Journal of Lower Genital Tract Disease最新文献

Objectives: The purpose of this study is to evaluate the content, delivery, and quality of medical information for vulvar lichen sclerosus on the social media platform TikTok.

Materials and methods: This is a descriptive, cross-sectional study. Using the third-party data scraping tool Apify, TikTok videos tagged with #lichensclerosus or "lichen sclerosus" were identified and sorted by view count. A sample of 100 videos was reviewed by 2 independent reviewers, excluding those not discussing lichen sclerosus. Videos were assessed using a coding document, the Patient Educational Materials Assessment Tool, and the DISCERN instrument. Interrater reliability was measured, and statistical analyses included Fleiss' kappa, intraclass correlation coefficient, t tests, and Wilcoxon rank sum test with Holm-Bonferroni correction.

Results: Content creators included patients (46%), health care professionals (30%), and others. Topics focused on clinical disease (52%) and treatment (48%). Evidence-based medicine was discussed in 71.7% of treatment-related videos, while 51.7% included nonevidence-based approaches, with a neutral or positive sentiment. Videos discussing topical steroids often had negative sentiments. Quality assessment revealed 61% of videos were understandable, 27% actionable, and 46% contained misinformation. Videos by health care professionals had less misinformation and higher quality scores compared to patient-generated content. Commercially biased videos were more understandable but contained more misinformation.

Conclusions: TikTok serves as a significant platform for sharing information on lichen sclerosus, but nearly half of the content contains misinformation. Health care professionals need to engage in social media to provide accurate information and counteract misinformation. Enhanced collaboration with patient advocates and careful resource sharing can improve the quality and reliability of medical information available online.

Objectives: Contributors to disparities and worse cervical cancer outcomes include limited education and loss to follow-up after an abnormal Pap smear. Effective interventions are necessary to engage diverse populations. The authors piloted an intervention to assess acceptability, knowledge uptake, and follow-up.

Materials and methods: This prospective pilot study recruited patients scheduled for colposcopy visits at a government-insured clinic and faculty clinics within an academic medical center to use the Patient Activated Learning System (PALS). The PALS intervention included 5 short educational videos about human papillomavirus and colposcopy. Participants completed a baseline knowledge questionnaire, viewed PALS videos followed by post-intervention knowledge and acceptability surveys. Perceptions of PALS, anxiety, and impact on follow-up were evaluated.

Results: Of 63 (70%) participants completing the intervention, 24 (38%) were from the government-insured clinic and 39 (62%) from faculty clinics. Median age was 36 (range 30-48), 38 (63%) were racial and ethnic minorities, and 21 (33%) were non-Hispanic White. The intervention improved knowledge scores for the entire cohort (60%-75%, p < .01), even when stratified by race/ethnicity ( p < .01 for all), income ( p < .01), education ( p < .01), practice ( p < .01), and insurance type ( p < .001). Participants found PALS convenient to use (4.6/5), enjoyable (4.2/5), and acceptable (4.6/5); 75% said the videos alleviated colposcopy-related anxiety, and 84% indicated PALS made them more likely to follow up. The guideline concordant follow-up rate among study completers was 73%.

Conclusion: In this pilot study, PALS was effective and acceptable among a diverse cohort. These free, widely viewed videos can successfully engage diverse populations to improve colposcopy knowledge and follow-up.

Objectives: Genital lichen sclerosus (LS) is a chronic mucocutaneous disorder causing considerable discomfort. Despite this, comprehensive comparison of LS impacts on quality of life (QoL), particularly on men's health or relative to other dermatological conditions like pemphigus, are sparse. This research aims to discern the effects of LS on sexual functionality and overall QoL, benchmarking against pemphigus patients and healthy controls. The study's intent is to broaden the understanding of sexual dysfunction, satisfaction, and psychological distress attributable to LS.

Materials and methods: From March 2021 to September 2023, this observational multicenter study at the affiliated university hospitals involved 176 individuals, 120 females and 56 males, with LS, pemphigus, or as controls. Questionnaires employed were the Female Sexual Function Index or the International Index of Erectile Function depending upon subject's gender, the General Health Questionnaire-12, the Clinical Lichen Sclerosus Score, and Pemphigus Disease Area Index. Differences in QoL were analyzed using either the Fisher exact test or the Mann-Whitney U test, and the correlation between Clinical Lichen Sclerosus Score sexual QoL using Spearman's coefficient.

Results: LS patients faced more sexual health challenges than pemphigus patients and healthy people. Women with LS had difficulties with lubrication and pain, men had less satisfaction during intercourse, and all had increased psychological distress, although less than those with pemphigus. A strong link between LS severity and worse sexual QoL, especially for women, was identified.

Conclusions: LS significantly affects sexual function and psychological well-being, both for men and women, reaffirming the need for comprehensive management.

Objectives: American Indian (AI) women have a higher incidence and mortality from cervical cancer than non-Hispanic White (NHW) women in the US. This article's purpose is to detail the clinical events in the cervical cancer prevention continuum among the AI and White women with cervical cancer on the US frontier.

Materials and methods: A cancer center with a nearly 40,000 square-mile catchment area maintained a detailed cancer registry connected to the clinic records of all cervical cancer patients between 2010-2019. This catchment area provided records of both an AI and a White population. Descriptive and inferential statistics and modeling predictions detailed the prevention continuum.

Results: Among the 126 with cervical cancer, 20% were AI, and 78% were White. Sixty percent did not participate in cervical cancer screening within the 5 years before their diagnosis, and on average, 9.2 years passed since the last cervical cancer screening. 91% presented with symptoms, and most women presented with 2 or more symptoms. Thirteen percent underwent a colposcopic diagnostic step, significantly delaying the time to diagnosis compared to other diagnostic steps. Sixty-nine percent of the histopathologic diagnoses were squamous cell carcinoma, and 27% were adenocarcinoma. Forty-nine percent presented at stage I regardless of histopathology. Chemotherapy and radiation therapy were most commonly combined. Sixty-three percent of the population survived, and 42% survived at least 3 years from diagnosis. Younger age and earlier stages at diagnosis were the significant adjusted predictors of survival.

Conclusions: The authors' detailed cervical cancer prevention continuum events provide new data questioning the use of colposcopy for women symptomatic at presentation.

Introduction: The Australian National Cervical Screening Program has mandated management algorithms that are uniform across all age groups, but evidence is emerging that perhaps the risk of high-grade squamous intraepithelial lesion (HSIL) may decrease in the postmenopausal period.

Objective: The aim of the study is to identify whether patients ≥50 years of age referred to a tertiary colposcopy service have a different risk of HSIL or greater (+).

Materials and methods: This is a retrospective cohort study of 3239 referrals to a hospital colposcopy clinic with a positive human papillomavirus (HPV) cervical screening test between December 2017 and May 2023. Patients were included if they were aged 25-74 years, had a cervix, and completed an outpatient colposcopic assessment. Medical records were analyzed to determine the incidence of HSIL+ for each age group and compared them using χ2 and multivariable regression.

Results: The overall incidence of invasive carcinoma was 0.93% and HSIL/adenocarcinoma-in-situ was 20.38%. Patients ≥50 years of age were less likely to have HSIL or greater diagnosed than those <30 (p < .0001) or those 30-49 (p < .0001), even after considering referral HPV subtype and reflex cytology (OR = 0.45, 95% CI = 0.34-0.59). The risk of invasive carcinoma in those aged ≥50 was no different than those aged 30-49 (p = .982).

Conclusions: The authors observed a lower incidence of HSIL or greater with increasing age even after considering referral HPV subtype and reflex cytology. As further data emerges regarding the risk of high-grade disease in those ≥50 years of age, refinement of the risk-based screening algorithm to account for advanced age may be required.

Objective: The study aimed to assess sexual distress and quality of life in women with moderate-to-severe genital erosive lichen planus (GELP).

Materials and methods: Thirty-six women with GELP were recruited at the Oslo University Hospital in Norway. The diagnosis was confirmed by a dermatologist with experience in vulvovaginal disease and based on characteristic clinical changes in the vulva and/or vagina, and biopsy results if available. Clinical severity was measured using the GELP score with a score ≥5 required for inclusion. Sexual distress was measured using the revised Female Sexual Distress Scale (FSDS-R), and quality of life was measured using the Dermatology Life Quality Index (DLQI). Topical steroid treatment was allowed.

Results: The mean FSDS-R score was 22.7 (range 0-45) with 27 women reporting high scores for sexual distress (FSDS-R score >15). The mean DLQI score was 8.8 (range 1-19) with 15 women reporting a moderate impact (DLQI score 6-10), and 12 women reporting a very large impact (DLQI score 11-20) of GELP on their quality of life. No clear correlations were found between disease severity assessed by GELP scores and FSDS-R or DLQI scores. Age was not correlated with FSDS-R or DLQI scores.

Conclusions: These results demonstrate that a substantial number of women with GELP experience sexual distress and a reduced quality of life.

Objective: The phenomenon of topical corticosteroid (TC) phobia (TCP) poses a challenge to the adherence of patients requiring prolonged treatments, particularly those with conditions like atopic dermatitis. Nonadherence to treatment significantly contributes to the inadequate control of diseases. This study aimed to evaluate TCP among women suffering from vulvar lichen sclerosus (VLS) and its potential impact on treatment adherence and therapeutic outcomes.

Materials and methods: This observational, prospective study involved adult patients who received their first histological diagnosis of VLS and underwent a 12-week corticosteroid treatment regimen at the authors' Vulva Unit between June 2022 and September 2023. All participants completed the validated TOPICOP questionnaire, which assesses concerns, worries, and beliefs regarding TC usage. Baseline and 12-week control visit assessments were conducted to evaluate subjective and objective parameters of VLS. Patient adherence to treatment was monitored through diary entries.

Results: Among the 50 patients included (with a mean age of 64.9 ± 13.5 years), more than half (58%) had prior experience with TC treatments and 10.3% had used corticosteroids for vulvar symptoms without a precise diagnosis. The median global TOPICOP score was 19.4% (interquartile range = 5.6-36.1), with a corresponding median value of 7.0 (interquartile range = 2.0-13.0). A total of 41 patients (82.2%) adhered to the study treatment, which proved highly effective in alleviating symptoms and improving signs of VLS. Multivariate analysis revealed that neither treatment adherence nor effectiveness were significantly associated with the level of TCP.

Conclusions: Among the authors' VLS patients, TCP was relatively low and did not negatively impact treatment adherence to corticosteroids. Moreover, TCP did not influence the effectiveness of TC therapy, as it did not affect adherence.

Objective: The aim of the study is to evaluate adherence to national recommendations for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) testing during pregnancy including tests for cure/clearance and for persistence/potential reinfection at time of delivery.

Methods: The authors evaluated results of chlamydia and gonorrhea nucleic acid amplification tests (NAAT) performed by major national reference laboratory from January 2010 through July 2022.

Results: Of 3,519,781 uniquely identified pregnant individuals, the authors identified 4,077,212 pregnancies. Among pregnancies that had chlamydia or gonorrhea testing, 3.7% (149,422/4,055,016) and 0.4% (15,858/ 4,063,948) were initially positive, respectively. Initial tests occurred in the first trimester for approximately 88%. Of those initially chlamydia test positive, 71% were retested; 15.8% in <4 weeks and 37.3% >8 weeks (similarly for gonorrhea). Among patients initially test positive in early/mid pregnancy, more than one-third had no evidence of late pregnancy retesting. Individuals who were initially test negative and subsequently retested positive were approximately 50% likely to have the last available result be positive. Among all whom initially tested positive and were retested, 6.8% and 4.0%, were positive for chlamydia and gonorrhea, respectively on their last test before estimated delivery. There was no subsequent negative test before estimated delivery for 35.1% and 36.9% chlamydia or gonorrhea infected patients, respectively.

Conclusions: Adherence to current recommendations is suboptimal and may not be adequate to reduce disease burden. Professional societies and practice plans should work to encourage better adherence to existing guidelines to protect the health of women and their newborns. The authors propose recommendations that may be helpful in reducing disease burden.

Objectives: Women with a history of criminal legal system involvement have cervical cancer rates that are 4-5 times higher than the general population-a disparity that has persisted for nearly 50 years. The authors' objective is to describe the intersection of mass incarceration in the United States and risk factors for cervical cancer to offer equitable prevention and treatment strategies for the field.

Methods: A group was convened by American Society for Colposcopy and Cervical Pathology members and experts in the field to address a topic of importance relevant to cervical cancer elimination in underserved groups. This topic has received consistent attention from the American Society for Colposcopy and Cervical Pathology. After convening multiple times to discuss salient issues on the topic, the group proposed 12 specific recommendations related to vaccination, screening, treatment, practice, research, and policy to address the burden of cervical cancer among individuals with criminal legal system involvement.

Results: At least 10% of the incarcerated population is at risk for cervical cancer. Clinicians in all areas of practice will encounter patients with incarceration histories or current incarceration, regularly throughout their careers.

Conclusions: Clinicians who provide preventive care for people at risk of cervical cancer can play a critical role in eliminating disparities for this vulnerable population, by drawing on these expert recommendations.

Objective: The aim of this study was to develop a mobile application for vulvar self-examination and to examine its effect on performing vulvar self-examination.

Materials and methods: This is a quasi-experimental study. Forty-seven women accepted to participate. The mobile application was uploaded to the women's phones and the women's vulvar self-examination practices were followed through the application for 6 months. Obtained data were analyzed with descriptive statistics and the McNemar's test.

Results: The mean age of the participants was 35.34 ± 9.85 years. Initially, out of all the participants, none performed vulvar self-examination, 95.7% did not regularly have their yearly gynecological examination, 29% did not have pap smear, and 91.5% had no information about vulvar self-examination. In the third month after the mobile application was downloaded, 68.1% were performing vulvar self-examination and this percentage decreased to 57.4% in the sixth month without a significant difference (p < .05). The women reported that they had difficulty in performing the examination in the first follow-up and did not have time to do it in the second follow-up.

Conclusions: The mobile application increased the rate of examination, and there was no significant difference in the number of the women performing the examination between the follow-ups.