Journal of Lower Genital Tract Disease最新文献

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.

Objectives: In recent years, the prevalence of non -albicans Candida vulvovaginitis has risen with Candida glabrata and Candida krusei ( Pichia kudriavzevii ) being prominent contributors. Candida krusei poses a significant challenge due to its intrinsic resistance to fluconazole, both in vitro and clinically. Practitioners face difficulties managing patients with chronic symptomatic vulvovaginal candidiasis who fail to respond to multiple courses of oral fluconazole and over the counter (OTC) antifungals.

Methods: The authors analyzed retrospectively a cohort of women who had chronic vulvovaginal symptoms seen in their vaginitis clinic between 2017 and 2024. Clinical charts of 11 patients with positive C. krusei vaginal fungal isolates were reviewed. Antifungal susceptibility of isolates was assessed, and treatments, including novel antifungal agents oteseconazole and ibrexafungerp, were evaluated for their efficacy in symptom control.

Results: In 10 of 11 patients, symptoms were attributed to C. krusei vaginitis, while in 1 patient, C. krusei was found to be an innocent bystander. Candida krusei vaginal isolates in vitro susceptibility testing demonstrated resistance not only limited to fluconazole but also to miconazole, ketoconazole, and other azole agents. Although itraconazole exhibited in vitro activity, treatment often failed to achieve clinical or mycologic remission. Despite the availability of new antifungal agents, vaginal boric acid emerged as the initial if not definitive treatment method of choice.

Conclusion: Determining the antifungal susceptibility profile of C. krusei vaginal isolates may be required in selecting effective antifungal treatment of refractory vaginitis due to non -albicans Candida (NAC).

Objective: The aim of the study was to investigate the morpho-functional characteristics of the vulvar vestibule in women with provoked vestibulodynia (PVD), comparing clinical, structural, and sensory parameters with healthy controls.

Methods: This was a case-control study including 30 women diagnosed with PVD and 30 healthy controls. The following morpho-functional characteristics were considered: (i) vestibular trophism, (ii) vestibular epithelial thickness, (iii) pelvic floor muscle hypertonia, and (iv) vestibular current perception threshold evaluation, at 3 frequencies (2000 Hz, 250 Hz, and 5 Hz). Fisher's exact test and Mann-Whitney U test were used to compare parameters between PVD cases and healthy controls, while Pearson's correlation coefficient was calculated to assess vestibular trophism and epithelial thickness with neurosensitization.

Results: PVD patients compared to healthy controls showed higher vestibular trophism health score (6.5 vs 3.0, p < .001), lower epithelial thickness (987.0 vs 1,159.0 μm, p < .001), more frequently hypertonia of pelvic floor muscle ( p < .001), and lower thresholds at neurosensitization at all three frequencies. A linear negative correlation emerged between vestibular trophism health score and current perception threshold at 5 Hz (r = -0.53, p = .003) and 250 Hz (r = -0.45, p = .013) in PVD cases. No significant correlation emerged for controls and for both groups for current perception threshold at 2000 Hz.

Conclusions: This study identified substantial organic differences between PVD patients and healthy controls in critical parameters, such as vestibular trophism, epithelial thickness, pelvic floor muscle hypertonia, and neurosensitization. These findings enhance understanding of the complex and multifactorial mechanisms underlying PVD and highlight potential therapeutic targets for intervention.

Objectives: Depth of invasion (DOI) in vulvar squamous cell carcinoma (vSCC) predicts risk of nodal metastasis, with measurement >1 mm dictating the need for lymph node diagnostic procedures. In 2021, the International Federation of Gynecology and Obstetrics (FIGO) changed its advice on how pathologists measure DOI. Some organizations revised guidelines to this "New" method; others continued to endorse the FIGO 2009 "Old" method. This study compares interobserver variation of vSCC DOI using Old and New FIGO measurement strategies.

Methods: A single representative image was chosen from 50 consecutive vSCC excisions with reported DOI of 0.1-3 mm. Ten pathologists provided 2 electronic measurements for each, using Old and New methods. Statistical evaluation included analyses of variance, Student t -test, and the kappa statistic.

Results: The Old method yielded a larger mean DOI than the New [1.3 vs 0.9 mm; p < .001]. The Old method had a lower proportion of measurement disagreements spanning 1 mm (53%, κ = 0.65% vs 68%, κ = 0.6). Agreement by all pathologists of DOI being either ≤1 mm or >1 mm occurred in 29/50 cases (58%) using the Old and 26 (52%) using the New method. When at least 2 pathologists measured DOI >1 mm, interobserver variation was lower using the Old method in 30 (83%) of 36 cases [mean difference = -0.1 mm, t (280) = -2.78, p = .008].

Conclusions: The FIGO 2021 DOI measurement method has higher interobserver variation than FIGO 2009, with this difference arising from tumors with DOI >1 mm. This finding, combined with inadequate international consensus and scant clinical outcome data, should trigger reconsideration of 2021 FIGO staging guidelines.

Objectives: In Canada, cervical cancer rates remain well above the World Health Organization target, despite screening and vaccination programs. Modeling reveals that those who have never undergone screening represent one of the highest risk populations. The Canadian Longitudinal Study on Aging (CLSA) prospectively collected health outcomes on >50,000 individuals. The authors sought to identify the prevalence of Canadian female participants having never undergone cervical cancer screening and the association with social determinants of health.

Methods: The authors performed a cross-sectional analysis from CLSA data. The main outcome was self-report of ever having undergone a Pap smear. Regression analyses evaluated the association between demographic or social determinants of health and self-reported lifetime cervical cancer screening.

Results: The population-based sample comprised 22,910 participants aged 45-85, of whom 99.8% had available information on cervical cancer screening ( n = 22,720). The prevalence of never having undergone a Pap smear was 14.1%; weighted prevalence, 11.8% (95% CI = 11.0-12.6). The following factors were associated with never having undergone screening: older age (10-year) (OR = 1.5, 95% CI = 1.4-1.6), lower education (low vs. high) (OR = 1.5, 95% CI = 1.2-1.9), lower household income (low vs. high) (OR = 1.7, 95% CI = 1.3-2.3), having a religious affiliation (OR = 1.3, 95% CI = 1.1-1.5), and never being married/lived in common law (OR = 1.5, 95% CI = 1.2-1.9). Notably, not having a family physician was also associated (OR = 2.3, 95% CI = 1.6-3.3). However, among participants who never underwent a Pap smear, 97% reported having a family physician.

Conclusions: This analysis highlights inequities in cervical cancer screening in the Canadian context. These insights are critical in informing a more equitable approach to implementing human papillomavirus (HPV)-based screening.

Objective: The aim of the study was to provide recommendations on quality standards for colposcopy and colposcopy training.

Methods: A panel of experts from the Latin-American Federation of the Lower Genital Tract Pathology and Colposcopy agreed on quality standards for colposcopy and colposcopy training.

Results: A total of 17 general recommendations and the rationale behind them were provided. Eight colposcopy quality standards and nine standards for colposcopy training were issued.

Conclusions: Adherence to the proposed standards could help ensure quality care of women. Colposcopists must be trained and certified.

Objectives: The purpose of this study was to identify factors with uniquely high prevalence in vulvodynia-Ehlers-Danlos syndrome comorbid patients in order to identify patients who may need referral and to better understand management of this population.

Methods: This cross-sectional study was conducted in January 2025 using the TriNetX Platform Global Collaborative Network Database with statistical comparison of vulvodynia-Ehlers-Danlos comorbid cohort and vulvodynia non-Ehlers-Danlos cohort. Bonferroni correction was performed due to analysis of 100 demographic, associated condition, and treatment factors with statistical significance at p = .0005.

Results: Five hundred seventy vulvodynia-Ehlers-Danlos patients and 49,457 vulvodynia non-Ehlers-Danlos patients were identified with a mean age of 39 and 48 ( p < .0001), respectively. Vulvodynia-Ehlers-Danlos comorbid patients had more frequent chronic pain, musculoskeletal, neurologic, gynecologic, immune, and psychiatric conditions. Vulvodynia-Ehlers-Danlos patients had higher rates of most nonsurgical interventions but similar vaginal estrogen ( p = .0412) and vulvar surgery rates ( p = .4249). Vulvodynia-Ehlers-Danlos patients had signs of more frequent medical contact with more post-op visits, vaccines, and inpatient admissions ( p < .0001). Study limitations are those inherent to the TriNetX database, with ability to see associations but not causation.

Conclusions: Clinicians treating genital pain have a role in the treatment of vulvodynia-Ehlers-Danlos patients given the array of prevalent pelvic conditions. Clinicians should keep the high rate of muscular, neurologic, and immune conditions in mind when evaluating the vulvodynia etiology in this population, as well as the higher rate of gynecologic comorbidities, which could result in hormone-mediated etiology from chronic estrogen use. With a higher rate of mood disorders, mental health inquiry is also important.

Objective: The aim of the review evaluates the feasibility and acceptability of human papillomavirus (HPV) self-sampling in underscreened communities to increase cervical cancer screening rates in the United States.

Methods: Database searches were conducted on PubMed, CINAHL, MEDLINE, CENTRAL, and ClinicalTrials.gov using the following search terms: HPV or human papillomavirus viruses, self-sampling, self-swabbing, or self-collection, acceptability, feasibility, and United States. The study aims to identify factors related to the feasibility and acceptability of HPV self-sampling uptake.

Results: Sixteen studies were included in this scoping review. Most studies reviewed associated factors, such as demographic data (age and ethnicity), and socioeconomic data (income, education level, and insurance status). There was a higher HPV self-sampling rate (75%-100%) in the 11 studies where there was an in-person component including completing self-sampling kits in-person after recruitment, scheduled appointments or education sessions compared with studies where kits were returned by mail (3%-93%). Eleven studies measured acceptability and/or feasibility, and subjects reported the self-sampling process and devices were acceptable and easy to use. Of the 11 that measured feasibility and acceptability, 3 studies noted that the majority preferred self-sampling over clinician-collected Pap tests. Six studies incorporated community health worker-led education prior to distributing self-sampling kits, and improved attitudes toward self-sampling. Two studies evaluated the incidence of abnormal results between self-sampling and clinician-collected Pap test and found no difference.

Conclusions: HPV self-sampling is seen as an acceptable and feasible option for cervical cancer screening for underscreened individuals. Furthermore, patient-facing education components led by community health workers greatly influenced participants' decision to self-sample.

Objective: The aim of the study was to examine factors associated with timely colposcopy following abnormal cervical cancer screening among patients receiving care at an urban safety-net obstetrics and gynecology clinic.

Methods: In this cohort study, the authors reviewed the care cycle of index abnormal cervical cancer screening requiring colposcopy follow-up from 3 separate years: 2016, 2018, and 2021. Primary outcomes included colposcopy attendance and timely colposcopy evaluation based on established guidelines. Multivariable log binomial regression models were used to evaluate patient characteristics and outcomes.

Results: Across the 3 years, the authors identified 820 abnormal cervical cancer screening results from 752 patients for which a colposcopy was indicated. Of these patients, 42.2% identified as non-Hispanic Black, 79.7% were English-speaking, and 80.0% were publicly insured. Pap tests requiring colposcopy resulted in completion 85.2% of the time, with 59.8% completed within guideline-concordant intervals. Human papillomavirus-vaccinated patients were less likely to attend colposcopy (relative risk [RR] = 0.84, 95% confidence interval [CI] = 0.76-0.93). Current smokers had lower colposcopy attendance compared to never-smokers (RR = 0.89, 95% CI = 0.81-0.98). Timely colposcopy took place 59.6% of the time in 2016, 56.9% of the time in 2018, and 63.3% of the time in 2021. Patients aged 40-49 and 50-64 were more likely to complete colposcopy within guideline recommended intervals than those younger than age 30 (RR = 1.23, 95% CI = 1.03-1.47; RR = 1.38, 95% CI = 1.15-1.66).

Conclusions: Despite modest overall improvement in the rate of guideline-concordant colposcopy attendance, significant gaps in timely follow-up persist. Targeted interventions are needed to improve follow-up care, particularly for younger patients and smokers.

Objective: Loop electrosurgical excision (LEEP) is the standard of care for high-grade cervical intraepithelial neoplasia. The primary aim of this study was to compare patient-reported outcomes among patients who received local anesthesia (LA) during LEEP with those who received GA.

Methods: PubMed, Embase, and Cochrane databases were searched for studies comparing GA with LA in LEEP. Primary outcomes were postprocedure pain and satisfaction, including the likelihood of choosing the same anesthesia method again. Statistical analysis used Review Manager 5.4, heterogeneity was assessed with I2 , and a random-effects model was applied.

Results: Six studies (2,169 patients; 1,536 LA, 633 GA) met inclusion criteria. Postprocedure pain was slightly lower with GA than LA (standardized mean difference: -0.49, 95% CI = -1.88, 0.89), but this was not statistically significant. Satisfaction was higher for GA (odds ratio: 1.62; 95% CI = 0.94, 2.79), though not significantly. GA patients had larger cone volumes (mean difference: 0.46 cm 3 ; 95% CI = 0.29, 0.62), and deeper excisions, though depth was not statistically significant (mean difference: 0.75 mm; 95% CI = -0.23, 1.74).

Conclusions: While GA was associated with minimally lower pain and greater satisfaction, these differences were not statistically or clinically meaningful. GA was also linked to larger cone volumes, potentially increasing risks for future pregnancies. Given the higher risks and costs of GA, LA may be preferable for LEEP.