Journal of Lower Genital Tract Disease最新文献

Objective: The aim of the study was to evaluate whether a teaching session and optional reminders improved frequency of performance of vulvar self-examination (VSE) in a population at increased risk of vulvar cancer.

Methods: Participants were recruited from Colposcopy and Vulvar Dermatology clinics at a publicly funded academic hospital in Ontario, Canada. Participants completed a questionnaire, were taught how to perform a VSE, and were given an information booklet. They had the option to receive phone or electronic health record reminders to complete a VSE over the course of the next 6 weeks. After 6 weeks, participants were contacted to survey their VSE behaviors. Data were analyzed using descriptive statistics.

Results: Two hundred nineteen participants completed the study. Prior to the study, 28 participants (13%) had heard of VSE, while 31 (14%) had never looked at their external genitalia before. At a 6-week follow-up, 181 out of 219 participants (83%) completed a VSE, compared to 16% who regularly performed VSEs prior to the intervention ( p < .001). There was a statistically significant improvement in self-reported ability to find the labia minora, labia majora and urethra after the intervention.

Conclusions: Despite low baseline levels of familiarity with VSE, a simple teaching session, with or without reminders was associated with high performance of VSE in a population at increased risk of vulvar cancer.

Objective: Quality of colposcopy determines accurate diagnosis and treatment planning. India and low-middle income countries have varied resource settings offering colposcopy services; this group's objective was to develop defined standards for colposcopy with quality assurance in them to reach the goal of cervical cancer elimination.

Methods: An expert group comprising colposcopists, gynecologists, and gynecologic oncologists collated existing literature and guidelines. A framework applicable to India and similar low-middle income countries with diverse resources for providing colposcopy services in a standardized manner, stratified according to basic and advanced colposcopy centers, was formulated and circulated among experts. The revised version was deliberated in a face-to-face meeting to finalize the standards. Public comments were incorporated in the final document.

Results: Basic and advanced colposcopy centers were defined; essential and desirable components at these centers were specified. Recommendations for quality assurance evaluation and audits of ongoing services at both types of centers were also defined. Guidelines and recommendations for advanced centers suited for training were made.

Conclusions: These good clinical practice recommendations will guide the provision and assessment of colposcopy services and can be widely applicable to all low-middle income countries.

Objective: The study aimed to assess the use of boric acid and probiotics among patients treated at a tertiary care vulvovaginal health center.

Methods: The authors conducted a cross-sectional survey of 206 new patients from October 2024 and January 2025. Participants completed a questionnaire on demographics, vulvovaginal history, self-treatment practices, and a Vulvar Quality of Life Index. Descriptive statistics, bivariate analyses, multivariable logistic regression, and subgroup analyses were performed.

Results: Fifty percent of participants reported use of boric acid, and 61.2% used probiotics. Only 2.9% used boric acid for the CDC guideline-recommended duration of >21 days. Among those with vulvovaginal candidiasis or bacterial vaginosis, 62.3% and 55.9%, respectively, reported prior boric acid use. Patients learned about boric acid and probiotics from healthcare providers (63.4% and 55.8%, respectively), followed by social media (29.0% and 24.2%). Primary treatment goals included pH balance, symptom relief, and treating infections. Patients spent an annual average of $397 on their condition, with an average of $23 on boric acid and $9 on probiotics. Higher Vulvar Quality of Life Index scores ( p = .042) and being single ( p = .015) were independently associated with boric acid use.

Conclusion: Boric acid and probiotics are widely used among patients with vulvovaginal conditions requiring tertiary care, almost always with unsupported reasons. Although nearly half of the respondents received treatment recommendations from providers, few reported use aligned with clinical guidelines. Given the significant financial burden and extensive misinformed use, there is a critical need for improved patient education and evidence-based counseling to prevent reliance on ineffective or misleading therapies.

Objective: The aim of the study was to evaluate the risk for cervical intraepithelial neoplasia II (CIN 2) or worse associated with high-risk (HR) non-16/18 human papillomavirus (HPV) types among women with normal cytology in a screening context.

Methods: This population-based historical cohort study was conducted in a large state-mandate health provider. Human papillomavirus genotyping was performed on Pap tests collected in women that were positive for non-16/18 HPV types from 2019 to 2023. HPV detection was performed using COBAS (4800/6800) (Roche Diagnostics) test: a qualitative in vitro test for the detection of 14 HR HPV types. The women were followed for histopathologic outcomes until end of 2024. Cumulative incidence proportions of CIN 1, 2, and 3 or worse were calculated.

Results: Of 24,439 women tested positive for HPV during the study period, a total of 7,930 women tested positive for HR HPV non-16/18 with a normal cytology. Among these, 875 (11.1%) developed pathological findings in biopsy including CIN II ( n = 68, 0.9%) and CIN III ( n = 802, 10.1%) lesions, cervical squamous cell carcinoma and adenocarcinoma (4, 0.1%), as well as one case of adenocarcinoma in situ (0.01%).

Conclusions: Women with HR HPV non-16/18 and normal cytology represent a high-risk group requiring long-term follow-up. No malignancies were observed in the first year of follow-up, supporting the recommendation for retesting after 12 months and colposcopy referral if the infection persists.

Objectives: Practice recommendations for the minimum steps to perform a colposcopy were published in 2017. The goals of this study are to assess whether adherence to these guidelines correlates with detection of cervical intraepithelial neoplasia and to analyze factors associated with rates of biopsy during colposcopy.

Methods: All colposcopies performed at 2 academic medical centers between 2018-2023 were identified by billing code. Patient demographics, cervical cancer screening, medical history, colposcopy details, and pathology were collected from retrospective medical record review. Adherence to guidelines was determined by the number of criteria met on colposcopy documentation. The outcomes assessed were grade of pathology and rate of biopsy.

Results: In univariable regression analysis, no association between adherence to guidelines and detection of cervical intraepithelial neoplasia 2+ was identified (odds ratio [OR] = 1.11, p = .12). When controlling for race, ethnicity, insurance type, Pap test cytology, and human papillomavirus vaccination status in multivariate analysis, there remained no statistically significant correlation (adj. OR = 1.11, p = .14). Black patients (OR = 0.66, p = .039), publicly insured patients (OR = 0.38, p < .001), and patients with HIV (OR = 0.39, p < .001) were each significantly less likely to have a biopsy taken during colposcopies compared to White, privately insured patients, or HIV-negative patients. In multivariate analysis, HIV and public insurance remained factors associated with lower rates of biopsy (adj. OR = 0.46, p < .001 and adj. OR = 0.63, p = .035, respectively).

Conclusions: The study found insufficient evidence to support current colposcopy guidelines. The analysis revealed disparities in the execution of biopsies during colposcopies, particularly in Black, publicly insured, and HIV-positive patients, underscoring the importance of standardization of colposcopic practices.

Objective: Vulvar health conditions such as lichen sclerosus and vulvodynia are often misdiagnosed or delayed in diagnosis, leading to worsened clinical outcomes. A standardized intake questionnaire for the initial patient visit could improve early detection and management of these complex conditions. This study aimed to develop a consensus-based standardized intake questionnaire for vulvar health clinics using the eDelphi methodology.

Methods: An international eDelphi process was initiated. Specialists in vulvar health were recruited to participate in 2 rounds of online surveys to achieve consensus on key questions. The consensus was defined as 70% agreement among panelists for inclusion or exclusion of questions, with feedback incorporated between rounds.

Results: A total of 80 panelists from various specialties, including dermatology and gynecology, participated. In the first round, 136 items were reviewed, with 64 meeting consensus for inclusion. After the second round, an additional 20 items were added, leading to a final intake questionnaire consisting of 82 items that were condensed and reorganized to 52 questions and 2 validated surveys (the Vulvar Quality of Life Index and Patient Health Questionnaire 2).

Conclusions: This study successfully identified key questions for a standardized intake questionnaire for vulvar health clinics using the eDelphi methodology. The methodology may also be applicable to other health conditions requiring structured patient intake processes.

Objective: Timely treatment of anal high-grade intraepithelial lesions (HSIL) prevents progression to anal cancer. Available screening tools (anal Pap test and high-risk human papillomavirus testing) have inconsistent and suboptimal performance, often leading to overreferral to high-resolution anoscopy, the gold standard test for HSIL diagnosis. The authors aimed to develop and externally validate a clinical prediction model for histologic HSIL to improve triage to high-resolution anoscopy among individuals at increased risk for anal cancer.

Methods: Medical records from 2 institutions were reviewed to identify candidate predictors of histologic HSIL. A penalized logistic regression model with elastic net regularization was developed and internally validated with five-fold cross-validation. External validation was performed in a third institution cohort. Candidate predictors were age, sex, HIV status, history of anogenital HPV-related disease, immunosuppressant use, anal cytology, anal high-risk HPV (hrHPV) status, and interaction terms (HIV status*hrHPV infection) and (HIV status*history of anogenital HPV-related disease).

Results: The derivation dataset included 536 patients, 382 (71.3%) were people living with HIV, 168 (31.3%) were women, and HSIL prevalence was 21.1%. The area under the ROC on the derivation dataset was 0.80 (95% CI = 0.69; 0.90). The external validation dataset included 242 patients, 159 (65.7%) people living with HIV, 18 (7.4%) women, with HSIL prevalence of 37.2%. The final model included age, sex, anal cytology, anal hrHPV, immunosuppressant use, history of anogenital HPV-associated disease, and the 2 interaction terms. The area under the receiver operating characteristic (ROC) on the external validation dataset was 0.73 (95% CI = 0.67; 0.80).

Conclusions: This clinical prediction model demonstrated a promising performance and included objective factors that are easily obtained.

Objectives: The study aims are to evaluate the utility of cervical or vaginal human papillomavirus (HPV) status in predicting recurrence of noncervix lower genital tract (LGT) high-grade squamous intraepithelial lesion (HSIL), assess factors associated with HPV positivity, and explore patterns of HSIL surveillance.

Methods: This retrospective cohort included patients undergoing ≥12 months of surveillance after biopsy-proven vulvar, vaginal, or anal HSIL between 2015 and 2023 at an Australian hospital with a laboratory that performs universal p16 and p53 immunohistochemistry for vulvar squamous neoplasia. Data collected included demographics, HPV results, medical comorbidities, vulvar dermatoses, treatment, frequency of surveillance, outcomes, and follow-up duration. Data were stratified by HPV status at the time of LGT HSIL diagnosis.

Results: Of 143 patients with a median age of 54 years, 23% used topical steroids for lichen sclerosus or planus, 93% had a recent or concurrent HPV test, and 53% of these were positive. Positive HPV was more frequent in vaginal versus vulvar HSIL (92% vs 46%; p = .003) and less frequent in patients with diabetes (23% vs 3%; p < .001). Recurrent or persistent HSIL occurred in 65%. HPV positivity was not associated with overall recurrence, but afforded a 6-fold higher vaginal HSIL recurrence risk. There was a documented surveillance strategy in 92% with 78% of these having 6-monthly assessments for 5 disease-free years, then annually.

Conclusions: Cervical or vaginal oncogenic HPV results do not predict vulvar HSIL recurrence but may inform surveillance for vaginal disease. Limitations include the retrospective design, potential referral bias, and limited generalizability.

Objective: This study aimed to determine the prevalence of anal dysplasia in women who had anal high-risk human papillomavirus (HR-HPV) and/or abnormal cytology in 2012-2014.

Methods: The authors performed a prospective cohort study evaluating females with a history of lower genital high-grade dysplasia or cancer who underwent HR-HPV anal testing and anal cytology between 2012 and 2014. Patients from this original cohort ( N = 190) were approached for rescreening with anal cytology and HR-HPV testing. Descriptive statistics and Fisher's exact test were performed.

Results: Forty-one patients were rescreened. Fourteen patients (34%) had abnormal results (abnormal cytology and/or positive HR-HPV) and were referred for high-resolution anoscopy. Eight underwent high-resolution anoscopy with the following 7 undergoing biopsies resulting as normal: 3, anal low-grade squamous intraepithelial lesion (AIN 1): 3, anal high-grade squamous intraepithelial lesion (AIN2/3): 1. Of the 27 (66%) patients with prior abnormal results in 2012-2014, 10 (37%) had persistent abnormal results. Four patients had newly abnormal screening results. Persistent HR-HPV infections were identified in 10%, new infections in 2%, and resolved infections in 22%. Nine patients (22%) followed up with colorectal since their initial 2012-2014 anal screening with 1-2 visits. Of those who followed up, 4 patients had persistent abnormal screening results including 1 with persistent HPV-16 and high-grade dysplasia.

Conclusions: Women in the cohort continued to display high rates of anal dysplasia and HR-HPV infection on 10-year follow-up anal screening. The data support long-term, regular anal screening in patients with a history of lower genital tract dysplasia or cancer to identify and treat anal dysplasia in this high-risk cohort.

Objectives: Cervical conization (loop electrosurgical excision procedure) under local anesthesia is often associated with anxiety and procedural pain. Virtual reality (VR) glasses may enhance patient experience and reduce discomfort during medical interventions. The authors aimed to prospectively and randomly evaluate whether VR use during loop electrosurgical excision procedure may impact reported pain and anxiety.

Methods: In this randomized controlled study, women undergoing conization under local anesthesia were assigned to either a control group (no VR) or a study group using VR glasses during the procedure. Demographics, baseline anxiety levels, anticipated pain, intraprocedural pain, heart rate, patient satisfaction, and surgeon-reported procedural difficulty were compared between groups. Anticipated and actual pain was assessed using a 0-10 visual analog scale.

Results: A total of 67 women were randomized. Groups were comparable in age, body mass index, pathology, and anticipated pain (median 5.0 vs. 6.0, p = .667). No significant difference was found between groups in pain experienced during the procedure (median 3.0 vs. 2.0, p = .318), discomfort, anxiety, or heart rate. Experienced pain was significantly lower than anticipated in both groups (p < .001). Patient satisfaction was high in both groups, 90% of patients who used VR would recommend it to others. Adverse effects related to VR were rare.

Conclusions: While the use of VR glasses did not reduce perceived pain compared to standard care, it was safe and associated with high patient satisfaction. Most women overestimated the pain they would experience during conization. Integrating VR technology may improve overall patient experience during cervical conization, even if it does not alter pain perception.