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Adjuvant chemotherapy and endocrine therapy can induce early iatrogenic menopause or worsen pre-existing menopausal symptoms in breast cancer survivors (BCS). The second most frequent menopausal symptom after hot flushes is the genitourinary syndrome (GSM). Since hormone replacement therapy is contraindicated in BCS, vaginal laser might represent a new nonhormonal option for GSM. This study aims at evaluating the effectiveness of the fractional CO₂ vaginal laser for GSM in BCS compared with healthy women. This is a retrospective study on 135 postmenopausal women (45 BCS and 90 healthy women) who underwent fractional CO 2 laser for GSM. Objective (VHI and VVHI) and subjective outcomes (VAS for dyspareunia and vaginal dryness and a pain questionnaire) were evaluated at baseline visit and at every follow-up visit. Subjective and objective parameters improved significantly in both groups after laser therapy. The improvement was progressive and long-lasting up to 12 months after the end of the treatment. No severe adverse events were observed during the treatment. Fractional CO₂ vaginal laser induces a significant and long-lasting improvement on GSM symptoms in BCS. However, this improvement is slower than in healthy women undergoing the same treatment. Laser therapy turns out to be safe and well-tolerated., (© 2021 Wiley Periodicals LLC.)

Introduction: Recently, it has been suggested that the occurrence of posthysterectomy vaginal cuff dehiscence has increased. Consequently, we evaluated the incidence of vaginal cuff dehiscence after different types of hysterectomies. Our hypothesis is that vaginal cuff dehiscence is more often associated with total laparoscopic hysterectomy (TLH) than other types of uterine removal., Material and Methods: A total of 13 645 hysterectomies from 1992 to 2015 were evaluated in the Turku University Hospital district, Finland. The primary outcome was occurrence of vaginal dehiscence after different types of hysterectomy. The hysterectomy and postoperative vaginal dehiscence trends were analyzed as the secondary outcome. In a subanalysis of dehiscence cases, women's characteristics and perioperative vaginal cuff opening and closure techniques were compared between conventional hysterectomies (vaginal, abdominal, and laparoscopic with vaginal closure) and TLH., Results: Altogether, 22 cases of vaginal cuff dehiscence were included. Most cases (n = 15) occurred after TLH (n = 1104), resulting in an incidence of 1.27%. After conventional laparoscopic hysterectomy with vaginal closure (n = 2853), vaginal (n = 4150), and abdominal (n = 5538) hysterectomies, the incidence rates were 0.11%, 0.05%, and 0.02%, respectively. Compared to abdominal hysterectomy, which was associated with the lowest incidence rate, vaginal dehiscence after TLH had an odds ratio (OR) 71.1 (9.34-541.38, P < 0.001). In the subanalysis of possible underlying factors, the technique of opening of the vaginal cuff with or without electrocoagulation, duration of operation, and occurrence of postoperative infection or hematoma prior to VCD were observed differences between TLH and conventional hysterectomies., Conclusions: Compared with other types of hysterectomies, vaginal dehiscence was observed at the highest rate after TLH. Studies are needed to define if vaginal opening technique contributes to the risk of dehiscence., (© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.)

There are approximately 3,000 new UK diagnoses of cervical cancer annually, with many women presenting symptomatically. We aimed to identify and quantify features of cervical cancer in primary care in a case-control study in the UK. Putative features of cervical cancer were identified, and odd ratios and positive predictive values (PPVs) were calculated. About 1,006 women aged ≥40 years diagnosed with cervical cancer and 4,992 age-, sex- and practice-matched controls were selected from the Clinical Practice Research Datalink. Median age at diagnosis was 61 years (interquartile range 51-75). Seven symptoms and two abnormal investigations were associated with cervical cancer: post-menopausal bleeding, odds ratio 43 (95% confidence interval 25, 75); vaginal discharge or vaginitis 8.8 (5.2, 15), intermenstrual bleeding 4.7 (1.6, 14); haematuria 4.6 (2.1, 10); irregular menstruation 3.8 (1.6, 9.0); urinary tract infection 1.9 (1.3, 2.8); abdominal pain 1.8 (1.4, 2.5); high white cell count 5.1 (2.9, 8.8) and low haemoglobin 2.6 (1.8, 3.8): all p < .005. The PPV of cervical cancer in women aged ≥55 with post-menopausal bleeding was 4.6% (2.5, 8.3). Other than for post-menopausal bleeding no symptom is high risk. Some symptoms, particularly haematuria, may be helpful. The primary care clinician must consider the unlikely diagnosis when the likely diagnosis does not settle with treatment., (© 2017 John Wiley & Sons Ltd.)

Objective: To investigate short- and long-term postpartum complications of different delivery methods in terms of sexual satisfaction, stress urinary incontinence (SUI), and pelvic-floor dysfunction in the Beijing region., Methods: A questionnaire-based study was conducted between June 30, 2013 and July 1, 2014. Female residents of Beijing aged 20-65 years, who were attending routine physical examinations, were enrolled and completed a face-to-face survey including questions on short- and long-term complications related to sexual satisfaction, SUI, and pelvic-floor dysfunction postpartum., Results: In total, 2649 individuals were enrolled. In comparison with patients that underwent vaginal delivery, patients that had undergone cesarean delivery experienced a greater length of time before resuming intercourse (2.70±2.0 9months vs 4.32±4.10 months; P<0.001) and higher incidences of decreased libido (93 [6.1%] vs 234 [20.7%]; P<0.001), vaginal dryness (39 [2.6%] vs 177 [15.7%]; P<0.001), sexual dissatisfaction (117 [7.7%] vs 234 [20.7%]; P<0.001), and painful intercourse (48 [3.2%] vs 252 [22.3%]; P<0.001) after delivery. Cesarean delivery did not demonstrate any long-term protective effects against future SUI in comparison with vaginal delivery., Conclusion: Cesarean delivery resulted in a greater incidence of adverse effects on postpartum sexual function and cesarean delivery provides no long-term protective effects against postpartum SUI., (Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine the incidence of vaginal cuff dehiscence (VCD) among women undergoing hysterectomy according to clinico-surgical factors including surgical route, and to describe patient characteristics associated with VCD., Methods: In a retrospective study, the medical records of all women who underwent hysterectomy between January 2005 and March 2011 at a university teaching hospital in Seoul, Republic of Korea, were reviewed. The incidence of VCD was determined in relation to the following factors: patient age, hysterectomy route, indication for hysterectomy, and extent of resection (either simple or radical hysterectomy)., Results: Among 9973 hysterectomies, 37 (0.37%) cases of VCD were identified. The incidence of VCD was significantly higher after abdominal hysterectomy (0.6%) than after laparoscopic (0.2%) or vaginal (0.4%) hysterectomy (P=0.016). Compared with laparoscopic approaches, abdominal hysterectomy was associated with a higher risk of VCD (odds ratio, 2.735; 95% confidence interval, 1.380-5.420). However, there was no significant difference in the incidence of VCD according to surgical indication or extent of resection., Conclusion: Laparoscopic hysterectomy was found to be associated with a lower risk of VCD compared with abdominal hysterectomy. The lower risk is probably related to the different techniques used for colpotomy and cuff closure., (Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To identify the prevalence of vulvar and vaginal symptoms during pregnancy and at 3 months post partum., Methods: A prospective, longitudinal, descriptive study of 103 pregnant women was undertaken in which a self-administered questionnaire was completed at each trimester and 3 months post partum. Retrospective data was collected from 122 women, queried using similar tools, who comprised a nonpregnant control group. Descriptive and comparative statistics were employed., Results: The prevalence of vulvar burning, itching, pain, and vaginal discharge generally increased during pregnancy, and improved postpartum. Dyspareunia increased during pregnancy, but remained elevated post partum. Compared with the historical nonpregnant group (adjusted for age, marital status, education, and smoking), dyspareunia was reported less often in the first trimester (P=0.03) and more often post partum (P<0.01). Furthermore, reports of vulvar pain and vaginal discharge were significantly greater during the second and third trimesters., Conclusions: Vulvar and vaginal symptoms are common during pregnancy, and the prevalence of some, but not all, increase during gestation and decrease post partum.

Objective: To compare vaginal length after iliococcygeus fixation (ICF) and sacrospinous ligament fixation (SSLF)., Methods: A retrospective cohort study was performed on patients undergoing ICF or SSLF. Sixty-seven patients were identified and, of these, only 46 had complete data sets, leaving 23 patients in either group eligible for study., Results: There were no significant differences in demographic data between the 2 groups. Mean vaginal length measurements were not significantly different before and after the ICF procedure (7.7+/-0.9 cm vs 7.6+/-0.8 cm, respectively; P=0.68). However, the mean vaginal length was significantly shortened following SSLF (7.9+/-0.8 cm vs 7.1+/-1.1 cm, P=0.001). The mean vaginal lengths preoperatively (7.7+/-0.9 cm vs 7.9+/-0.8 cm, P=0.51) and postoperatively (7.6+/-0.8 cm vs 7.1+/-1.1 cm, P=0.07) were similar., Conclusion: Iliococcygeus fixation does not significantly shorten vaginal length at the time of vaginal vault suspension, whereas the sacrospinous ligament fixation procedure does shorten vaginal length.

We describe a very unusual presentation of misplaced Macroplastique injection. This incidentally showed up as bladder lesion and vaginal nodule during a tension-free vaginal tape surgery.

Although menopause is a normal developmental milestone through which all women pass, the transition has been long associated with chronic pain conditions that may be more accurately viewed as secondary to aging. Clinicians need to understand management of pain problems women may experience. This article examines pain syndromes including headache, back pain, osteoarthritis, pelvic pain, vulvo-vaginal pain, and burning mouth syndrome.

Background: Vaginal hematoma is a rare but painful complication during and after childbirth, with little information in the literature regarding risk factors and management. Aim. To study the risk factors in a national population-based registry., Setting: All births in Sweden from 1987 to 2000 inclusive., Methods: Data were analyzed using the Mantel-Haenszel technique, with odds ratio (OR) and 95% confidence interval (CI), adjusting for maternal age, parity and birthweight., Results: Nulliparity was a strong risk factor (OR 3.63, 95% CI 3.25-4.08), as was maternal age over 29 years and a birthweight exceeding 4000 g. Irrespective of year of delivery the mother stayed an extra 1.3-1.7 days in hospital following this complication., Conclusion: Risk factors for vaginal hematoma during delivery include primiparity and a maternal age > 29 years.

Seventeen cases of spontaneous, partial or total vaginal rupture, in pregnant ewes, involving the dislocation and herniation of the intestines and uterus, were studied. Four of them also had a uterine torsion, and three of these recovered after treatment. In the remaining 13 cases the condition of the uterus was unknown. The lesion always consisted of a dorsolateral tear in the vagina with a partial or total perforation of the wall close to the uterine cervix. The affected animals were all in normal body condition. Their average age was just under five years, and most were carrying twins. Most cases occurred approximately one week before expected lambing. None of the cases was observed to have a vaginal prolapse before the vaginal rupture. Histological examination of one case revealed scar formation in the vaginal wall close to the rupture, which appeared to be due to an earlier inflammatory process or injury. The circulatory disturbance in the reproductive organs caused by the uterine torsion potentially weakens the vaginal wall. This weakness, in combination with excessive tenesmus resulting from increased tension in the uterine ligaments, and in some cases possibly with a lower vaginal resistance due to previous scarring, may be of aetiological significance in spontaneous vaginal rupture.

We have reviewed the literature on third and fourth degree perineal lacerations, with respect to occurrence, risk factors, repair, short and long term morbidity, and secondary treatment. Suggestions of delivery procedures aiming to reduce the extent of perineal trauma are given. The long term sequelae of severe lacerations are clearly underestimated.

From July 1973 to December 1980, 6942 patients were admitted to the Gynaecology unit of the University of Benin Teaching Hospital, Benin City, Nigeria. Fifty-nine patients presented with gynatresia (vaginal atresia and stenosis), an incidence of 8.5 1000. The most common causes of this condition were caustic vaginitis, secondary to local herb pessary insertion, and circumcision. The resulting vaginal adhesions were effectively treated surgically by simple adhesiolysis . There was a low incidence of congenital gynatresia . As the large proportion of cases of acquired gynatresia were preventable, improvement in health education should further reduce incidence of this condition in our community.

Persistent bleeding from the vulva was the only presenting clinical sign in five non-pregnant pluriparous mares varying in age from eight to 20 years. These were two hunter types, one shire, one thoroughbred and one Arab pony. The haemorrhage originated from ulcerated varicose veins present on the dorsal wall of the vagina adjacent to the vestibulovaginal junction. All five mares were successfully treated, by submucosal resection (two), ligation of vessels (two) or diathermy (one). In four mares there was evidence of vulval incompetence caused by depression of the perineum. The importance of this and the role of impaired venous return during and after pregnancy are discussed.

The effects of irradiation therapy on the surrounding pelvic structures are well known. Most women develop some degree of vaginal stenosis following irradiation for cervical cancer. Although complete vaginal occlusion is less common, it seriously affects the patient's self-image. The author treated five patients who had complete vaginal occlusion following irradiation for stage II uterine cervical carcinoma. By means of a regimen of digital pressure and an estrogenic cream, for an average of six weeks, the function of the vagina was restored.

A case is reported of a woman who presented with bleeding from a vaginal extension of a synovial sarcoma. The patient was unaware of the primary tumor in the left thigh and histologically, the tumor resembled a carcinosarcoma. Awareness of the physical and radiologic findings allowed the correct pathologic diagnosis to be made. The manner of presentation of the tumor is believed to be unique.

A case of severe infection following pudendal anesthesia is presented. The probable spread of the infection to the subgluteal space and the complications are discussed. Musculoskeletal symptoms arising in the hip area and the pelvis during the early postpartum period pose a challenging diagnostic problem. When these symptoms are accompanied by fever and pain, the possibility of a severe infection with possible abscess in the subgluteal or retropsoas space must be considered. The treatment consists of prompt surgical drainage and appropriate antibiotics.

Amniotic fluid infections manifested by an inflammatory response in the extraplacental membranes and subchorionic plate of the placenta are a common phenomenon thought to be due in most cases to ascending bacterial infections via intact membranes. Fatal spread to the fetus is much less common and more likely to occur in underprivileged communities. The probable reasons are nutritional deprivation in the mother or both, leading to production of a liquor with diminished ability to suppress bacterial growth. Zinc is one component of the antibacterial system but liquor levels of zinc vary widely and inconsistently with antibacterial activity. Dietary supplementation with zinc did not improve antibacterial activity of liquors in a population with diminished liquor antibacterial activity and large number of fatal infections. Other factors in the genesis of amniotic fluid infections may be interference with normal defence mechanisms as a result of coitus in late pregnancy and vaginal infections with Trichomonas vaginalis. Socioeconomic factors may play a role apart from their association with maternal nutrition, through diminished hygiene associated with insufficient use of water and insufficient availability and use of medical facilities.