Vaginal aplasia or hypoplasia often requires the creation of a neovagina using vaginal dilation therapy, vaginoplasty surgery, or a combination of both. However, the absence of validated guidelines and the controversy surrounding vaginoplasty surgery have limited our understanding of the long-term outcomes and impact on quality of life and psychosexual functioning for women with a short or absent vagina. This study provides valuable insights into the Australian context, reflecting the treatment approaches and long-term psychosocial outcomes for this patient group.
This study aimed to assess the long-term effects of vaginal dilation, with or without vaginoplasty surgery, on quality of life and psychosexual functioning in women diagnosed with a short or absent vagina.
A mixed-methods design was employed, utilising validated psychometric tools and a semi-structured interview. The study included patients with disorders of sex development aged above 16 who underwent vaginal dilator therapy between 2012 and 2020, as well as healthy age-matched controls. The research was conducted at a single tertiary hospital in Sydney, NSW, Australia.
The questionnaire was completed by 30 participants, including 11 non-surgical cases, four surgical cases, and 15 controls. The mean age at inclusion was 30.8 ± 14.1 years. The non-surgical group exhibited significantly higher scores indicating a greater ‘need for help’ compared to the surgical group (30.0 ± 19.3 and 4.5 ± 9.0; P = 0.0121). No other statistically significant differences were observed between the two groups.
Choice of treatment should consider various factors, including patient preference and responsiveness to treatment. These findings emphasise the importance of personalised care in the Australian context and highlight the need for further research, particularly with larger and more homogenous sample sizes, to enhance clinical decision-making in this population.
Infectious syphilis among women of reproductive age continues to rise in many countries including Australia, with a resultant increase in congenital syphilis. In response, new guidelines for management of syphilis in pregnancy were published in Queensland, Australia in 2018.
This study evaluates the management of women diagnosed with syphilis in pregnancy in South-East Queensland (SEQ) after release of this guideline.
This retrospective review of notification data identified women in SEQ who had a positive syphilis serology during pregnancy, without evidence of adequate treatment prior to the pregnancy, between January 2019 and December 2021 inclusive. Maternal demographics and pregnancy details including syphilis staging, testing and management were extracted, with management assessed against the 2018 Queensland syphilis in pregnancy guideline.
Of the 42 women identified, 79% were diagnosed in the first or second trimester, 69% had early-stage syphilis at the time of diagnosis and 86% were asymptomatic at the time of diagnosis. All, including the eight (19%) Aboriginal and/or Torres Strait Islander women identified, completed stage-appropriate treatment with penicillin, 83% completed treatment four weeks prior to delivery and 60% achieved a four-fold reduction in rapid plasma reagin at time of delivery.
Our findings suggest compliance with syphilis in pregnancy management recommendations has improved in SEQ since release of the 2018 guidelines. However, congenital syphilis rates continue to rise; further initiatives addressing barriers to timely testing and management of syphilis in pregnancy are urgently needed at both healthcare system levels and for individual women.
Human papillomavirus (HPV) testing became the primary cervical screening modality in Aotearoa New Zealand in September 2023. To inform the national roll-out of HPV primary screening, a multiregion implementation study (‘Let's Test for HPV’) was undertaken in primary care in 2022–2023.
To explore participant perspectives and information needs following receipt of an HPV detected result.
An online survey completed in 2023 by 921 Let's Test for HPV participants included 95 people with an HPV detected result (10.3%). Data collection included: adequacy of information provision, receipt of results, emotional response, views on HPV primary screening and needing cervical cytology and/or colposcopy, and intent to screen again.
Receipt of an HPV detected result was worrying for most people and many had unanswered questions about HPV, how HPV testing fits with cytology, implications for follow-up and outcomes. Knowledge gaps and uncertainty appeared to be linked with feeling anxious about possible outcomes and fear of a cancer diagnosis. All survey participants received recommended follow-up (cytology and/or colposcopy). Having a choice of screening test and the ability to self-test were welcomed and the majority (88%) expressed intent to screen again.
These survey findings highlight the importance of giving clear information about potential outcomes at the time of screening and again when sharing results. Sensitive delivery of results, providing reassurance and answering questions are also important to mitigate fear and worry. Population-level education would help improve understanding of key messages about HPV testing and the changes to cervical screening.
Intrapartum antibiotic prophylaxis (IAP) administration to group B streptococcal (GBS) positive pregnant women and other pregnant women with risk factors may reduce the rate of neonatal early-onset GBS infection (EOGBSI).
Our aims were estimating the current indications for IAP among women presenting in labour, evaluating compliance to the current local IAP guidelines and to provide recommendations for improving clinician compliance.
We retrospectively analysed IAP data at our tertiary perinatal centre over a 16-month period. Our cohort included women, positive for GBS (± risk factors for EOGBSI), and a comparable number of randomly selected women with risk factors and GBS status negative or unknown.
A total of 424 mother-baby pairs were included in this study. Forty-seven percent of the study cohort had IAP indication (n = 202/424). Of these, 72% (n = 145/202) received some form of IAP and 61% (n = 123/202) received ‘adequate’ IAP. IAP was adequately administered in 67% (n = 99/148) of women positive for GBS, 27% (n = 9/33) of women with unknown GBS status and 71% (n = 15/21) of women negative for GBS with IAP indication. Most frequent reason (30%, n = 125/424) for ‘inadequate’ IAP was less than four hours from birth for women positive for GBS despite spending more than 60 min in the hospital before birthing.
A substantial number of IAP were administered less than four hours before birth and were therefore ‘inadequate’ according to the current recommendations. These high rates could be reduced if those administered at least two hours prior to birth were redefined as ‘adequate’.
It remains unclear if there is an endometrial thickness (ET) threshold below which malignancy can be excluded. Guidance on whether endometrial biopsy is needed based on ET varies among regions in New Zealand and there is a desire to standardise guidance nationwide. This study evaluates the potential impact of limiting endometrial biopsy in pre-menopausal persons with abnormal uterine bleeding (AUB) to those with an ET of less than 12 mm.
To determine the number of pre-menopausal patients with AUB with an ET of less than 12 mm undergoing endometrial sampling annually and assess the prevalence of pathology among these patients.
Endometrial samples from patients aged 18–50 years processed at a tertiary hospital between 15/06/2022 and 13/06/2023 were identified via a pathology lab search. Clinical, radiologic, and pathological data were obtained by case note review for those with AUB whose ET was less than 12 mm.
Of 1271 endometrial samples, 355 patients met the eligibility criteria, and 2.2% of these were cancerous (three cases) or pre-malignant (five cases).
If sampling thresholds would change to not perform biopsies in those with an ET of less than 12 mm, eight cases of treatable disease would be missed in pre-menopausal people. This represents 13.6% of all endometrial cancers diagnosed in pre-menopausal people in the same time period. There is no ET cut-off to reliably exclude high-risk pathology and endometrial sampling should be performed in all cases of AUB with risk factors.
Infertility is a prevalent issue worldwide. Current investigation of female pelvic infertility uses transabdominal laparoscopy, exposing patients to its associated risks. An alternative method is fertiloscopy, comprising hysteroscopy, tubal dye studies, and transvaginal hydrolaparoscopy (TVHL), falling under the broader category of VNOTES. This study reviews fertiloscopy cases in Australia to assess its role in managing infertility.
Retrospective analysis of 76 cases was performed with review of imaging results, fertiloscopy findings and interventions, and fertility outcomes. Statistical analysis was conducted via R Studio v4.1 with means and averages used for descriptive data and a Kruskal–Wallis analysis of variance test used to evaluate differences in continuous variables. Kaplan–Meier curves were constructed to describe cumulative pregnancy incidence, with differences evaluated using log-rank tests. Statistical tests were two-tailed, and a P-value < 0.05 was considered significant.
Of 76 cases, 70 underwent fertiloscopy and 35 an intra-operative intervention. Of the cohort, 53 conceived, 18 spontaneously. The highest chance of spontaneous conception was 44% by day 283. The failure rate of fertiloscopy was 5.3%, and complications occurred in 1.3% of cases.
The highest chance of spontaneous conception post-fertiloscopy was 44% by day 283, possibly indicating the time between the procedure and referral to reproductive therapies. This study identified a low associated failure and complication rate, supporting fertiloscopy as a low-risk procedure.
Despite limitations, this study highlights spontaneous pregnancy outcomes and associated low complication and failure rates, emphasising fertiloscopy's role in managing infertility in Australia as a lower risk surgical alternative to standard laparoscopy.
In recent years, the landscape of gynaecological care has undergone a profound transformation, reflecting broader changes in healthcare delivery and patient expectations. A critical issue, with limited penetration into the general community, is the burgeoning wait list for non-urgent gynaecological consultations in public hospitals, particularly those related to persistent pelvic pain, and especially in Victoria.
Outpatient waiting times are a challenge in any country that seeks to provide universal access to health care. An informal survey of major tertiary referral hospitals across Australia reveals that wait times for non-urgent first visit public gynaecological referrals range from four months to two and a half years, with the longest wait in Victoria. New South Wales, the Australian Capital Territory, the Northern Territory and Western Australia do not currently publish these data.1
Several factors have contributed to this increase. In general, wait lists across all Australian public outpatient domains has grown. This is due to many issues including the need for resource realignment in an increasing and aging demographic, issues of operational inefficiencies, and need for process improvements.2
Gynaecological outpatient clinics are a little different in that the patients' issues are frequently not related to aging. Historically, gynaecology was primarily a surgical specialty characterised by relatively swift consultations and procedures, with a rapid dispatch of patients back into the community. We had defined operative options and few medical options, so consultations were quick. We could also have been fairly accused of minimising women's experiences of pain.
In the last 20 years, the complexity of cases, especially those involving pelvic pain, has significantly expanded. Pelvic pain, for instance, is frequently associated with comorbid conditions such as irritable bowel syndrome, painful bladder syndrome, migraine, chronic fatigue syndrome, and central sensitisation. These complex, multifaceted cases require more time and expertise to address, further stretching the finite resources of gynaecological departments.
As options for managing these conditions have diversified, more information needs to be explained to each individual patient, and patients' expectations of the standard of care has increased, meaning that the time required for each individual consultation and the number of consultations for each patient has increased, leading to extended waitlists for those seeking to access gynaecological outpatient care in a public hospital.
The COVID-19 pandemic exacerbated the situation by shifting much of the outpatient care to telehealth consultations, particularly in Victoria. This transition, while necessary, has led to delays in patient management and increased the burden on outpatient services. The reduction and cancellation of many in-person clinics
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