginal fistula deposited around an inadvertently unremoved medical gauze.