Patient’s experience with the Arabin cervical pessary during pregnancy: A questionnaire survey

Introduction The cervical pessary is used in women with precocious cervical ripening to prevent preterm birth. Up to now however, there have been no systematic studies on compliance and tolerance, which vary among different study cohorts. Material and methods A questionnaire was administered to 166 women treated with the Arabin cervical pessary in one center. Data were analysed about the patient’s experience before insertion (adequacy of information received), during treatment (follow-up, impact on daily life, perceived discomfort, side effects) and at the time of removal (pain, if the patient’s expectations had been met regarding the treatment). Results Information received before the insertion of the Arabin cervical pessary was considered adequate in 163/166 (98.2%) women. An increase in vaginal discharge was experienced by 70/166 (42.2%) women. Discomfort or other side effects were reported in 13.8% and 16.3% of cases, respectively. Overall, 77% of women reported an improved quality of life and 94% considered the follow-up during pregnancy adequate. Removal was moderately painful for 58/166 (35%) of women. Patient’s expectations regarding the treatment were exceeded in the majority of cases (75.3%). In a final step, we compared our results to previous studies regarding the use of the pessary in singleton and twin pregnancies. Conclusion Although some trials report high rates of non-compliant patients, this could not be confirmed by our study. In contrast, most women reported having a positive experience and that they were motivated to continue the treatment when they were continuously followed by experienced clinicians.

HUBUNGAN PENGETAHUAN DAN SIKAP REMAJA PUTRI DENGAN PENCEGAHAN KEPUTIHAN DI SMAN 2 TONDANO

Abstrak Keputihan sering kali dianggap suatu hal yang biasa sehingga sering diabaikan pentingnya pencegahan dan penanganan yang benar dan tepat. Jika remaja putri dapat mengenali gejala keputihan dan penanganannya maka remaja putri dapat beraktivitas dengan nyaman, aman, dan sehat, sehingga dapat meningkatkan produktivitas belajar. Sebaliknya jika mengabaikan pencegahan dan penanganan keputihan maka akan aktivitas belajar remaja putri akan terganggu sehingga tidak bisa menerima pembelajran dengan baik bahkan harus absen dari sekolah. Jika keputihan tidak segera diatasi akan dapat menimbulkan risiko bahaya yang fatal bagi kesehatan. Aktivitas yang menjadi acuan dalam penelitian ini adalah pengetahuan dan sikap siswa putri di SMAN 2 Tondano dengan pencegahan keputihan. Pada observasi atau pengamatan awal yang dilakukan, didapati bahwa siswa putri SMAN 2 Tondano pernah mengalami keputihan. Keputihan yang dialami siswa putri SMAN 2 Tondano didapati ada yang terjadi tidak hanya sekali dan terjadi dalam waktu yang cukup lama. Kondisi seperti ini dapat mengakibatkan timbulnya risiko penyakit reproduksi. Penelitian in menggunakan metode deskriptif analitik korelasi dengan pendekatan cross sectional. Teknik sampel yang digunakan yaitu total sampling berjumlah 39 responden. Hasil analisa dan pengujian data yang sudah dilakukan di SMAN 2 Tondano, maka terdapat hubungan yang signifikan antara pengetahuan siswa putri SMAN 2 Tondano dengan pencegahan keputihan dengan nilai p = 0.042 dan terdapat hubungan yang signifikan antara sikap siswa putri SMAN 2 Tondano di dengan pencegahan keputihan dengan nilai p = 0.022. Kata kunci: Pengetahuan, Sikap, Penanganan, Keputihan, Remaja Putri Abstract Vaginal discharge is often considered a common thing so that is often overlooked the importance of prevention correct and appropriate treatment. Teenage girls can recognize the symptoms of vaginal discharge and their treatment, they can move in a comfortable, safe, and healthy way so that they can increase their learning productivity. On the other hand, if they ignore the prevention and treatment of vaginal discharge, the learning activities of a teenage girl will be disrupted so that they cannot receive learning properly and even have to be absent from school. If vaginal discharge is not immediately addressed, it can pose a risk of fatal danger to health. The activity that is used as a reference in this study is the knowledge and attitudes of female students at Senior High School Public 2 Tondano, with the prevention of vaginal discharge. In the initial observations, it was found that the female students of Senior High School Public 2 Tondano had experienced vaginal discharge. The discharge experienced by female students of Senior High School Public 2 Tondano was found to occur not only once and for a long time. Conditions like this can lead to the risk of reproductive disease. This research uses a descriptive-analytic correlation method with a cross-sectional approach. The sampling technique used is a total sampling of 39 respondents. The results of data analysis and testing that have been carried out at Senior High School Public 2 Tondano, there is a significant relationship between the knowledge of female students of Senior High School Public 2 Tondano and prevention of vaginal discharge with p = 0.042 and there is a significant relationship between the attitudes of female students of Senior High School Public 2 Tondano in the prevention of vaginal discharge with p-value = 0.022. Keywords: Knowledge, Attitude, Handling, Vaginal, Young Women

Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

Literature review: The Effect of Using Non-Herbal Panty Liners on Abnormal Vaginal Discharge in Adolescent Girls

Teenagers are very vulnerable to experiencing problems such as vaginal discharge and because of that teenage girls often wear panty liners outside of their menstrual period. Improper use of panty liners will make vaginal discharge abnormal. Therefore, this literature review aims to find out how to use non-herbal panty liners so that they can cause abnormal vaginal discharge. This research usesliterature review with data sources from the PubMed, Research Gate, and Google Scholar databases with a range of 2018-2021. The results of this literature review contained 4 journals which stated that the effect of using panty liners could cause vaginal discharge but under normal conditions and 4 journals also stated that abnormal vaginal discharge was caused by panty liners. It can be concluded that abnormal vaginal discharge is caused by a different way of using panty liners and the lack of information about using panty liners properly.

Some Clinical and Inflammatory Aspects of Trichomonas vaginalis Infection among Women with Pelvic Inflammatory Diseases

Infection with Trichomonas vaginalis and its relation to some diseases have lately had much attention. The objective of this study was to assess the infection rate of T. vaginalis and its relation to pelvic inflammatory diseases, infertility, and vaginosis. The study also assessed some demographic, clinical, and immunological parameters in women infected with T. vaginalis. The study included 160 non-pregnant married women who attended some private clinics and public hospitals in Baghdad from October 2020 to February 2021. All participants had symptoms of vaginal discharge only or vaginal discharge with lower abdominal pain. The participants were divided into an infertility group (n = 61) and fertility group (n = 99). The participants were also divided into Pelvic Inflammatory Disease (PID) group (n=41) and non-PID group (n=119). All participants underwent vaginal examination. Vaginal swabs were taken from all participants for T. vaginalis, bacteria, yeast, clue cell, pH, and vaginal leukocyte examinations. Sera were also taken to measure both IL-1α and IL-8 using sandwich ELISA technique to compare them with apparently healthy control subjects who had no vaginal discharge. The study revealed that the total infection rate of T. vaginalis was 14.37%. The results showed no significant relations between T. vaginalis positive status and each of age, infertility, vaginosis, contraceptive use, and high BMI. While a significant relation (P=0.03) was noticed between T. vaginalis positive status and PID. Women with PID exhibited a higher infection rate with T. vaginalis (24.39%) versus non PID women (10.92%). High clue cells number was not significantly related to T. vaginalis positive status, only if both PID and vaginosis were considered in the statistical analysis. In addition, high leukocytes count was not related to T. vaginalis positive status. While abnormal vaginal pH was significantly (P=0.01) related to T. vaginalis positive status. Finally, the levels of both IL-1α and IL-8 were noticed to be declined in women who had T. vaginalis infection, although they were not declined significantly. This study gives an insight about some clinical aspects of T. vaginalis infection among PID women. T. vaginalis is highly predictable in women with PID. Consequently, attention and more investigation would be needed on this topic in Iraq.

A Case of Ovarian Dysplasia and a Vaginal Fibroleiomyoma in a Young Golden Retriever

This case demonstrates a unique ovarian congenital anomaly that likely contributed to the development of a rare fibroleiomyoma in the cranial vagina of a young bitch. A 13 month old intact female Golden Retriever presented to the veterinary teaching hospital for urinary incontinence, hematuria, and persistent vaginal discharge. Physical examination revealed a mucopurulent serosanguinous malodorous vulvar discharge, and after further diagnostics was reclassified as persistent estrus. Abdominal palpation and ultrasound revealed uterine thickening and poorly visualized ovaries. The reproductive tract was removed during an ovariohysterectomy, revealing small ovaries and a white anterior vaginal mass. Histopathology revealed dysplastic ovaries with hyperplastic granulosa cells and a benign vaginal fibroleiomyoma. These morphologic changes are consistent with elevated estrogen levels. It was thus concluded that her persistent estrus and the fibroleiomyoma were both secondary to persistent estrogen production by the hyperplastic granulosa cells.

Possibilities of using neodymium laser to improve the condition of vaginal mucosa in women of various ages with initial stages of genital prolapse

Genital prolapse is a sort of epidemic and is registered today in 30% to 56% of women of both reproductive and menopausal ages. Until now, the initial stages of prolapse were not taken into account; as a rule, the correction began immediately with surgical treatment, the results of which were not always satisfactory, and the recurrence rate with plastic correction with one’s own tissues ranged from 37 to 45%. One of the main manifestations of prolapse of the vaginal walls, especially n perimenopause, is vulvovaginal mucosal atrophy, which directly depends on the pH in the vagina. The study is devoted to the analysis of the effectiveness of using neodymium laser to improve the condition of the vaginal mucosa in women of different age groups with initial degrees of genital prolapse. Purpose: scientific substantiation of using neodymium laser in patients of different age groups with grade I–II cysto-rectocele. Material and research methods. Studies were carried out in 69 women aged 31 to 52 years with cysto-rectocele of grade I–II (ICD-10 code N81.6), with the duration of the disease from 4 to 15 years. All patients, depending on their age and the method of treatment used, were divided into 2 groups comparable in terms of clinical and functional characteristics — the main and control groups, each of which had 2 subgroups. In the main group: subgroup 1 included 27 patients of reproductive age with grade I–II cysto-rectocele, who underwent a neodymium laser course with Magic Gyno, consisting of 3 intravaginal procedures with an interval of 28 days; subgroup 2 included 22 patients of perimenopausal and menopausal age with grade I–II cysto-rectocele, who underwent a course of 3 intravaginal procedures with Magic Gyno neodymium laser with an interval of 28 days. The control group included 20 patients with grade I–II cysto-rectocele, who underwent a special complex of exercise therapy; depending on their age, they were also divided into two subgroups: 1 (10 patients) — of reproductive age, 2 (10 patients) — of perimenopausal and menopausal age. The results obtained indicate a pronounced effect of the course application of intravaginal exposure by a neodymium laser on the state of the vulvovaginal mucosa in patients with grade I–II cysto-rectocele, of both reproductive and, most importantly, peri-menopausal age, which was manifested in the normalization of the pH of vaginal discharge and elimination of signs of atrophy of the mucous membrane of the vulva and vagina and was confirmed by the data of pH-metry and the Vaginal Health Index Score. Conclusion. The course use of a neodymium laser in patients of different age groups with grade I–II cysto-rectocele contributes to the formation of a pronounced tropho-stimulating effect, which is manifested in the normalization of the pH of the vaginal discharge and the elimination of signs of atrophy of the mucous membrane of the vulva and vagina.

Practical approaches to examination of women with abnormal vaginal discharge: a review of evidence-based recommendations 2021

Abnormal vaginal discharge (AVD) is a syndrome that combines conditions of different origin (microbial/non-microbial) and of different anatomical localization (limited to vagina and exocervix/spreading from the endocervix to the pelvic organs) that cause discomfort and changes in the characteristics of vaginal discharge.Review objective: to systematize modern approaches to the diagnosis of the most common causes of AVD – bacterial vaginosis (BV), trichomoniasis, aerobic vaginitis (AV), vulvovaginal candidiasis (VVC) – in a practical context. Laboratory component of diagnosing the AVD causes should be complex due to the not fully understood mechanisms of regulation of vaginal biocenosis and changes in the virulence of opportunistic and pathogenic flora, leading to an increase in the frequency of mixed forms of vaginosis and their atypical course. The tasks of laboratory tests in AVD are determination of the sexually transmitted infections (gonorrhea, chlamydia, Mycoplasma genitalium) more often as a concomitant asymptomatic infection in combination with BV or another cause of AVD; confirmation of the suspected cause of AVD (BV, trichomoniasis, AV, VVC); differential diagnosis with more rare microbial causes (cytolytic vaginosis) and non-microbial causes.Vaginal pH and microscopy of vaginal discharge with an assessment according to the diagnostic criteria for dysbiosis are first line of available diagnostic tests of BV, AV and VVC. They make it possible to differentiate typical AVD causes from non-microbial AVD causes and rare causes of microbial AVD. Additionally, complex modern molecular methods for assessing the vaginal biocenosis can be used. Cultural methods play an important role in the diagnosis and treatment of recurrent/complicated VVC and AV. PCR for chlamydia, gonorrhea, trichomoniasis and Mycoplasma genitalium is a mandatory component of a comprehensive test in patients with suspected BV, AV or mixed dysbiosis. Patients diagnosed with BV or trichomoniasis has to be tested for HIV and sexually transmitted infections.

RANDOMISED CONTROLLED CLINICAL STUDY OF KUSHTADI YONI VARTI ON CERVICAL EROSION

Cervical Erosion may present with symptoms like vaginal discharge or serious problems of female infertility and thus gains importance in the gynaecological practice1. This entity is correlated with GarbhashayaMukhaGata Vrana (GGV), of Vatakaphaja variety. In the present study, Kushtadi YoniVarti (KYV) 2 is proposed as a local treatment for Cervical Erosion. The present study has two groups: Group A:30 patients, were treated with Kush- tadi Yoni Varti, followed by Sukhoshna Jala Prakshalana for 7 consecutive days. Group B:30 patients were ad- vised with Pathya and apathy for 7 days. The Follow up for both groups were on 14th Day and 21st Day. The re- sults were analysed statistically with paired and unpaired t-test. On comparing the two groups, it was found that the efficacy of treatment in Group A was better than the efficacy of treatment in Group B with reference to amount and odour of discharge, appearance and degree of erosion. Keywords: Cervical Erosion, Kushtadi Yoni Varti, GarbhashayaMukhaVrana, PAP Smear.