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Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure. [ABSTRACT FROM AUTHOR]

We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98–33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01–7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70–0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22–0.96); (v) vomiting (aOR 95% CI 0.38, 0.19–0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18–0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. [ABSTRACT FROM AUTHOR]

In Gilgit, capital of the Gilgit-Baltistan region in northern Pakistan, leucorrhea – vaginal discharge known in the vernacular as safaid pani, or 'white water' - serves as both a medical diagnosis and signifier of the chronicity of the reproductive, social, and emotional burdens endured by women. While ethnomedical providers explained safaid pani as resulting from relatively benign forms of 'weakness', which required minimal dietary or ethno-botanical recourse, allopathic physicians approached discharge as evidence of numerous pathologies that necessitated protracted and sometimes also expensive treatments. Physicians' clinical assessments were not solely biomedical, but also integrated informal folk and formal ethnomedical theories of causation. Clinical diagnoses that affirmed leucorrhea as a pathophysiology substantiated women's belief that it was proof of the destructive effects of sustained social inequity, peril, and distress on the body, and the uterus in particular. Women and their treating providers recognized the power of the (dys)functional uterus to not only threaten women's reproductive wellness but also their social, marital, and familial status, which hinged on their ability to become pregnant and give birth, to sons especially. Because of the ailing uterus's expansive importance, weeping wombs served as a potent source for women's claims making and calls for attention and care. [ABSTRACT FROM AUTHOR]

In beef cows, cycle is expected to resume within 30–35 days postpartum. Uterine diseases may delay these processes, extending the partum to conception to 50 days. Biomarkers for the diagnosis of Purulent vaginal discharge (PVD) in beef cows remain undefined. Creatine kinase (CK) has been investigated in dairy cows as a marker for clinical endometritis but not in beef cows. Mucus score and blood sampling were performed at 30 ± 5 in 264 non-pregnant Piedmontese beef cows and 28 of them were diagnosed with PVD. Cows that showed no successful conception after more than three AI with no apparent clinical disease were defined as repeat breeders (N = 33). Kruskal-Wallis test was used to detect difference in CK between cows with PVD and heathy ones and RB (p = <.001 and p =.048 respectively). No difference was found between healthy cows and RB (p >.05), cows PVD showed lower reproductive performances (PC and n°/IA) than healthy ones. Parity and farm didn't show differences between healthy and PVD cows. ROC curve was created to define a CK cut-off value for PVD detection (241 U/L, Sp 69%, Se 92%, AUC 0.81, Younden Index (J) 0.61) and to determine CK accuracy in predicting infertility at 120- and 150-days postpartum (Sp 77%, Se 42%, AUC 0.57, J 0.19 and Sp 82%, Se 34%, AUC 0.59, J 0.16 respectively). This study underlines the potential of CK as a marker of PVD in beef cows. Creatine kinase seems to be a useful on field marker of PVD in beef cows Creatine kinase cut-off for PVD is 241 U/L Creatine kinase has low accuracy in prevision of infertility [ABSTRACT FROM AUTHOR]

We aimed to systematically review the impact of local estrogen use in combination with a pessary on vaginal complications in postmenopausal women with pelvic organ prolapse (POP). We searched databases including Medline, Embase, PubMed, Clinical Trials and the Cochrane Central Register of Controlled Trials for relevant literature published in English from inception to 31 May 2021. Only randomized controlled trials (RCTs) and cohort studies were included. In total, five studies were included (three RCTs, one prospective study and one retrospective cohort study). The meta-analysis was performed with subgroups. Our results indicated a significantly lower incidence of bacterial vaginosis (BV) among postmenopausal women who used estrogen than among controls, with a total pooled odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.11–0.72; I2 = 38%; p = 0.008). The summary ORs of the estrogen use group were 0.98 (95% CI: 0.59–1.63; I2 = 41%; p = 0.95) for vaginal ulceration, 0.80 (95% CI: 0.42–1.54; I2 = 29%; p = 0.50) for vaginal bleeding and 0.74 (95% CI: 0.35–1.58; I2 = 35%; p = 0.44) for vaginal discharge. Local estrogen in combination with a pessary could decrease the BV rate among postmenopausal women with POP. However, consensus regarding the value of estrogen use for decreasing other pessary complications has not yet been reached. Additional multicenter RCTs with large sample sizes should be conducted to better understand the effect of estrogen use on reducing pessary-related complications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to improve the understanding of different types of oblique vaginal septum syndrome (OVSS), and to explore the efficacy of combined hysteroscopy-laparoscopic surgery and hysteroscopy in the treatment of OVSS, in order to provide a certain reference value for clinical diagnosis and treatment. The types, clinical manifestations, treatment methods and efficacies of 46 patients with OVSS who were treated in our hospital were retrospectively analysed. Forty-six patients underwent ultrasonography with a diagnostic accuracy of 100%. Among the 46 cases, 18 cases were type I, 20 were type II, five were type III and three were type IV. The postoperative VAS scores in both groups were significantly lower than those before surgery, indicating that postoperative abdominal pain symptoms were effectively relieved after surgery, and the remission rate was 100%. Of the 43 surgically treated patients, 26 had fertility requirements, of which 17 (65.4%) had a successful pregnancy. There are many types of OVSS, which should be diagnosed by ultrasound, magnetic resonance imaging (MRI) and hysteroscopy before surgery based on the clinical symptoms of patients. Besides, hysteroscopic trapezoidal septum resection is the most minimally invasive, simple and effective surgical method for the treatment of OVSS. What is already known on this subject? Oblique vaginal septum syndrome (OVSS) is a congenital malformation of the female reproductive tract with a low incidence. The appearance of the external genitalia and normal menstruation before puberty made the diagnosis of OVSS difficult and the rate of misdiagnosis and missed diagnosis is high. What do the results of this study add? Dysmenorrhoea or abdominal pain were the main reasons for the first diagnosis in patients with types I and IV OVSS, while vaginal discharge and abnormal menstruation were the main reasons for the first diagnosis in patients with types II and III OVSS. The combined hysteroscopic–laparoscopic surgery and hysteroscopic surgery can significantly alleviate OVSS. What are the implications of these findings for clinical practice and/or further research? There are many types of OVSS, which should be diagnosed by ultrasound, magnetic resonance imaging (MRI) and hysteroscopy before surgery based on the clinical symptoms of patients. Besides, hysteroscopic trapezoidal septum resection is the most minimally invasive, simple and effective surgical method for the treatment of OVSS. [ABSTRACT FROM AUTHOR]

Family Health Care Worker (FHCW) led educational interventions to have the potential to educate and promote community health. Improvement of women’s knowledge of vulvovaginal discharge will promote health-seeking behaviours and prevent complications. This study was designed to evaluate the impact of an educational intervention (EI) on vulvovaginal discharge (VVD) for FHCWs in improving the knowledge and attitudes of females aged 18–49 years in selected communities in Sri Lanka. The EI was first implemented for the FHCWs. The effectiveness was assessed by a non-randomized controlled trial using an intervention group of n = 259 and a control group of n = 259 of females. Knowledge and attitudes on VVD were assessed using a pretested, validated interviewer-administered questionnaire at baseline and a posttest after six months of the intervention. The mean knowledge and attitude scores among the females in the intervention and control groups were similar at the baseline. At the post-test, the mean knowledge score among females in the intervention group was 44.96% (Standard Deviation (SD) ± 12.68) and the control group was 20.75% (SD ± 7.37) with a significant improvement (p < 0.001, Mean (M) = 23.68, 95.00% Confident Interval (CI) = 21.63 to 25.72) at the post-test. A significantly higher mean difference in attitudes scores (pre-test and post-test) was observed among the intervention group compared to the control group (p < 0.001, M = 2.90, 95.00% CI = 2.15 to 3.65). This highlights the importance of educational interventions to FHCW that in turn will enhance community health. [ABSTRACT FROM AUTHOR]

To design a monitoring strategy that could be applied to regular veterinary visits to dairy farms to assess the prevalence and association between health conditions (uterine disease, hyperketonaemia and suboptimal body condition score) when diagnosed and treated at 1–7 days post-calving (DPC) and then re-examined at 28–35 DPC. This study evaluated data from 187 high-yielding dairy cows (21 primiparous, 166 multiparous) on one South Australian dairy farm on two occasions; Visit A which was 1–7 DPC and Visit B which was 28–35 DPC. On each visit, the nature of vaginal discharge, concentration of beta-hydroxybutyrate (BOH) in blood and BCS were recorded and assigned a clinical score. This was converted to a categorical outcome denoting the presence or absence of an abnormal health event, namely metritis or endometritis, hyperketonaemia (BOH concentration ≥1.2 mm/L) and suboptimal body condition score (>0.5 from optimum score). Cows with uterine disease or hyperketonaemia at either visit were treated. The prevalence of abnormal health events at each visit was determined and the association between the prevalence of disease at Visit A and Visit B (following appropriate treatment at Visit A) was measured using regression analysis. The prevalence of abnormal vaginal discharge, hyperketonaemia and suboptimal BCS at Visits A and B were 26%, 7%, 35% and 25%,16%, 33% respectively. A higher proportion of primiparous cows (Visit A: 0.86 (95% CI = 0.70–1.00); Visit B: 0.95 (95% CI = 0.86–1.00)) were found to have suboptimal BCS at both visits compared to multiparous cows (Visit A: 0.28 (95% CI = 0.20–0.35); Visit B: 0.24 (95% CI = 0.17–0.32)). A higher prevalence of hyperketonaemia at Visit B for multiparous compared to primiparous cows (19 (95% CI = 12–25)% vs. 0 (95% CI = 0–17) respectively) was identified. An increase in clinical discharge score at Visit A increased the odds of purulent vaginal discharge at Visit B (OR = 1.77 (95% CI = 1.31–2.40)). Failing to calve at target BCS was strongly associated with cows missing target BCS at Visit B (OR = 5.77 (95% CI = 2.35–13.11)) and for every unit increase in BCS at Visit A, BCS at Visit B increased by 0.40 (95% CI = 0.26–0.53). This study describes a pilot monitoring strategy for clinical parameters indicative of post-partum disease at 1–7 and 28–35 DPC. Determining the herd prevalence of these conditions will enable tracking of herd disease status over time. Abbreviations: BCS: Body condition score; BOH: Beta-hydroxybutyrate; DPC: Days post-calving; NEFA: Non-esterified fatty acids; SCHK: Subclinical hyperketonaemia [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness of cervical pessary in preventing preterm birth (PTB) and improving perinatal outcomes among singleton and twin pregnancies.Methods: Electronic databases were systematically searched from their inception until 14 March 2019. Randomized clinical trials comparing the effectiveness of cervical pessary placement with expectant management were included. The primary outcome was the incidence of PTB <34 weeks.Results: Thirteen studies were included, involving eight studies about singleton and six studies about twin pregnancies. For singleton pregnancies with short cervical length, cervical pessary, comparing with expectant treatment, seemed have no effectiveness in preventing PTB <34 weeks (relative risk, 95% confidence interval, 0.73, 0.42-1.28), <37 weeks (0.69, 0.43-1.09), and <28 weeks (0.79, 0.42-1.48); while for twin pregnancies with short cervical length, cervical pessary also did not reduce the risk of PTB <34 weeks (0.81, 0.49-1.35), <37 weeks (0.93, 0.83-1.05), and <28 weeks (0.72, 0.38-1.38). However, cervical pessary seemed have the effectiveness of reducing the risk of spontaneous PTB <28 weeks (0.50, 0.25-0.99) and low birth weight (<1500 g) (0.68, 0.50-0.94) among twin pregnancies with short cervical length. In addition, cervical pessary increased the rate of vaginal discharge and did not improve perinatal outcomes among both singleton and twin pregnancies.Conclusions: Comparing with the expectant treatment, the effectiveness of cervical pessary for reducing the risk of PTB remains uncertain. Additional trials are warranted to further evaluate the effectiveness of cervical pessary. [ABSTRACT FROM AUTHOR]

There are no robust national prevalence of Human Papillomavirus (HPV) genotypes in Nigerian women despite the high burden of cervical cancer morbidity and mortality. This study aims to determine the pooled prevalence and risk factors of genital HPV infection in Nigeria through a systemic review protocol. Databases including PubMed, Scopus, Google Scholar and AJOL were searched between 10 April to 28 July 2020. HPV studies on Nigerian females and published from April 1999 to March 2019 were included. GRADE was used to assess the quality of evidence. The pooled prevalence of cervical HPV was 20.65% (95%CI: 19.7–21.7). Genotypes 31 (70.8%), 35 (69.9%) and 16 (52.9%) were the most predominant HPV in circulation. Of the six geopolitical zones in Nigeria, northeast had the highest pooled prevalence of HPV infection (48.1%), while the least was in the north-west (6.8%). After multivariate logistic regression, duration (years) of sexual exposure (OR = 3.24, 95%CI: 1.78–9.23]), history of other malignancies (OR = 1.93, 95%CI: 1.03–2.97]), history of sexually transmitted infection (OR = 2.45, 95% CI: 1.31–3.55]), coital frequency per week (OR = 5.11, 95%CI: 3.86–14.29), the status of circumcision of the sexual partner (OR = 2.71, 95%CI: 1.62–9.05), and marital status (OR = 1.72, 95%CI: 1.16–4.72), were significant risk factors of HPV infection (p < 0.05). Irregular menstruation, post-coital bleeding and abdominal vaginal discharge were significantly associated with HPV infection (p < 0.05). HPV prevalence is high in Nigeria and was significantly associated with several associated risk factors. Rapid screening for high-risk HPV genotypes is recommended and multivalent HPV vaccines should be considered for women. [ABSTRACT FROM AUTHOR]

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function. What is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion. What do the results of this study add? Although the patients' quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy. What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function. [ABSTRACT FROM AUTHOR]

Objective: Much of the literature on clinical decision-making regarding the optimal route of delivery for periviable birth, 23 0/7-25 6/7 weeks gestation, has focused on neonatal risks. In fact, routine cesarean delivery at these early gestational ages has not been shown to improve neonatal mortality or neurological outcomes. Neonatal risks associated with the route of delivery are well known. Conversely, there is a paucity of data on maternal morbidity associated with the route of delivery. We examined maternal morbidity according to the attempted route of delivery in women undergoing periviable birth.Study Design: In a secondary analysis of the Consortium on Safe Labor, a retrospective cohort study, maternal outcomes were compared between attempted vaginal delivery and planned cesarean delivery in women undergoing periviable birth. Analyses were repeated to compare maternal outcomes among actual mode of delivery (vaginal delivery versus cesarean delivery). Multivariable Poisson regression was used to estimate adjusted relative risks (aRR) with 95% confidence intervals (95% CI), controlling for predefined covariates.Results: Of 678 women who underwent periviable birth, 558 (82.3%) and 120 (17.7%) attempted vaginal delivery and planned cesarean delivery, respectively. Of 558 women who attempted a vaginal delivery, 411 (73.7%) achieved a vaginal delivery. Women who attempted a vaginal delivery compared to those who had a planned cesarean delivery were less likely to have endometritis (3.1 versus 15.0%; aRR 0.18, 95% CI 0.09-0.35). Women who attempted a vaginal delivery compared to those who had a planned cesarean delivery had 7-day shorter total length of hospital stay (p < .001). Comparison of actual mode of delivery showed that women with vaginal had decreased risks of fever (2.9 versus 7.9%; aRR 0.42, 95% CI 0.20-0.90), endometritis (0.5 versus 12.4%; aRR 0.03, 95% CI 0.01-0.13), and maternal thrombosis (0.2 versus 3.0%; aRR 0.08, 95% CI 0.01-0.93) compared to cesarean delivery. Women with vaginal delivery had 3-day shorter total length of hospital stay (p < .001) compared to cesarean delivery.Conclusion: The majority of women (73.7%) who attempted a vaginal delivery achieved a vaginal delivery. Attempting a vaginal delivery between 23 0/7 and 25 6/7 weeks gestation compared to a planned cesarean delivery was associated with decreased risks of maternal infectious morbidity. Deciding the route of delivery is challenging in women undergoing periviable delivery. Our analysis provides important information on short-term maternal risks when considering the risks and benefits during these discussions. [ABSTRACT FROM AUTHOR]

Purpose: To compare between continuous and interrupted use of vaginal probiotic after vaginal clindamycin cream for treatment and prevention of recurrence of bacterial vaginosis.Methods: A double-blinded randomized controlled clinical trial, 273 women were randomly allocated to use clindamycin 2% vaginal cream 5 g at bedtime for 7 days followed after 1 week by continuous probiotics vaginal capsule once daily for 6 weeks (n = 129) or clindamycin 2% vaginal cream 5 g at bedtime for 7 days followed by one probiotic vaginal capsule twice a week for 6 weeks (n = 144). The initial evaluation was at 1 week after cessation of probiotics treatment to estimate the cure rates, the follow-up visits were at 1, 3, 6, and 9 months from the initial visit. The primary outcome of this study was cure rate; the secondary outcomes were the frequency of recurrence, the presence of vaginal discharge, pH > 4.5, positive whiff test and detection of clue cells.Results: At the initial visit there was no significant difference in cure rate between continuous probiotics group and interrupted probiotics group (87.4 versus 82.5%; p = .81). There was no significant difference between the two groups in the recurrence rate at one, three, six and 9 months follow up visits (p = .16, p = .42, p = .59, p = .66). There was no significant difference between both groups regarding vaginal discharge reduction, pH dropping, the presence of positive whiff test and detection of clue cells at one, three, six and 9 months follow up visits. Except at 9-month visits, the differences in vaginal discharge reduction and positive whiff test were statically significant.Conclusions: After initial treatment of bacterial vaginosis with vaginal clindamycin cream, the continuous use of vaginal probiotics is equally effective to short repetitive courses in terms of cure rates and prevention of relapse. [ABSTRACT FROM AUTHOR]

In Persian medicine, topical ingredients such as Rosa damascena Mill. (Rosaceae), are usually recommended for the treatment of uterine diseases. Scientific evaluation of these historical documents can be valuable for finding new potential use in conventional medicine. This clinical trial was performed to determine whether the use of the 'ward' vaginal tablet, which contains Rosa damascena, Punica granatum L. (Punicaceae), Querqus infectoria Oliv. (Fagaceae), Myrtus communis L. (Myrtaceae) and Nardostachys jatamansi (D.Don) DC. (Caprifoliaceae) could alleviate the symptoms of vulvovaginal candidiasis. A parallel double-blinded placebo-controlled study was done. Eighteen to fifty-year-old women with vulvovaginal candidiasis were divided into the 'ward' and placebo groups, 46 individuals in each group. The 'ward' group received the 'ward' vaginal tablet containing 200 mg of dried extract. Placebo group received a placebo (composed of corn starch and lactose). One tablet was applied through the vagina for 7 consecutive nights. Two weeks after medication administration, the vaginal discharge sample of patients was re-cultured; 29 patients (63.045%) in the 'ward' group and 6 (13.04%) patients in the placebo group had negative culture (p < 0.001). All clinical symptoms including itching, irritation, and vaginal discharge were significantly reduced in the 'ward' group compared with the placebo group following the intervention and the follow up (p < 0.05). The findings suggest the 'ward' vaginal tablet could ameliorate vulvovaginal candidiasis. Future larger studies are recommended due to compare the therapeutic effect of the 'ward' vaginal tablet with common treatments. [ABSTRACT FROM AUTHOR]

The objective of this study was to characterise pre-discharge maternal pain and stress severity after vaginal delivery and associations with parity. This is a descriptive analysis with 148 women in the early post-partum period (84 primiparae and 64 secondiparae) after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Psychological Stress Measure (PSM). Vaginal delivery in primiparae women was associated with MGPQ, significantly higher pain scores. Sensorial, affective and mixed pain descriptive categories were also significantly higher. Pain location involved lower abdomen, vagina and perianal area. In addition, their PSM showed a significantly higher 'Sense of effort and confusion' subscale scores. In conclusion, this study provides important information on the quality of care implications of hospital-to-home discharge practices in puerperae after vaginal delivery, a critical time characterised by qualitatively and quantitatively high pain and stress in primiparae.Impact statementWhat is already known on this subject? Pain and fatigue are the most common problems reported by women in the early postpartum period.Whatthe results of this study add? Primiparae who delivered vaginally presented at the time of hospital-to-home discharge significantly higher pain and stress, as compared to secondiparae. Pain involved lower abdomen, vagina and perianal area, whereas the stress was quantitatively higher in the 'sense of effort and confusion'.Whatthe implicationsareof these findings for clinical practice and/or further research? Awareness of problematic pain and stress associations with parity may offer the opportunity to better support puerperae to develop maternal orientation and adjust to motherhood. [ABSTRACT FROM AUTHOR]

Purpose: To describe single center clinical experience with cervical pessary used for high-risk pregnant women who also had short cervix. We have focused on the techniques to optimize efficacy and minimize the risk of complications and side effects related to pessary insertion, removal, and pregnancy management.Methods: This is an audit from specialist preterm birth prevention clinic in Liverpool Women's Hospital, United Kingdom for the period between January 2013 and December 2017. We also conducted postal survey in November 2015 to evaluate women's experience with vaginal pessary.Results: Out of 235 women who were treated for short cervix, 129 (55%) had cervical pessary as a first line treatment. Overall, 50% of treated women reached term. 17 women (13%) needed additional treatment, 9 women had pessary reinserted (7%), and 53 (41%) had pessary removed before 36 weeks, mainly due to ruptured membranes. Significant vaginal discharge and pelvic discomfort were reported by 14 and 7% women, respectively. 89% of treated women would recommend the pessary treatment to others.Conclusions: Whilst the cervical pessary continues to be evaluated in clinical trials, our experience suggests that pessary is quite easy to insert and remove and is well tolerated by the women. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a common problem, and allegations of CSA require a thorough multidisciplinary investigation which includes a comprehensive medical evaluation. Although most CSA victims will have normal exams, some will have physical injuries, sexually transmitted infections (STIs), and/or other problems. We are reporting the results of the examinations of 573 children evaluated in the West Alabama Child Medical Evaluation Program (WACMEP). This is the first report of CSA exams coming from Alabama and one of a few from a smaller medical center. Most were victimized by a single, older male perpetrator who was known to the family, often related, and had unsupervised access to the child. One-fourth (24.1%) of the children had significant exam findings, including 7.5% with a STI. Females were more likely to have significant findings including most of the STIs. Other historical factors statistically linked to an increased risk of having significant exam findings included being African-American, providing a clear history of abuse, and/or reporting vulvar pain or vaginal symptoms such as discharge, itching, or bleeding. The incidence of significant findings including STIs was similar to previously reported studies from larger urban centers across the United States, United Kingdom, and New Zealand. [ABSTRACT FROM AUTHOR]

Purpose: To characterize predischarge maternal pain and stress after caesarean delivery and short hospitalization.Materials and Methods: This is a descriptive study with 60 women in the postoperative period of caesarean section and 60 control women after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Stress Measure (Psychological Stress Measure (PSM)), respectively, at mother-infant dyad discharge, scheduled at 36 hours after delivery.Results: Caesarean section was the delivery modality with the highest MGPQ pain and sensorial, evaluative and mixed pain descriptive categories scores. The pain location involved lower abdomen, with associated localizations at back, breast and shoulders. Conversely, vaginal delivery was the delivery modality with the highest stress scores.Conclusion: This study provides important information on the quality of care implications of early discharge practices in puerperae after caesarean delivery, a critical time characterized by qualitatively and quantitatively high pain and stress. [ABSTRACT FROM AUTHOR]

To better understand the impact of sexual stimuli on genital pain, a new instrument was developed: the Vaginal Pressure Inducer (VPI). We administered gradually increasing vaginal pressure with the VPI to sexually functional women as they watched a neutral, erotic, or explicit sex film. Women had higher unpleasantness thresholds in a sexual context compared to a nonsexual context. Moreover, ratings of pleasurableness were higher in the sexual compared to neutral context and most so during the explicit sexual film. These results provide initial support for the suitability of the VPI to study determinants of pleasant and unpleasant appraisal of vaginal pressure. [ABSTRACT FROM AUTHOR]

Keywords: Incision site discharge; postpartum haemorrhage; relaparotomy; uterocutaneous fistula.; intrapartum care; maternal medicine EN Incision site discharge postpartum haemorrhage relaparotomy uterocutaneous fistula. intrapartum care maternal medicine 3374 3375 2 01/06/23 20221001 NES 221001 Introduction A fistula is an abnormal connection between two epithelial surfaces of two different organs that are usually lined with granulation or epithelial tissue. According to the case reports published so far, uterocutaneous fistulas are usually treated with surgical hysterectomy, excision of the tract of the fistula or medical treatment with a gonadotropin-releasing hormone agonist (Athanasias et al. [2]). [Extracted from the article]

Aim: To transcultural adapt and analyze the reliability of Spanish version of Pregnancy Symptoms Inventory (PSI) and assess the prevalence of pregnancy symptoms in Spanish pregnant women.Materials and Methods: A subsample of 120 healthy pregnant women answered the PSI twice and a sample of 280 report the prevalence and limitation of pregnancy symptoms. The reliability was examined by means of percent agreement and weighted Kappa coefficients. The prevalence of pregnancy symptoms was evaluated by the frequency of answers.Results: Perfect and perfect-acceptable agreement was observed in 82% and 96% of the pregnant women, respectively. Weighted Kappa coefficients ranged from 0.589 to 0.889, indicating a good reliability. The most frequent symptoms perceived by Spanish pregnant women were urinary frequency, poor sleep, increased vaginal discharge and tiredness.Conclusion: Spanish Pregnancy Symptoms Inventory is a brief, conceptually equivalent and satisfactory reliable tool that allows an early assessment of the wide range of pregnancy symptoms in the health care practices. [ABSTRACT FROM AUTHOR]

Objective: To determine whether urea and creatinine measurements in vaginal fluid could be used to diagnose preterm premature rupture of membranes (PPROM) and predict delivery interval after PPROM.Methods: A prospective study conducted with 100 pregnant women with PPROM and 100 healthy pregnant women between 24 + 0 and 36 + 6 gestational weeks. All patients underwent sampling for urea and creatinine concentrations in vaginal fluid at the time of admission. Receiver operator curve analysis was used to determine the cutoff values for the presence of PPROM and delivery within 48 h after PPROM.Results: In multivariate logistic regression analysis, vaginal fluid urea and creatinine levels were found to be significant predictors of PPROM (p < 0.001 and p < 0.001, respectively) and delivery within 48 h after PPROM (p = 0.012 and p = 0.017, respectively). The optimal cutoff values for the diagnosis of PPROM were >6.7 mg/dl for urea and >0.12 mg/dl for creatinine. The optimal cutoff values for the detection of delivery within 48 h were >19.4 mg/dl for urea and >0.23 mg/dl for creatinine.Conclusion: Measurement of urea and creatinine levels in vaginal fluid is a rapid and reliable test for diagnosing and also for predicting delivery interval after PPROM. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have reported that concentrations of squamous cell carcinoma (SCC) antigen in amniotic fluid are extremely higher than that in the maternal serum. The aim of this study was to assess the potential clinical utility of vaginal fluid SCC level as a marker for diagnosing premature rupture of membranes (PROM).Methods: A case-control study was performed using patients admitted to Nara Medical University Hospital, delivery ward, from January 2011 to December 2012. The discriminatory potential of SCC assay was determined using 54 PROM and 108 gestational age-matched control vaginal fluid samples, in a 1:2 ratio. Levels of vaginal fluid SCC in patients with PROM and control pregnant women were quantified by an enzyme-linked immunosorbent assay.Results: The statistical results showed no correlation between gestational age and vaginal fluid SCC levels. There was no significant difference in vaginal fluid SCC levels between patients with PROM and those with control pregnant women (16156.5 ± 10495.8 ng/mL versus 15471.9 ± 11362.2 ng/mL, p = 0.467).Conclusion: We conclude that SCC could not be regarded as a potential marker for diagnosis of PROM. SCC may be a physiologic constituent of the vaginal fluid during pregnancy. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of this study was to analyse the significant variables for vaginal discharge after ultrasound-guided percutaneous microwave ablation (PMWA) therapy. Materials and methodsPMWA was performed on 117 patients with adenomyosis from October 2012 to July 2014. The presence or absence, colour, quantity and duration of vaginal discharge, which was different from pre-ablation, were recorded within 1 year after PMWA. Patients were categorised into G1 (n = 26, without vaginal discharge), G2 (n = 40, vaginal discharge lasting 1 to 19 days), and G3 (n = 51, vaginal discharge lasting ≥20 days) groups. The potentially correlative variables were analysed. Variables with significant correlations with vaginal discharge post-ablation were identified via binary logistic regression analysis. ResultsThe differences in adenomyosis type, pre-ablation uterine volume, total microwave ablation energy, total non-perfused volume (NPV) and minimum distance from the non-perfused lesion (NPL) margin to the endomyometrial junction (EMJ) among groups were statistically significant (p = 0.005,p = 0.000,p = 0.000,p = 0.005 andp = 0.000, respectively). Minimum distance from the NPL margin to the EMJ was the strongest predictor of vaginal discharge post-ablation with odds ratio (OR) 0.632,p = 0.018, 95% CI 0.432–0.923. Patients with diffuse adenomyosis were more likely to have prolonged vaginal discharge (≥20 days) post-ablation (OR 3.461,p = 0.000, 95% CI 1.759–7.536). ConclusionThe minimum distance from the NPL margin to the EMJ and adenomyosis type were significantly associated with vaginal discharge post-ablation. [ABSTRACT FROM PUBLISHER]

Candida spp. is an invasive infectious fungus, a major risk factor that can increase morbidity and mortality in hospitalized patients. In this study, 2,508 Candida spp. were isolated from various clinical specimens collected from university hospitals from July 2011 to October 2014. They were identified in order to determine isolation frequencies and characteristics by specimen, gender, age group, year, season, and month. The strain-specific isolation rate of Candida spp. is in the order of Candida albicans (1,218 strains, 48.56%), Candida glabrata (416 strains, 16.59%), Candida utilis (305 strains, 12.16%), Candida tropicalis (304 strains, 12.12%), and Candida parapsilosis (116 strains, 4.63%) and these five species accounted for more than 94% of the total strains. Of the specimens, Candida spp. were most frequently isolated from urine-catheter, followed by urinevoided, blood, sputum, other, open pus, vaginal discharge, Tip, ear discharge, bronchial aspiration and bile, in that order. Looking at the age distribution, the detection rate of patients in their 60s and older was significantly higher at 75.8% (1,900/2,508). The detection rate of patients in their 20s and younger was shown to be very low at 2.55% (64/2,508). By year, the detection rate of non-albicans Candida spp. showed a tendency to gradually increase each year compared with C. albicans. As isolation of Candida spp. from clinical samples at the specie level can vary depending on characteristics of the patient, sample, season, etc., continual studies are required. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the relationship between lactate level in vaginal fluid and the latent phase of labour in pregnancies complicated by preterm premature rupture of membranes (PPROM). Seventy pregnant women with PPROM during 28–34 weeks’ gestation were selected for this prospective observational study. All subjects underwent a pelvic examination involving the insertion of a vaginal speculum, and lactate levels were measured in vaginal fluid samples. The relationship between the lactate levels in the vaginal fluid and the latent phase of the labour was analysed using a logistic regression test. Of the patients, 48 (68.6%) had a latent period of 48 h or less, and 22 patients (31.4%) had a latent period longer than 48 h. The median lactate level was 3.81 mmol/L in patients with a latent period ≤ 48 h, and 3.36 mmol/L in patients with a latent period > 48 h. The lactate level in vaginal fluid was not found to be distinctive in the differentiation of patients according to the duration of the latent phase (receiver operating characteristic or ROC: 0.509; 95% confidence interval or CI: 0.361–0.657;p= 0.904). There was no significant correlation between the lactate level in the vaginal fluid and the transition from the latent phase to the active phase of labour in pregnancies complicated by PPROM. [ABSTRACT FROM PUBLISHER]

Case: Although many complications have been reported with intrauterine contraceptive devices (IUDs), vesicovaginal fistula with secondary vaginal stones is rare. We report the case of a 46-year-old woman who presented with a vaginal discharge lasting 2 months. Two years previously, she had undergone cystoscopic lithotripsy and surgery to remove an IUD, after pelvic radiography had revealed a fractured Chinese stainless steel ring IUD with secondary vesical stones that had been the cause of her urinary tract symptoms. When she again complained of vaginal discharge, vaginal stones and a vesicovaginal fistula were found on physical examination and CT urography. The patient underwent stone removal and concurrent vesicovaginal fistula repair. IUD fragments were found in the vesicovaginal and rectovaginal spaces. No abnormalities were found at follow-up 6 months after surgery.Conclusion: In any woman undergoing surgery to remove a migrated IUD, complete exposure and removal of the IUD are necessary to avoid fracturing of the IUD, secondary breakage and residue. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare high-intensity focused ultrasound (HIFU) treatment for type I and type II submucosal fibroids.Materials and methods: From October 2011 to October 2013, 55 patients with submucosal fibroids were enrolled in this study. Based on submucosal fibroid classification, 27 patients were grouped as type I submucosal fibroids, and 28 patients were classified as type II submucosal fibroids. All patients received HIFU treatment and completed 1-, 6-, and 12-month follow-ups. Adverse effects were recorded.Results: There were no significant differences in the baseline characteristics between the two groups (p > 0.05). Using similar sonication power, sonication time, and acoustic energy, the non-perfused volume (NPV) ratio was 83.0 ± 17.3% in the type I group, and 92.0 ± 9.5% in the type II group. All the patients tolerated the procedure well, and no serious adverse events occurred. During the follow-up intervals, the treated fibroids shrank and fibroid-related symptoms were relieved. No other reinterventional procedures were performed during the follow-up period.Conclusion: Based on our results with a small number of subjects, HIFU is suitable for both type I and type II submucosal fibroids. It seems that type II submucosal fibroids are more sensitive to HIFU ablation. Future studies with larger sample sizes and longer follow-up times to investigate the long-term results, including long-term symptom relief, pregnancy outcomes, and the recurrence rate as well as the reintervention rate are needed. [ABSTRACT FROM PUBLISHER]

AIMS: Firstly, to define, in dairy cows in the first 5 weeks post-calving fed a predominantly pasture-based diet, cut-points of concentrations of beta-hydroxybutyrate (BHBA) in blood, above which there were associations with purulent vaginal discharge (PVD), reduced pregnancy rates (PR) and decreased milk production, in order to better define subclinical ketosis (SCK) in such cattle; and secondly, to determine the prevalence, incidence and risk factors for SCK. METHODS: An observational field study was conducted in 565 cows from 15 spring-calving and predominantly pasture-fed dairy herds in two regions of New Zealand during the 2010– 2011 dairy season. Within each herd, a cohort of randomly selected cows (approximately 40 per herd) was blood sampled to determine concentrations of BHBA on six occasions at weekly intervals starting within 5 days of calving. The key outcome variables were the presence/absence of PVD at 5 weeks post-calving, PR after 6 weeks (6-week PR) and after the completion of the breeding season (final PR), and mean daily milk solids production. RESULTS: Two cut-points for defining SCK were identified: firstly concentration of BHBA in blood ≥1.2 mmol/L within 5 days post-calving, which was associated with an increased diagnosis of PVD (24vs. 8%); and secondly concentration of BHBA in blood ≥1.2 mmol/L at any stage within 5 weeks post-calving, which was associated with decreased 6-week PR (78vs. 85%). The mean herd-level incidence of SCK within 5 weeks post-calving was 68 (min 12; max 100)% and large variations existed between herds in peak prevalence of SCK and the interval post-calving at which such peaks occurred. Cows >8 years of age and cows losing body condition were at increased risk of SCK within 5 weeks of calving. CONCLUSIONS: Cows with concentration of BHBA in blood ≥1.2 mmol/L in early lactation had a higher risk of PVD and lower 6-week PR. Cow and herd-level prevalence of SCK varied widely in early lactation. CLINICAL RELEVANCE: Subclinical ketosis is common and is significantly associated with reproductive performance in mainly pasture-fed New Zealand dairy cattle. Controlling SCK may therefore result in improvements in herd reproductive performance. However considerable variation exists among herds in the incidence of SCK and in the timing of peak prevalence which means that herd-specific monitoring programmes are required to define herd SCK status accurately. [ABSTRACT FROM PUBLISHER]

Objective: To determine the vaginal fluid interleukin (IL)-6 and IL-8 concentrations in pregnancies complicated by preterm prelabor rupture of membranes and their correlation to microbial invasion of the amniotic cavity (MIAC) as well as histological chorioamnionitis (HCA). Methods: Sixty-eight women with singleton pregnancies were included in this study. Vaginal fluid was collected at the time of admission. IL-6 and IL-8 concentrations in the vaginal fluid were determined using ELISA. Result: Women with MIAC had higher vaginal fluid IL-6 levels compared to those without MIAC (with MIAC: median 374 pg/mL versus without MIAC: median 174 pg/mL; p = 0.03). IL-8 levels were higher in women with MIAC only in the crude analysis but not after adjustment for gestational age. There was no difference in the IL-6 and IL-8 concentrations between those with and without HCA. Women with both MIAC and HCA had higher IL-6 vaginal fluid levels than those without both MIAC and HCA (with MIAC and HCA: median 466 pg/mL versus without MIAC and HCA: median 178 pg/mL; p = 0.02). IL-8 levels were higher in women with MIAC and HCA only in the crude analysis but not after adjustment for gestational age. Conclusions: Vaginal fluid IL-6 but not IL-8 levels reflect the presence of MIAC and both MIAC and HCA. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence and pelvic organ prolapse are two of the commonest conditions affecting women today. It is associated with significant compromise to quality of life. Through the years, there has been an evolution of technique and graft material to augment repairs for durability. Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications, including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management and outcomes associated with mesh removal. In addition, we will briefly review the safety communications issued by the US FDA on transvaginal mesh placement and a new classification system for complications arising from the use of synthetic graft endorsed by both the International Continence Society and International Urogynecological Association. [ABSTRACT FROM AUTHOR]

She had undergone CS 2 years before due to dystocia, whereas now, repeat CS was indicated by an unfavourable cervix in the 40th week of gestation and healthy neonate was born. Genito-digestive post caesarean section (CS) fistulas are a known entity, but to our knowledge, early puerperal colouterine fistula (CUF) has not yet been described in the literature (Eleje et al. [1]; Keskin et al. [2]). There are reports on cutaneouterine fistula as a rare post CS complication (Eleje et al. [1]) and late post CS vesicouterine fistula (Youssef's syndrome) after 20 years (Keskin et al. [2]). [Extracted from the article]

Gynecological morbidity has been reported to be associated with psychological distress among women. However, no formal research has been conducted in Pakistan on psychological and gynecological morbidity in women presenting with vaginal discharge. This study aimed (1) to examine whether women presenting with a primary complaint of vaginal discharge are more likely to have a Common Mental Disorder compared with those not presenting with vaginal discharge and (2) to examine whether gender disadvantage is associated with vaginal discharge. Psychological morbidity was examined in women (n=377) presenting at gynecological clinics with and without a primary complaint of vaginal discharge. Gynecological and Psychological morbidity were assessed using Urdu version of General Health Questionnaire (GHQ-28) and the National Family Health Survey Interview. Women presenting with a primary complaint of vaginal discharge were significantly more likely to have a common mental disorder than women presenting with other gynecological problems. Hunger, a marker of poverty, and low social integration, a domain of gender disadvantage, were associated with vaginal discharge in the multivariate model. Pakistani women presenting with vaginal discharge were at increased risk of having a common mental disorder. This research highlights the need for training of medical professionals such as gynecologists to identify common mental disorders among women reporting with gynecological problems. Study limitations and suggestions for future research are discussed. [ABSTRACT FROM PUBLISHER]

Premature rupture of membranes is a significant contributor to preterm birth with its associated short- and long-term complications. The absence of a standard approach to its management places a burden on the clinicians' ability to promptly and accurately diagnose premature rupture of membranes. For the last half century, there have been no significant changes in the way premature ruptured membranes is diagnosed. With the advent of newer, amniotic fluid-specific, noninvasive, and accurate markers, there is an opportunity to update the diagnosis of premature rupture of membranes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the feasibility, safety and therapeutic effects of ultrasound (US)-guided percutaneous microwave thermal ablation (PMTA) in situ for the treatment of symptomatic uterine fibroid. Materials and methods: The microwave (MW) antenna was percutaneously inserted into the fibroid under US guidance to perform the ablation. The ultrasound images, any complications and side effects were assessed during and after ablation. The shrinkage rate of the fibroid was calculated after the treatment. Results: Forty patients underwent the treatment. The baseline fibroid volume was 14.6 to 341.1 cm3 (mean 140.1 ±± 87.4 cm3). When the MW therapy started, a heightened echo around the MW emission aperture of the antenna was observed and gradually propagated throughout the fibroid while the ablation continued. The mean ablation time was 490 s. Contrast enhanced MRI showed no enhancement in the fibroid post-ablation. The shrinkage rate of the fibroid was 61.8%%, 78.7%%, 73.2%% and 93.1%% at 3, 6, 9, and 12 months after ablation, respectively. Six patients felt pain in their lower abdomens or waists within 12 hours post-ablation, and the discomfort rapidly disappeared. Seven patients had a small amount of vaginal bloody secretions within one to two weeks after treatment, and six of these patients recovered from the bleeding without any therapy after one week. No patient developed complications and fever during or after the ablation. Conclusions: PMTA for fibroid is feasible and safe, and it is an easy and fast procedure that is minimally invasive. [ABSTRACT FROM AUTHOR]

Intravaginal insertion is often associated with the concept of 'dry' sex. All HIV-prevention microbicides tested to date have been vaginally applied lubricant-based gels. In this paper, we examine whether the use of intravaginal insertions could be in conflict with the introduction of vaginal microbicide gels. The Africa Centre site was part of the Microbicides Development Programme evaluating PRO2000/5 microbicide gel. We conducted in-depth-interviews and focus-group discussions with women enrolled in the trial as well as women and men from the community. The analysis focused on people's knowledge of intravaginal insertion in the community and trial participants' experience of using trial gels. Intravaginal use of a variety of products was widely acknowledged. We found that the experience of using trial gels - which made sex 'hot', 'tight' and 'dry' - matched the desired outcomes of intravaginal insertion. We found that vaginal 'dryness' described the removal of excessive amounts of unusual discharge, rather than the removal of normal vaginal secretions and that intravaginal insertion is not exclusively associated with a desire for 'dry' sex. Study findings provide evidence that vaginal microbicide gels may be more acceptable in communities where intravaginal insertion is practiced than was previously thought. [ABSTRACT FROM AUTHOR]

The article presents a case study of hemolymphangioma of the broad ligament in a 41-year old female with nonspecific lower abdominal pain and vaginal discharge. Hemolymphangioma was confirmd through histology with macroscopic analysis revealed a collapsed cystic structure and immunostaining suggest CD31 with negative staining for CK7 and calretinin. It discusses the importance of hemolymphangiomas as differential diagnosis for adnexal mass due to risks of infection, rupture and hemorrhage.

Previous studies suggest that larger sutures increase the risk of complications after prolapse surgery. This study aimed to assess whether multifilament sutures increased complications compared with monofilament sutures. A series of 100 women with 2/0 multifilament suture were matched by operation to a previous cohort when a size 2/0 monofilament suture was used. Offensive vaginal discharge was more common in the multifilament than in the monofilament group (24% vs. 12%; p = 0.04). However, there was no increased requirement to seek advice from a health professional (33% vs. 25%; p = 0.27) or to require antibiotics. Vaginal bleeding (10% vs. 5%; p = 0.28) and urinary infection (2% vs. 5%; p = 0.44) were statistically no more common in the multifilament 2/0 compared with the monofilament 2/0 group. Multifilament sutures used for closure of the vaginal skin are associated with a clinically non-significant higher incidence of vaginal discharge in the early post-operative period. [ABSTRACT FROM AUTHOR]

"Physical Dependence on Nicotine in Gum: A Placebo Substitution Trial," JOHN R. HUGHES, et al. To test whether ex-smokers become physically dependent on nicotine in gum, we entered eight ex-smokers who were using nicotine gum into a randomized, double-blind, placebo-substitution trial. When placebo was substituted, seven of the eight subjects were observed to have withdrawal symptoms and two relapsed to smoking or nicotine gum. This result suggests that physical dependence (i.e., withdrawal) may be a cause of behavioral dependence on nicotine gum (i.e., use of gum beyond the recommended period) and physicians should emphasize the need for gradual reduction of nicotine gum. (Journal of the American Medical Association 1986;255:3277–3279.) "Absence of Therapeutic Benefit From Antacids or Cimetidine in Non-Ulcer Dyspepsia," OLOF NYREN, et al. We randomly assigned 159 patients with non-ulcer dyspepsia, defined as chronic or recurrent epigastric pain without concomitant symptoms of the irritable bowel syndrome and with no evidence of organic disease, to treatment for three weeks with an antacid suspension one and three hours after meals, 400 mg of cimetidine twice a day, or placebo, according to a double-blind, double-dummy model. The intensity and duration of epigastric pain were recorded by the patients four times daily during a one-week period without therapy and during the three weeks of treatment. The mean reduction in pain intensity after three weeks in the placebo group was 25 percent. Neither antacid nor cimetidine treatment resulted in more than a 4 percent better effect. The reduction of pain was statistically significant (P < 0.01) in all three groups. The time course of the pain scores in the groups receiving active drugs followed closely those in the placebo group, and there were no significant differences between the groups at any stage of the treatment. We conclude that the neutralization or suppression of gastric acid is of no clinical value in patients with this syndrome. (New England Journal of Medicine 1986;314:339–43.) [ABSTRACT FROM AUTHOR]

The article presents a case study of a 21-year-old nulliparous Thai woman who was referred to the Colposcopy Clinic after an episode of inadequate cervical smears with post-coital bleeding and vaginal discharge. Findings of her physical examination revealed irregular cervix, inflammatory posterior mass and offensive vaginal discharge. It notes that her anaesthetic examination confirmed the presence of smelly faeculent discharge from the vagina.

The article describes the case of a 29-year-old woman with life-threatening rituximab-induced pyoderma gangrenosum. The patient had a history of proteinase-3-anti-neutrophil cytoplasmic antibody (PR3-ANCA)-positive granulomatosis with polyangiitis (GPA). She experienced symptoms of septic peritonitis, copious vaginal discharge, and more extensive vulvovaginal ulceration. Her illness was successfully treated with intravenous immunoglobulin.

The article presents a study which aimed to localise the intrauterine contraceptive devices (IUCDs) inserted after first trimester abortion, and to determine the misplaced IUCDs, as well as complications. The study reported the frequencies of IUCD malposition, adverse effects and complication rates. Results showed that the malpositioned IUCDs were corrected at six weeks and various complaints were reported including menstrual irregularity, vaginal discharge, and pain in lower abdomen.

The article presents the case study of a 17-year-old senior secondary school student who is experiencing abnormal vaginal bleeding and offensive watery vaginal discharge for the period of five months. The examination conducted to the patient under anaesthesia showed that fungating cervical mass measuring about 6 cm in diameter with spread to the upper third of her vagina. It discusses the risk factors of cervix carcinoma.

The article presents a case study of a 37-year-old gravida woman who was presented to the gynaecology department with a history of intermittent, vaginal discharge, chronic lower abdominal pain, and lower backache. It says that ultrasonographic test of the abdomen shows a right, anechoic, tubo-ovarian, cystic mass with thick internal septation that measures 10 6 8.8 6 4.4 centimeter. It adds that histological sections from the fallopian tube suggests features of xanthogranulomatous inflammation.

The article presents a case study of a 50-year-old postmenopausal woman who was presented to the gynaecology outpatient department due to painless swelling over the external genitalia since 2000. She had been diagnosed with carcinoma of the cervix stage IIIB and had received radiotherapy. She had history of intermittent fever and occasional discharge from the swelling. Post-radiation fibrosis of the anterior abdominal wall and large irregular swelling were shown during examination.

The article presents the case of a 34-year-old woman with the rupture of uterine at 17 weeks of a twin pregnancy with placenta percreta. She was presented with 17th week of pregnancy with vaginal bleeding. Speculum examination did not revealed any vaginal or cervical pathology of an inevitable miscarriage. Ultrasound scan detected a placenta lying at the anterior-left lower segment of the uterus. The pathology report confirmed the diagnosis of placenta percreta.

The article presents the case of a 40-year-old woman with degeneration of uterine fibroid. She was presented with lower abdominal swelling with frequency of urination. Magnetic resonance imaging (MRI) revealed a pelvic mass with fluid collection, which may represent collection in one of the uterine cavities.

The article presents the case of a 23-year-old woman with a dermoid cyst. She had a stinking vaginal discharge for one week. She was initially managed with broad spectrum antibiotic cover and swabs were sent for culture and sensitivity. Her physical examination discovered a fixed left adnexal mass.