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Intravaginal Practices and Risk of Bacterial Vaginosis and Candidiasis Infection Among a Cohort of Women in the United States
Abstract
: To measure intravaginal practices among women of differing ages, ethnicities, and human immunodeficiency virus status and the association between intravaginal practices and bacterial vaginosis and candidiasis infection.
: Between 2008 and 2010, we recruited and followed sexually active women aged 18-65 years living in Los Angeles. At the enrollment and month 12 visit, participants completed a self-administered, computer-assisted questionnaire covering demographics, sexual behaviors, vaginal symptoms, and intravaginal practices over the past month. At each visit, bacterial vaginosis and candidiasis infection were diagnosed by Nugent criteria and DNA probe, respectively.
: We enrolled 141 women. Two thirds (66%) reported an intravaginal practice over the past month; 49% reported insertion of an intravaginal product (other than tampons) and 45% reported intravaginal washing. The most commonly reported practices included insertion of commercial sexual lubricants (70%), petroleum jelly (17%), and oils (13%). In univariable analysis, intravaginal use of oils was associated with Candida species colonization (44.4% compared with 5%, P<.01). In multivariable analysis, women reporting intravaginal use of petroleum jelly over the past month were 2.2 times more likely to test positive for bacterial vaginosis (adjusted relative risk 2.2, 95% confidence interval 1.3-3.9).
: Intravaginal insertion of over-the-counter products is common among women in the United States and is associated with increased risk of bacterial vaginosis. The context, motivations for, and effects of intravaginal products and practices on vaginal health are of concern and warrant further study.
: III.
... A total of 328 full-text articles were assessed for eligibility, with 13 studies eligible for inclusion in the review (see Fig. 1). Table 1 shows that of 13 eligible studies, eight were cross-sectional studies, 22,40-46 three were cohort studies, [47][48][49] one was a nested case-control study 50 and one was a randomised controlled trial. 51 Three studies were from the USA, 47-49 three were from Italy, 22,45,46 and one study from each of the UK, 41 Kenya, 40 South Africa, 50 Brazil, 51 Greece, 44 China 43 and India. ...
... 51 Three studies were from the USA, 47-49 three were from Italy, 22,45,46 and one study from each of the UK, 41 Kenya, 40 South Africa, 50 Brazil, 51 Greece, 44 China 43 and India. 42 The populations included were ethnically diverse, including Afro-Caribbean, 41 Asian 46 , Caucasian, 22,41,51 Central West African 46 , East European 46 , Han Chinese, 43 Hellenic, 44 Hispanic or Latina, 47,49 Indian subcontinent, 41 Italian, 46 Non-Hispanic African American, 49 Non-Hispanic Black, 47 Non-Hispanic White, 47,49 North African, 46 South American 46 and West European. 46 Four studies recruited participants from gynaecological clinics or inpatient gynaecological wards, 41,44,45,51 two were from community screening programs (cervical screening, employment screening), 22,43 three were from HIV-positive populations, 40,42,50 one was a population cohort, 48 two were community-based cohorts 47,49 and one used archived laboratory data. ...
... 51 Three studies were from the USA, 47-49 three were from Italy, 22,45,46 and one study from each of the UK, 41 Kenya, 40 South Africa, 50 Brazil, 51 Greece, 44 China 43 and India. 42 The populations included were ethnically diverse, including Afro-Caribbean, 41 Asian 46 , Caucasian, 22,41,51 Central West African 46 , East European 46 , Han Chinese, 43 Hellenic, 44 Hispanic or Latina, 47,49 Indian subcontinent, 41 Italian, 46 Non-Hispanic African American, 49 Non-Hispanic Black, 47 Non-Hispanic White, 47,49 North African, 46 South American 46 and West European. 46 Four studies recruited participants from gynaecological clinics or inpatient gynaecological wards, 41,44,45,51 two were from community screening programs (cervical screening, employment screening), 22,43 three were from HIV-positive populations, 40,42,50 one was a population cohort, 48 two were community-based cohorts 47,49 and one used archived laboratory data. ...
Bacterial vaginosis (BV), the most common cause of vaginal discharge in women of reproductive age, is associated with considerable reproductive and gynaecological sequelae and increases the risk of acquiring sexually transmissible infections including HIV. Although we understand the burden of BV in women of reproductive age, much less is known about the burden of BV in postmenopausal women. We undertook this systematic review and meta-analysis to estimate the prevalence of BV in postmenopausal women. The electronic databases PubMed, EMBASE, Web of Science, and The Cochrane Library were searched for English-language papers reporting on the prevalence of BV in postmenopausal women and published up until the end of July 2020. Search terms included: (prevalence OR survey OR proportion) AND 'bacterial vaginosis'. Meta-analysis was used to calculate pooled estimates of prevalence. We identified 2461 unique references and assessed 328 full-text articles for eligibility, with 13 studies included in the meta-analysis. The prevalence of BV ranged from 2.0 to 57.1%, with a summary estimate of 16.93% (95% CI: 8.5-27.4; I2=97.9). There was considerable heterogeneity between studies and quality varied considerably. Further research is needed to provide a better understanding of the condition in postmenopausal women and understand its effect on their lives.
... The present study showed that several oils approved for vaginal use can be used to retain urogenital probiotic strain viability over six months. The use of personal care products either externally or intravaginally is common practice around the world [29][30][31]. These include vaginal washes, lubricants, and wipes ostensibly to relieve itching, dryness, malodour, or burning sensations, as well as to improve their sexual lives. ...
... Of critical importance in using local applications, in addition to safety, is that strains are selected for appropriate properties, and they can survive in the delivery vehicle. Unfortunately, some locally applied products can increase the risk of vaginal dysbiosis and subsequent BV or UTI [4,31,32]. ...
... External use of mineral oil is common (i.e. perianally or on the vulval area) [34,35], and despite it being linked to adverse reactions [29] and Candida colonization [31], it is a mainstay ingredient of medical pomades intended for vaginal use [36]. ...
Vaginal care products are widely used by women to relieve discomfort such as pain, itching and malodour, all of which are commonly caused by conditions resulting from microbiota dysbiosis. Previous studies showed that probiotic strains Lacticaseibacillus (formerly Lactobacillus) rhamnosus GR-1 (LGR-1) and Limosilactobacillus (formerly Lactobacillus) reuteri RC-14 (LRC-14), can aid in restoring homeostasis in the vaginal microbiome when taken orally. A topical product containing these strains could be of value for reducing malodour and improving quality of life. However, the formulation of such a product is a challenge, given that its ingredients must maintain shelf-life viability by excluding moisture. Here, we tested petroleum jelly, mineral oil, coconut oil, and olive oil for how well they maintained the viability of freeze-dried probiotic strains over a six-month time frame. None of the oils caused excessive loss of bacterial viability, with petroleum jelly and coconut oil showing the most promise. Based on existing knowledge of these oils on the female genitalia, coconut oil and petroleum jelly could be suitable probiotic carriers for clinical testing.
... Water-based lubricants are easy to remove and safe for use with latex (for example, with condoms) and with all types of sexual device, but they have the disadvantage of being easily absorbed through the skin and, therefore, their sliding effect is short lived (~5-10 min). Water-based lubricants can be flavoured with the addition of sugar and/or glycerine and chemical flavourings, which can be disadvantageous as sugar and glycerine can cause vaginal infections, in particular bacterial vaginosis and candidiasis 118 . In general, petroleum-based lubricants are not recommended for penetrative sex, because they tend to have an unpleasant odour and can increase the risk of vaginal infection by clogging the pores in the vagina 118 . ...
... Water-based lubricants can be flavoured with the addition of sugar and/or glycerine and chemical flavourings, which can be disadvantageous as sugar and glycerine can cause vaginal infections, in particular bacterial vaginosis and candidiasis 118 . In general, petroleum-based lubricants are not recommended for penetrative sex, because they tend to have an unpleasant odour and can increase the risk of vaginal infection by clogging the pores in the vagina 118 . Furthermore, petroleum-based lubricants have been shown to undermine the strength of latex and make the surface of latex devices and condoms more porous, which increases the risk of breakage if they are used in combination with latex condoms or sexual devices 119 . ...
Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.
... A study conducted in the United States showed that 6.4% of the females involved who engaged in intravaginal practices such as inserting certain libido products had vaginal candidiasis. It was accepted to be one of the common causes of health care problem for women (Brown et al., 2013). ...
... On the other hand, few patients had vaginitis which probably occurs as a result of increase in pH of the vaginal microenvironment that is believed to promote vaginitis (Peters et al., 2014). Brown et al. (2013) explained that intravaginal practices including wiping, cleansing, douching, or the insertion of products, including sexual lubricants, into the vagina may disturb the vaginal protective systems, which are based on hydrogen peroxide and pH. These can cause chemical damage and increase vaginal pH and further predisposes to acquisition of infections. ...
Vulvovaginal candidiasis is primarily caused by Candida albicans, and some of the major predisposing factors that lead to the infection include pregnancy, uncontrolled diabetes mellitus, oral contraceptive usage, tight fitting and synthetic wears, intravaginal practices and long-term broad spectrum antibiotic treatment. The objective of the study was to determine the prevalence of vulvovaginal candidiasis among women attending some Gynaecology clinics in Kano metropolis, Nigeria. Records of 1788 patients that attended two tertiary hospitals in Kano Metropolis from whom high vaginal swabs were collected and cultured onto Sabouraud dextrose agar were studied. Microscopy and culture results of the patients were also studied. Results of the study revealed that the prevalence of C. albicans among the studied women was 20.8%. Women in the age group 26-35 years had the highest prevalence of 43.1% followed by those aged 16-25 years (36.7%). The least prevalence of 1.6% was recorded in those aged <15 years. Pelvic inflammation (40.2%) and white vaginal discharge (20.8%) were the most common clinical manifestations seen in the patients. Amenorrhoea and repeated miscarriage were the least seen clinical manifestations with prevalence of 0.5% each. Vulvovaginal candidiasis is common in Kano metropolis among sexually active women which is mostly clinically manifested with inflammation and vaginal discharge.fudma
... Vaginal lubricants are commonly used in sexual practices and are often utilized by postmenopausal women [1][2][3][4][5][6]. The symptoms of vaginal dryness, dyspareunia, and vulvovaginal pain that accompany the genitourinary syndrome of menopause affects approximately 50% of postmenopausal women, and the first line of treatment is nonhormonal vaginal lubricants [7]. ...
... A vaginal microbiota that has low abundance of Lactobacillus species, clinically defined as bacterial vaginosis, has been consistently associated with increased risk to a number of sexually transmitted infections, including human immunodeficiency virus (HIV) [9,10]. Several epidemiologic studies suggest that lubricants adversely affect the vaginal microbiota and are associated with bacterial vaginosis states [2,4,[11][12][13][14]. Lubricants may directly disturb the vaginal ecosystem because they are markedly hypertonic to mucosal epithelia and contain antimicrobial preservatives, such as chlorhexidine gluconate. ...
Background:
A majority of US women report past use of vaginal lubricants to enhance the ease and comfort of intimate sexual activities. Lubricants are also administered frequently in clinical practice. We sought to investigate if hyperosmolar lubricants are toxic to the vaginal mucosal epithelia.
Methods:
We tested a panel of commercially available lubricants across a range of osmolalities in human monolayer vaginal epithelial cell (VEC) culture and a robust 3-dimensional (3-D) VEC model. The impact of each lubricant on cellular morphology, cytotoxicity, barrier targets, and the induction of inflammatory mediators was examined. Conceptrol, containing nonoxynol-9, was used as a cytotoxicity control.
Results:
We observed a loss of intercellular connections, and condensation of chromatin, with increasing lubricant osmolality. EZ Jelly, K-Y Jelly, Astroglide, and Conceptrol induced cytotoxicity in both models at 24 hours. There was a strong positive correlation (r = 0.7326) between lubricant osmolality and cytotoxicity in monolayer VECs, and cell viability was reduced in VECs exposed to all the lubricants tested for 24 hours, except McKesson. Notably, select lubricants altered cell viability, barrier targets, and inflammatory mediators in 3-D VECs.
Conclusions:
These findings indicate that hyperosmolar lubricants alter VEC morphology and are selectively cytotoxic, inflammatory, and barrier disrupting in the 3-D VEC model.
... VVC represents one of the most frequent infections of the genital tract affecting millions of women each year [2]. Several studies evaluating the prevalence of candidiasis among pregnant women showed that the distribution of isolated Candida species varies between countries, and it is greatly depending on several risk factors such as age, hygienic habits, and disease history [2,6,10,16]. To the best of our knowledge, this is the first study investigating the prevalence of vaginal candidiasis among pregnant women in Lebanon. ...
... The higher percentage of occurrence of VVC attributed to non-albicans Candida species (56.6%) compared to that related to C. albicans species is consistent with data reported in recent studies [25]. Indeed, a remarkable increase in the incidence of isolation rate of non-albicans Candida species has been recently observed in several Asian and African countries, with C. glabrata regarded as the most common associated species with VVC [2,3,16,20,[24][25][26]. These non-albicans Candida species are comparatively nonpathogenic, but eventually they are elected, and begin emerging frequently due to the extensive misuse of over the counter antifungals, the use of singledose oral and topical azoles treatments, and the long-standing protection treatments of oral azoles [25]. ...
Objective:
Candida species colonize the vagina in at least 20% of women, with rates rising to 30% during pregnancy. This study aimed at determining the prevalence and risk factors of vulvovaginal candidiasis (VVC) in pregnant women at 35-37 weeks of gestation. It also aims at finding possible correlations between VVC and vaginal colonization by other agents, such as Group B Streptococcus (GBS) and bacterial vaginosis.
Methodology:
Over a one-year period, high vaginal swabs were collected from pregnant women during their regular antenatal checkup in different polyclinics in Beirut and South Lebanon. Swabs were examined microscopically, cultured on Sabouraud Dextrose Agar, and Candida isolates were identified using Chromatic Candida medium and Germ Tube Test.
Results:
VVC was detected in 44.8% of samples, with C. glabrata (44.4%) and C. albicans (43.4%) being the most isolated species. Approximately, half of pregnant women (57.7%) were coinfected with Candida and bacterial vaginosis, while 26% of them carried simultaneously Candida spp. and GBS. No significant correlation was found between the occurrence of VVC and demographic, clinical, medical, and reproductive health characteristics of pregnant women. In contrast, participants with previous miscarriages and those being hospitalized during the past 12 months were more susceptible to develop vaginal C. krusei infection in comparison to other Candida species (p=0.0316 and p=0.0042, respectively).
Conclusion:
The prevalence of VVC in pregnant women is an increasing trend in our community. Therefore, routine medical examination and regular screening for candidiasis in the antenatal care program is highly recommended to manage the disease and its complications.
... Mucosal irritation has been shown to increase with increasing hyperosmolality of several commercially available vaginal lubricants using the slug mucosal irritation assay [4] and perhaps most importantly, to significantly increase vaginal transmission of genital herpes infections in the mouse/HSV model [5]. Lastly, use of some vaginal lubricants is associated with increased incidence of bacterial vaginosis (BV) [6][7][8][9][10]. BV is strongly associated with increased risk of HIV-1 [11] as well as gonorrhea, trichomonas is, upper-tract infections that contribute to preterm deliveries and perinatal complications, pelvic inflammatory disease, and other gynecological and urinary tract infections (see [12]). ...
... Sexual lubricants have been associated in several studies with increased risk of episodes of BV [6][7][8][9][10] and most sexual lubricants are hyperosmolal with respect to the osmolality of healthy vaginal fluids (370 mOsm/Kg as reported here). Hyperosmolal vaginal lubricants disrupted the barrier functions of the basal and parabasal layers and shedding of the apical layers. ...
Most of the widely used vaginal lubricants in the U.S. and Europe are strongly hyperosmolal, formulated with high concentrations of glycerol, propylene glycol, polyquaternary compounds or other ingredients that make these lubricants 4 to 30 times the osmolality of healthy vaginal fluid. Hyperosmolal formulations have been shown to cause marked toxicity to human colorectal epithelia in vivo, and significantly increase vaginal transmission of genital herpes infections in the mouse/HSV model. They also cause toxicity to explants of vaginal epithelia, to cultured vaginal epithelial cells, and increase susceptibility to HIV in target cells in cell cultures. Here, we report that the osmolality of healthy vaginal fluid is 370 ± 40 mOsm/Kg in women with Nugent scores 0–3, and that a well-characterized three-dimensional human vaginal epithelium tissue model demonstrated that vaginal lubricants with osmolality greater than 4 times that of vaginal fluid (>1500 mOsm/Kg) markedly reduce epithelial barrier properties and showed damage in tissue structure. Four out of four such lubricants caused disruption in the parabasal and basal layers of cells as observed by histological analysis and reduced barrier integrity as measured by trans-epithelial electrical resistance (TEER). No epithelial damage to these layers was observed for hypo- and iso-osmolal lubricants with osmolality of <400 mOsm/Kg. The results confirm extensive reports of safety concerns of hyperosmolal lubricants and suggest the usefulness of reconstructed in vitro vaginal tissue models for assessing safety of lubricants in the absence of direct clinical tests in humans.
... In addition, distal FRT inflammation was increased in women who used vaginal douches and had BV when compared to those who did not use vaginal douches and/or did not have BV, regardless of demographic, risk factors and HIV status.In the US, the use of commercially available vaginal douches for vaginal cleansing has previously been identified as one of the main risk factors for developing BV, and BV has been associated HIV acquisition. 14,36,37 In addition to HIV, BV has also been associated with STI acquisition, HIV transmission to sexual partners and newborns, preterm delivery, and spontaneous abortions.38 Therefore, both vaginal cleansing and BV are important contributors to poor women's health outcomes and risk of STI and HIV acquisition. ...
... In addition, women who are not at risk for HIV should be included in future studies as controls.Public health efforts should be undertaken to inform women of the potential damaging effects of douching on the vaginal mucosal surface, and the risks associated with vaginal douches as well as other intravaginal cleansing practices, including the risk of HIV acquisition. Both BV and vaginal douching are difficult to influence; BV is often asymptomatic and screening for asymptomatic BV has not shown to be beneficial in the general population, and douching is a common behavior among women.15,36 This study provides further evidence to support continued research evaluating interventions to decrease the use of vaginal douches and BV in both HIV infected and uninfected women, as such interventions could be of relevance in women's health programs, especially in those that focus on STI and HIV prevention.Page 12 of 27 AIDS Research and Human Retroviruses matory cytokines in the reproductive tract of women with BV and engaging in intravaginal douching. ...
High levels of inflammatory cytokines in the genital tract suggest mucosal vulnerability and increased risk of HIV and STI acquisition. Intravaginal douching is associated with bacterial vaginosis (BV) in women in the US, and both douching and BV are linked to HIV and STI acquisition. This study evaluates inflammatory cytokines in the genital tract to increase understanding of the effects of both BV and intravaginal douching to the vaginal mucosa. A cross-sectional study of participants in the Miami WIHS investigated 72 reproductive age women (45 HIV+ and 27 high-risk HIV-) who completed intravaginal douching questionnaires and underwent collection of vaginal swabs and cervicovaginal lavages (CVL). BV was assessed using the Nugent score. Inflammatory cytokines in the CVL (IL-6, IL-8, IL1α, IL1β, sICAM-1, IFNα2, CCL5, VEGF, MCP1 TNFα, and SLPI) were measured. Fourteen (19%) women reported intravaginal douching; 24 (33%) had BV. BV, intravaginal douching, and HIV were associated with higher levels of inflammatory cytokines. After controlling for demographic, risk factors and HIV status, women who had BV and douched had higher levels of inflammatory cytokines than those without BV and who did not douche, or who only had BV or only douched. These findings suggest that BV and douching is associated with greater mucosal inflammation and may facilitate HIV acquisition and transmission. Although longitudinal studies are needed to determine temporal associations and causality, interventions to decrease rates of intravaginal douching and BV could significantly decrease women's risks of acquiring STIs and HIV and limit the spread of HIV.
... Although sexual intercourse appears to be a risk factor, there is no evidence that BV is an STI. Women using petroleum jelly as a lubricant have more BV [9]. BV early in pregnancy is a vital risk factor for preterm birth and spontaneous abortion [10]. ...
In a healthy pregnancy, the best response to sexual insecurity is reassurance and telling the couple that they can continue to be sexually active. When the situation gets complicated, things can be different. This chapter elaborates on the sexual risks in conditions such as premature birth, shortened cervix, placental dysfunction, and multiple gestation. It will delineate the relationship between various sexual activities and their potential influence on the uterus and the pregnancy. The chapter will also address how to communicate when specific sexual acts should be discouraged (or forbidden) and simultaneously give room for other sexual acts, in other words: the sexual do’s and don’ts. Midwives and HCPs must be aware of the cultural taboos between the woman and the couple regarding sexuality and pregnancy. It is a common finding in research that patients have many questions about sex but do not ask them. The consequence is that the professional must anticipate when providing information, as it were, by ‘answering the not-asked questions’. This chapter provides the background information needed to do just that in high-risk and complicated pregnancies.
This chapter is part of ‘Midwifery and Sexuality’, a Springer Nature open-access textbook for midwives and related healthcare professionals.
... En relación al uso de los aceites (aceite de oliva, aceite de coco y aceite mineral) o de vaselina, utilizados como lubricantes, existen datos limitados sobre su seguridad; además es conocido el negativo efecto sobre la motilidad de los espermatozoides, la integridad del condón y un mayor riesgo de colonización de especies de Candida y vaginosis bacteriana [44,45]. ...
El síndrome genitourinario de la menopausia (SGUM) describe los síntomas y signos vulvo-vaginales y del tracto urinario inferior, de carácter crónico y progresivo, secundario a un estado clínico de hipoestrogenismo que caracteriza a la postmenopausia. La presente revisión tiene como objetivo describir y analizar las diferentes alternativas terapéuticas no hormonales, con sus ventajas y desventajas, a fin de ofrecerle a los lectores una completa variedad de opciones a la hora de establecer el tratamiento en una mujer con SGUM. Se ha realizado una búsqueda en bases de datos, incluyendo investigaciones originales, consensos de expertos, revisiones sistemáticas y metaanálisis. Se ha revisado la evidencia actual para diversas modalidades terapéuticas farmacológicas y no farmacológicas (no hormonales), encontrando que los hidratantes y los lubricantes son la primera línea terapéutica para proporcionar alivio, a corto plazo, de la sequedad vaginal (leve a moderada) y la dispareunia; sin embargo, el tratamiento ha de ser individualizado. Existen numerosos tratamientos disponibles, cada uno con beneficios y limitaciones y se destacan las sustanciales lagunas, en la evidencia científica, de terapias seguras y efectivas, así como la necesidad de realizar investigaciones futuras.
... Применение данных препаратов не решает основную проблему, а лишь на время облегчает неприятные симптомы. Было показано, что вагинальные лубриканты не уменьшают симптомы инфекций мочевыделительной системы, а также могут отрицательно влиять на вагинальный эпителий и микробиоту влагалища, провоцируя развитие КВВ и БВ [57]. ...
Physiological loss of ovarian function during the menopausal transition often leads to the development of unfavorable symptoms associated with vulvovaginal atrophy, recurrent urinary tract infections and dyspareunia. Currently, the scientific community is actively discussing the risks and benefits of prescribing menopausal hormone therapy to relieve the consequences of estrogen deficiency. The study of vaginal microbiota in dynamics made it possible to take a deeper look at the development of genitourinary menopausal syndrome and associate several microorganisms with specific undesirable manifestations. The link between recurrent urinary tract infections during menopause and physiological replacement of microbiota by opportunistic flora with the development of unpleasant symptoms resolves doctors to resort to irrational courses of antibiotic therapy. The review is devoted to the generalization of information on microbiological changes in the vagina during perimenopause, the possibilities of choosing the optimal hormone therapy for the correction of symptoms, the use of new promising methods, including management by modulating the vaginal microbiota.
... BV has been also associated with intravaginal practices (IVP) and the use of products that alter the vaginal compartment (7,8). IVP refer to a variety of behaviors to maintain a vagina that women perceive as hygienic, healthy, or pleasing to sexual partners (9). ...
Bacterial vaginosis (BV) is the most common genital infection in women and is associated with an increased risk of sexually transmitted infections and HIV. This study uses a syndemic approach to evaluate factors associated with BV. Non-pregnant, HIV-negative, sexually active, cis-gender women aged 18-45 years living in Miami, Florida were recruited from Nov.2018- Jun.2021. Participants completed a sociodemographic and behavioral questionnaire along with gynecological examinations. BV was diagnosed by Amsel criteria and confirmed by a Nugent score ≥ 4. A syndemic score was calculated as the sum of factors associated with BV. The association between syndemic score and BV was assessed using logistic regression. Of 166 women included, 60.2% had BV. Race, ethnicity, education, vaginal sex, recent cannabis use, and reasons for intravaginal practices were included in the syndemic score. Higher odds of BV were found in women with a score of ≥ 3 compared to women with a score of 0/1. A higher syndemic score was associated with increased odds of having BV. Multilevel interventions to decrease BV are needed to decrease women's risk of acquiring HIV.
... Maximal benefits were noted after 12 wk. of intervention. However, the quality of this study was very poor, with only 25 breast cancer patients recruited [137]. There is concern regarding the use of natural oils (e.g., olive and coconut) for lubrication because these products are associated with vaginal infections [138]. ...
There is increasing attention about managing the adverse effects of adjuvant therapy (Chemotherapy and anti-estrogen treatment) for breast cancer survivors (BCSs). Vulvovaginal atrophy (VVA), caused by decreased levels of circulating estrogen to urogenital receptors, is commonly experienced by this patients. Women receiving antiestrogen therapy, specifically aromatase inhibitors, often suffer from vaginal dryness, itching, irritation, dyspareunia, and dysuria, collectively known as genitourinary syndrome of menopause (GSM), that it can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of quality of life (QoL). The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly. The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Systemic estrogen treatment is contraindicated in BCSs. In these patients, GSM may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment, but it is normally undertreated by oncologists because of fear of cancer recurrence, specifically when considering treatment with vaginal estrogen therapy (VET) because of unknown levels of systemic absorption of estradiol. Lifestyle modifications and nonhormonal treatments (vaginal moisturizers, lubricants, and gels) are the first-line treatment for GSM both in healthy women as BCSs, but when these are not effective for symptom relief, other options can be considered, such as VET, ospemifene, local androgens, intravaginal dehydroepiandrosterone (prasterone), or laser therapy (erbium or CO2 Laser). The present data suggest that these therapies are effective for VVA in BCSs; however, safety remains controversial and a there is a major concern with all of these treatments. We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. We include recommendations for an approach to the management of GSM in women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.
... 1,9,[11][12][13] While many studies have evaluated associations between vaginal microbiome composition and reproductive health outcomes, very few have examined factors that influence or are associated with the composition of the vaginal microbiome. For example, with the exception of research demonstrating that women who use products marketed for ''vaginal hygiene'' (e.g., douches, sexual lubricants, and antiseptic agents) are more likely to experience alterations in vaginal fluids resulting in increased vaginal pH, decreased levels of Lactobacillus spp., and overgrowth of pathogenic microbes, 14,15 very few other factors contributing to low levels of protective Lactobacillus predominance have been identified. ...
Background: Vaginal Lactobacillus is considered protective of some adverse reproductive health outcomes, including preterm birth. However, factors that increase or decrease the likelihood of harboring Lactobacillus in the vaginal microbiome remain largely unknown. In this study, we sought to identify risk and protective factors associated with vaginal Lactobacillus predominance within a cohort of pregnant African American women. Materials and Methods: Vaginal microbiome samples were self-collected by African American women (N = 436) during their 8-14th week of pregnancy. Sociodemographic information and measures of health behaviors, including substance use, antibiotic exposure, sexual practices, frequency of vaginal intercourse, and the use of vaginal products, were collected through participant self-report. The V3-V4 region of the 16S rRNA gene was targeted for amplification and sequencing using Illumina HiSeq, with bacterial taxonomy assigned using the PECAN classifier. Univariate and a series of multivariate logistic regression models identified factors predictive of diverse vaginal microbiota or Lactobacillus predominance. Results: Participants who used marijuana in the past 30 days (aOR 1.80, 95% CI 1.08-2.98) were more likely to have diverse non-Lactobacillus-predominant vaginal microbiota, as were women not living with their partners (aOR 1.90, 95% CI 1.20-3.01). Cohabitating or marijuana usage were not associated with type of Lactobacillus (non-iners Lactobacillus vs. Lactobacillus iners) predominance (aOR 1.11, 95% CI 0.52-2.38 and aOR 0.56, 95% CI 0.21-1.47, respectively). Conclusions: Living with a partner is conducive to vaginal Lactobacillus predominance. As such, cohabitation may be in important covariate to consider in vaginal microbiome studies.
... The explanation may be that intravaginal douches may trigger vaginal tissue damage and disrupt the vaginal microecosystem, leading to a decrease in vaginal homeostasis, encouraging yeast growth and thus triggering VVC. In contrast to this, one study detected that the association between intravaginal practices and VVC was not statistically significant (32). ...
Vulvovagal candidiasis is a common fungal infection that affects the female genital system. Resistance to antifungals is an emergent problem worldwide.
We aimed to detect the prevalence of different Candida species associated with Vulvovagal candidiasis, determine their antifungal susceptibility pattern, and evaluate the molecular mechanisms associated with fluconazole resistance.
Methodology: This study included 300 patients. Candida species were identified phenotypically. Antifungal susceptibility was tested by disc diffusion method. The molecular mechanisms of fluconazole-resistance were determined by analyzing the expression levels of fluconazole target, efflux pump and efflux pump-regulator genes by RT-PCR.
Results: Candida spp were detected in 75/300 (25%) of cases. C. albicans was the most frequently isolated species (61.8%), while the predominant non-albicans species was C. glabrata (28.9%). Nystatin was the most effective agent. Fluconazole-resistance was observed markedly in C. glabrata (54.5%), and efflux-pump was the predominant mechanism of resistance which was associated with overexpressed CgPDR1, CgCDR1 and CgSNQ2 genes. Upregulation of the efflux-pump genes and their regulator were associated with cross-resistance to different azoles.
Conclusion: C. glabrata is a common cause of non-albicans vulvovaginal candidiasis. The majority of clinical resistance in C. glabrata is attributed to the upregulati
... The authors found lubricant use in the last 24 hours to be associated with BV (25) . However, a larger cohort study by Brown et al. (n=141) did not find an association between commercial lubricant or oil use and BV (26) . This study did find, however, an increased risk of BV among petroleum jelly users compared to non-users. ...
... ► Endometrial infection with either Atopobium vaginae, BVAB1, Sneathia amnionii and/or Sneathia sanguinegens was found to partially mediate the association between vaginal douching and endometritis. jelly, for hygiene and lubrication, and these insertions practices also increase the risk of BV. 16 The rate of vaginal douching in the USA is estimated at 32.2% in women aged 15-44 years, and is highest among African-American women, followed by Hispanic women, with Caucasian women reporting the lowest rates. 17 A randomised, controlled trial in the southeastern USA showed that behavioural interventions, individualised counselling sessions, reduced the practice of vaginal douching by almost 50% among young women who had no intention to change their behaviour at baseline. ...
Objectives
We sought to determine whether the relationship between a history of vaginal douching and pelvic inflammatory disease (PID) is mediated by endometrial infection with one or more novel bacterial vaginosis (BV)-associated organisms among Atopobium vaginae , the BV-associated bacterium 1 (BVAB1), neathia ( Leptotrichia ) amnionii and Sneathia sanguinegens .
Methods
We first conducted log-binomial regression analyses to identify risk factors for endometrial infection in 535 adolescent and adult women with clinically suspected PID in the PID Evaluation and Clinical Health (PEACH) study. We then examined whether endometrial infection by the BV-associated organisms mediated the association between a history of vaginal douching and histologically confirmed PID using inverse probability weighted marginal structural models.
Results
Vaginal douching was significantly associated with endometrial infection with one or more of the targeted BV-associated organisms (relative risk (RR) 1.21, 95% CI: 1.08 to 1.35). The total effect estimate suggested that vaginal douching increased the risk of endometritis by 24% (RR 1.24, 95% CI: 1.03 to 1.49). The controlled direct effect of this association was attenuated with endometrial infection by one or more BV-associated organisms (adjusted RR (aRR) 1.00, 95% CI: 0.57 to 1.74) and endometrial infection by all four BV-associated organisms (aRR 0.95, 95% CI: 0.53 to 1.70) as intermediate variables.
Conclusions
Endometrial infection with one or more of the novel BV-associated organisms partially mediated the relationship between vaginal douching and histologically confirmed endometritis in the PEACH study. Frequent vaginal douching may confer risk for endometritis through increasing the risk of endometrial infection by novel-BV-associated organisms. Other potential pathways should be explored.
... They provide relief of short-term symptomatology. There is evidence in the literature that oil-based lubricants may increase the risk of candidiasis and bacterial vulvovaginitis [32][33][34]. Vaginal moisturizers have a more lasting effect in relieving symptoms by improving the hydration of the vaginal mucosa and by decreasing its pH. They are administered regularly: daily or every 2-3 days, depending on the severity of the symptoms. ...
... Current hypotheses of pathogenesis of BV include racial and societal differences, intravaginal practices, sexually transmitted infections and human immunodeficiency virus [46][47][48][49]. The major aim of this study was to examine variations in vaginal microbiome among women with suspected BV. ...
Background
One of the most common and recurrent vaginal infections is bacterial vaginosis (BV). The diagnosis is based on changes to the “normal” vaginal microbiome; however, the normal microbiome appears to differ according to reproductive status and ethnicity, and even among individuals within these groups. The Amsel criteria and Nugent score test are widely used for diagnosing BV; however, these tests are based on different criteria, and so may indicate distinct changes in the vaginal microbial community. Nevertheless, few studies have compared the results of these test against metagenomics analysis.
Methods
Vaginal flora samples from 77 participants were classified according to the Amsel criteria and Nugent score test. The microbiota composition was analyzed using 16S ribosome RNA gene amplicon sequencing. Bioinformatics analysis and multivariate statistical analysis were used to evaluate the microbial diversity and function.
Results
Only 3 % of the participants diagnosed BV negative using the Amsel criteria (A−) were BV-positive according to the Nugent score test (N+), while over half of the BV-positive patients using the Amsel criteria (A+) were BV-negative according to the Nugent score test (N−). Thirteen genera showed significant differences in distribution among BV status defined by BV tests (e.g., A − N−, A + N− and A + N+). Variations in the four most abundant taxa, Lactobacillus, Gardnerella, Prevotella, and Escherichia, were responsible for most of this dissimilarity. Furthermore, vaginal microbial diversity differed significantly among the three groups classified by the Nugent score test (N−, N+, and intermediate flora), but not between the Amsel criteria groups. Numerous predictive microbial functions, such as bacterial chemotaxis and bacterial invasion of epithelial cells, differed significantly among multiple BV test, but not between the A− and A+ groups.
Conclusions
Metagenomics analysis can greatly expand our current understanding of vaginal microbial diversity in health and disease. Metagenomics profiling may also provide more reliable diagnostic criteria for BV testing.
Electronic supplementary material
The online version of this article (10.1186/s12864-018-5284-7) contains supplementary material, which is available to authorized users.
... В настоящее время у пациенток с бактериальным вульвовагинитом встречаются 4-5 основных бактериальных профилей болезни [10], при этом грамотрицательные Prevotella или грамположительные Atopobium требуют разного выбора препаратов, но, учитывая, что новые классы антибиотиков отсутствуют в последнее время, а влагалищные формы лекарственных препаратов совершенствуются и увеличивают свою биодоступность, выбор смещается в сторону местного лечения. В случае восстановления вагинального микробиома доказательная база для метронидазола и миконазола уже не требует подтверждения [11], однако о введении в лекарственный препарат анестетика (лидокаин 100 мг) вызывает споры между сторонниками глюкокортикостероидных препаратов, при этом их супрессивное воздействие на местный иммунитет никто не оспаривает [12]. Данная группа препаратов хорошо купирует острые и хронические симптомы, но быстро приводит к рецидивированию болезни, в этой связи они могут считаться оптимальны для лечения вульвовагинитов аллергического, аутоиммунного генеза, а также при дистрофии вульвы в виде плоскоклеточной гиперплазии. ...
This paper outlines the issues of rational pharmacotherapy for women with various vulvovaginal etiology. Taking into consideration the pathogenesis of major diseases of the vagina, the concept of therapy based on combined drugs. Implementation of safe dosage forms of metronidazole, mikоnazole and lidocaine (Neo-Penotran® Forte L) allowed to quickly relieve symptoms of acute discomfort sensations in patients with symptomatic vulvоvaginitov, relieving pain, usually manifested in the form of burning, itching, edema, hyperemia of the vestibule and perineal tissues, allowed to achieve maximal compliance during treatment and achieve not only clinically but also pathogenic effect.The combination of metronidazole and mikоnazole showed a dose-dependance efficiency that depends on the type and form of the disease pathogens vagina, as this combination of drugs had a positive impact on the recurrent form of the disease.
... There is also evidence of an increased risk of developing bacterial vaginosis and vaginal candidiasis with the use of these medications. [20][21][22] Vaginal moisturizers have a long-lasting effect in relieving the symptoms of VVA, enhancing moisturizing of the vaginal mucosa, and reducing the pH. These drugs are prescribed on a regular basis: daily or every 2-3 days, depending on the extent of the symptoms. ...
Vulvovaginal atrophy (VVA) is a silent epidemic that affects up to 50%–60% of postmenopausal women who are suffering in silence from this condition. Hormonal changes, especially hypoestrogenism inherent in menopause, are characterized by a variety of symptoms. More than half of menopausal women are concerned about the symptoms of VVA, such as dryness, burning, itching, vaginal discomfort, pain and burning when urinating, dyspareunia, and spotting during intercourse. All these manifestations significantly reduce the quality of life and cause discomfort in the sexual sphere. However, according to research, only 25% of patients with the symptoms of VVA receive adequate therapy. This is probably due to the lack of coverage of this problem in the society and the insufficiently active position of specialists in the field of women’s health regarding the detection of symptoms of VVA. Many patients are embarrassed to discuss intimate complaints with a specialist, which makes it difficult to verify the diagnosis in 75% of cases, and some patients regard the symptoms of VVA as manifestations of the natural aging process and do not seek help. Modern medicine has in the arsenal various options for treating this pathological condition, including systemic and topical hormone replacement therapy, the use of selective estrogen receptor modulators, vaginal dehydroepiandrosterone, use of lubricants and moisturizers, as well as non-drug therapies. Timely diagnosis and adequately selected therapy for the main symptoms of VVA lead to restoration and maintenance of the vaginal function and vaginal health.
... Moreover, intravaginal douching may disturb the balance of vaginal microecosystem, lead to the decline of vaginal homeostasis, encourage the growth of yeasts, and further cause VVC. In contrast to this, one study hold that the association between intravaginal practices and VVC was not definite [23]. At the same time, this study showed that frequency of cleaning the vulva exerted no effect on the occurrence of VVC, while cleaning the vulva before or after sexual life was an advantageous factor for preventing against VVC. ...
Purpose. To explore risk factors of vulvovaginal candidiasis (VVC) among women of reproductive age in Xi’an district and then to offer reference for clinical prevention and treatment of VVC. Methods. Patients from the outpatient department of gynecology and obstetrics in the First Affiliated Hospital of Xi’an Jiaotong University from June 2016 to May 2017 were recruited strictly according to the inclusion and exclusion criteria. Participants diagnosed as simple VVC were assigned to the case group, while women who underwent routine gynecological examination and had normal vaginal microflora were assigned to the control group. Then we conducted a questionnaire survey of the two groups and used the logistic regression model to explore the related risk factors of VVC. Results. In the present study, ninety-seven cases were sample VVC patients and eighty-seven cases were healthy women. This cross-sectional study showed that occasionally or never drinking sweet drinks (odds ratio [OR] =0.161, 95% confidence interval [CI] =0.056-0.462, P=0.001), occasionally or never eating sweet foods (OR=0.158, 95%CI=0.054-0.460, P=0.001), and the use of condom (OR=0.265, 95%CI=0.243-0.526, P=0.001) were regarded as protective factors for VVC. In addition, sedentary life style (OR=7.876, 95%CI=1.818-34.109, P=0.006), frequently wearing tights (OR=6.613, 95%CI=1.369-27.751, P=0.018), frequent intravaginal douching (OR=3.493, 95%CI=1.379-8.847, P=0.008), having the first sexual encounter when under 20 years old (OR=2.364, 95%CI=1.181-7.758, P=0.006), the number of sexual partners being over two (OR=3.222, 95%CI=1.042-9.960, P=0.042), history of curettage (OR=3.471, 95%CI=1.317-9.148, P=0.012), history of vaginitis (OR=8.999, 95%CI=2.816-28.760, P
... 6 There are limited data on the safety of oils (eg, olive oil, coconut oil, and mineral oil) and petrolatum used as lubricants, although there are concerns about effects on sperm motility, condom integrity, and increased risk for Candida species colonization and bacterial vaginosis with the use of these products. [7][8][9] Vaginal moisturizers are used on a regular basis to maintain vaginal moisture (daily or every 2-3 days as needed on the basis of symptom severity). They provide longer-term relief by increasing mucosal moisture and reducing pH. ...
Genitourinary syndrome of menopause (GSM), previously known as atrophic vaginitis or vulvovaginal atrophy, affects more than half of postmenopausal women. Caused by low estrogen levels after menopause, it results in bothersome symptoms, including vaginal dryness, itching, dyspareunia, urinary urgency and increased frequency, and urinary tract infections. Even though women with GSM can have sexual dysfunction that interferes with partner relationships, women are often embarrassed to seek treatment, and health care professionals do not always actively screen for GSM. As a result, GSM remains underdiagnosed and undertreated. Several effective treatments exist, but low-dose vaginal estrogen therapy is the criterion standard. It is effective and safe for most patients, but caution is suggested for survivors of hormone-sensitive cancers. Newer treatment options include selective estrogen receptor modulators, vaginal dehydroepiandrosterone, and laser therapy. Nonprescription treatments include vaginal lubricants, moisturizers, and dilators. Pelvic floor physical therapy may be indicated for some women with concomitant pelvic floor muscle dysfunction. Sex therapy may be helpful for women with sexual dysfunction. This concise review presents a practical approach to the evaluation and management of GSM for the primary care physician.
... The moisture drawn into the rectum or vagina via osmosis leaves the epithelial and underlying stromal tissue drier and susceptible to microscopic lacerations which may cause irritation and enhance infection by microorganisms. Additionally, glycerin in the vagina can lead to increased occurrences of yeast infections and possible bacterial vaginosis [53]. Gelatin or hydrogel-based suppositories have minimal effects on tissue osmolality so they do not draw additional fluid from the underlying mucous membrane [54]. ...
Despite a long history of use for rectal and vaginal drug delivery, the current worldwide market for suppositories is limited primarily due to a lack of user acceptability. Therefore, virtually no rational pharmaceutical development of antiviral suppositories has been performed. However, suppositories offer several advantages over other antiviral dosage forms. Current suppository designs have integrated active pharmaceutical ingredients into existing formulation designs without optimization. As such, emerging suppository development has been focused on improving upon the existing classical design to enhance drug delivery and is poised to open suppository drug delivery to a broader range of drugs, including antiretroviral products. Thus, with continuing research into rational suppository design and development, there is significant potential for antiretroviral suppository drug delivery.
... The few reported studies were observational in design, relied on personal recall, and varied on the timing of lubricant use. For example, one study queried participants on their lubricant use 1 day prior to specimen collection, while others reported on lubricant use at any time in the preceding month, or 3 months, or year (Brotman et al., 2010;Brown et al., 2013;Marrazzo et al., 2010;Mitchell, Manhart, Thomas, Agnew, & Marrazzo, 2011). Not surprisingly, the study that examined lubricant use closer to specimen collection showed a significant relationship between lubricant use and BV (Brotman et al., 2010;Marrazzo et al., 2010). ...
The profound impact of the human microbiome on health makes it imperative that nurses understand the basic structures and functions of the various microbial communities. In studying the human microbiome, advances in DNA and RNA sequencing technology offer benefits over traditional culturebased methods. Such technology has permitted more thorough investigations of microbial communities, particularly those of the gastrointestinal (GI) and female reproductive tracts. Although individual variations exist, each site exhibits distinct compositions. The diverse GI microbiota aid in digestion, mood regulation, and vitamin synthesis. While many factors affect the composition and functions of the GI microbiota, diet likely exerts the strongest influence. Vaginal microbiota tend to be less diverse, and mainly serve to protect women from infection. The composition of the vaginal microbiota is influenced by sexual activity, hygienic practices, medications, smoking, and other factors. Our increasing knowledge about the structures and functions of the GI and vaginal microbiota allows nurses to provide targeted, evidence-based education and care for various populations.
... Another feasibility study combined a polycarbophil-based vaginal moisturizer, olive oil as a lubricant during sex, and pelvic floor muscle training [39]. Although pain improved, women using oil-or petroleumjelly-based vaginal lubricants have far higher rates of colonization with Candida and bacterial vaginosis than those using water-or silicone-based lubricants [40]. ...
PurposeA randomized pilot trial evaluated the hypothesis that early intervention lessens sexual dysfunction in the first year on aromatase inhibitors. A secondary aim was comparing the efficacy of two vaginal moisturizers. Methods
Fifty-seven postmenopausal women with early stage breast cancer starting aromatase inhibitors were randomized to three treatment groups. All received a handout on managing sexual and other side effects. The Usual Care group received no additional therapy. The Active Treatment groups received a 6-month supply of a vaginal moisturizer (hyaluronic acid-based in Active Group-H and prebiotic in Active Group-P) and a vaginal lubricant and dilator, plus access to an educational website and phone coaching. Questionnaires completed at baseline, 6, and 12 months included the Female Sexual Function Index (FSFI), Menopausal Sexual Interest Questionnaire (MSIQ), Female Sexual Distress Scale-Revised (FSDS-R), and a menopausal symptom scale. ResultsForty-nine women (86%) provided follow-up data. Mean age was 59 and 77% were non-Hispanic Caucasian. Sexual function was impaired at baseline, but remained stable over 12 months for all groups. The combined active treatment group had less dyspareunia (P = 0.07) and sexual distress (P = 0.02) at 6 months than the Usual Care group. At 6 months, the Active-H group improved significantly more than the Active-P group on FSFI total score (P = 0.04). Conclusions
Sexual counseling helped women maintain stable sexual function on aromatase inhibitors. Active intervention resulted in better outcomes at 6 months. Implications for Cancer SurvivorsThis promising pilot trial suggests a need for more research on preventive counseling to maintain sexual function during aromatase inhibitor treatment.
... The few reported studies were observational in design, relied on personal recall, and varied on the timing of lubricant use. For example, one study queried participants on their lubricant use 1 day prior to specimen collection, while others reported on lubricant use at any time in the preceding month, or 3 months, or year (Brotman et al., 2010;Brown et al., 2013;Marrazzo et al., 2010;Mitchell, Manhart, Thomas, Agnew, & Marrazzo, 2011). Not surprisingly, the study that examined lubricant use closer to specimen collection showed a significant relationship between lubricant use and BV (Brotman et al., 2010;Marrazzo et al., 2010). ...
The human microbiome profoundly influences health promotion and disease prevention. Improved DNA and RNA sequencing technologies have enhanced our knowledge on the composition of the various microbial communities that constitute the microbiome. The structure and stability of the vaginal microbiota is of particular importance during pregnancy and labor because maternal microbes form the basis of the neonate’s own microbiome during the birth process. Vaginal dysbiosis, or perterbations in vaginal microbial composition, that occurs during labor can lead to suboptimal neonatal colonization and may be linked to adverse health outcomes for infants and children, including asthma and obesity. Vaginal dysbiosis is linked with many factors, including the use of personal lubricants. Studies using cell and animal models show that lubricants can alter microbial composition as well as damage the integrity of vaginal epithelial cells. These findings are concerning because similar lubricants are frequently used during labor. However, the effect of lubricant use on vaginal microbiota in the health-care setting has not been studied. This article presents current evidence on vaginal microbiota during pregnancy with a focus on the influence of a common practice, lubricant use during labor. Areas for future research are presented, as well as practice and policy implications for perinatal health-care providers.
Importance and objectives:
Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women.
Methods:
This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia.
Findings:
Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists.
Conclusions:
Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.
Free available OA book on sexuality within midwifery.
In this study, we aimed to determine the effects of the PRECEDE-PROCEED model-based educational program on women's genital hygiene behaviors. A randomized controlled trial was conducted with 120 women diagnosed with genital infections and assigned to the experimental (n = 60) and control (n = 60) groups. Educational intervention was designed based on the PRECEDE-PROCEED model and implemented in the experimental group. Data were collected three times before (pretest), right after (posttest) and 1 month after the intervention using the personal information form, Data Form for Knowledge, Attitudes, and Beliefs about Genital Hygiene and Genital Hygiene Behaviors Inventory (GHBI). After the educational intervention, the participants' hygiene-related knowledge, attitudes and behaviors improved in the experimental group at the posttest and follow-up test from the baseline. A statistically significant difference was found between the groups. We concluded that PRECEDE-PROCEED model-based educational program positively affected the women's genital hygiene-related knowledge, attitudes, and behaviors.
Petroleum waxes are by‐products of the petroleum industry in that the wax must be removed from the oil to produce lubricants with proper low‐temperature characteristics. Slack wax is a refinery term for crude wax or paraffin that is separated from base stocks during solvent dewaxing. Petroleum waxes consist of relatively simple mixtures of aliphatic hydrocarbons. During the intensive study of the components of wood tar, the German scientist Carl Reichenbach discovered paraffin in 1830, for which he was knighted years later. The production and processing of crude oil unavoidably involve the production of petroleum and paraffin slack waxes. In the petroleum or oil and gas industry, waxes are a byproduct that, as repeatedly said, are removed from oils at different refinement stages. As physically decolorized slack waxes, scale waxes are essentially composed of the same substances as the raw materials from which they are obtained.
Background and objectives: Vulvovaginal candidiasis is known to be a global issue of concern due to its association with economic costs, sexually transmitted diseases, and the escalation of genital tract infections. This study aimed to determine the prevalence, species distribution and risk factors associated with Candida species causing vulvovaginal candidiasis.
Subjects and Methods: Non-pregnant women attending routine antenatal visits at Al-Olaifi-Family Center in Sana'a were enrolled in a cross-sectional study conducted from June 2018 to March 2019. Laboratory work was carried out at the National Center of Public Laboratories (NCPHL). Vaginal swabs were sampled from participants after oral consent was obtained. The swabs were inoculated in Sabouraud glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48 h under aerobic conditions in order to perform a fungal culture. Candida species were determined by culturing on HiCrome Candida differential Agar at 35°C for 48 h to produce species-specific colours. Data on demographic, clinical, and risk factors were collected in a pre-designed questionnaire.
Results: A total of 190 non-pregnant women were included. The prevalence of VVC was 22.1%. Candida albicans accounted for 16.3% and non-Candida albicans accounted for 5.8% of the isolates, mainly C. glabrata (3.2%), C. rugosa (1.05%), C. lipolytica (1.05%), and C. dubliniensis (0.53%). When VVC risk factors were considered, there were significant risk factors with age group 30-34 years (33.3%, odds ratio=2.1) and age group ≥35 years (62.5%, odds ratio=10.3), residence in a rural area (39.5%, OR=3.3), negative emotions (30.2%, OR=2.3), underwear replacement over 1 day (29.3%, OR=4.2), impure cotton underwear (29.4%, OR=4.9), while Condom use and vulvar cleaning before or after sexual life were found to be highly significant protective factors against VVC (p=0.008, 0.03, respectively).
Conclusions: Guidelines for the management of VVC syndrome in Yemen should be revised to include a protocol specifically for women over 30 years of age. VVC undoubtedly poses a significant threat to women's reproductive health. Risk factors for VVC are varied, and include ages, health habits, history of the disease, and other aspects. It is necessary to take appropriate measures to avoid risk factors and to help reduce the prevalence of VVC among women of childbearing age.
Background: Women commonly experience changes in genitourinary and sexual function during perimenopause and postmenopause due to decreasing levels of estrogen. Globally, women tend not to seek help for menopausal and sexual symptoms, and this may have a profound impact on their health and quality of life.
Sexual and reproductive health are important and valued aspects of a woman’s health and well-being and can be profoundly impacted by breast cancer diagnosis and treatments. For breast cancer survivors, sexual and reproductive health changes are associated with significant emotional distress and often negatively impact women’s emotional well-being, relationships, sense of self, and overall quality of life. In order to guide psychoeducation and normalization of sexual health problems, this chapter provides information regarding female sexual response and the impacts of breast cancer treatments on sexual function. Additionally, with the purpose of guiding proper evaluation, assessment, and treatment of sexual problems, latter sections include approaches for assessment and evaluation of sexual problems and strategies for managing sexual problems. Lastly, as many breast cancer treatments can adversely affect fertility, essential information regarding these effects and common methods for managing fertility concerns are provided.
Hot flashes are common in breast cancer survivors because they can occur as a result of natural aging, surgery, or medications used in the treatment of cancer. Unfortunately, some survivors will have to cope with bothersome hot flashes for years even after completing cancer-directed therapies, and these symptoms can detrimentally impact life quality in multiple domains. Many drug and non-drug interventions have been studied in recent decades, and some are quite effective at reducing the frequency and severity of hot flashes. This chapter provides a succinct overview of supportive care strategies for dealing with hot flashes, the data behind each approach, and important information about toxicities that may occur as a result of therapies.
PREVALENCE OF DIFFERENT HEPATITIS B VIRUS GENOTYPES AND RISK FACTORS ASSOCIATED AMONG SELECTED YEMENI PATIENTS WITH CHRONIC HEPATITIS B INFECTION
ABSTRACT
Background and objectives: Vulvovaginal candidiasis is known to be a global issue of concern due to its association with economic costs, sexually transmitted diseases, and the escalation of genital tract infections. This study aimed to determine the prevalence, species distribution and risk factors associated with Candida species causing vulvovaginal candidiasis. Subjects and Methods: Non-pregnant women attending routine antenatal visits at Al-Olaifi-Family Center in Sana'a were enrolled in a cross-sectional study conducted from June 2018 to March 2019. Laboratory work was carried out at the National Center of Public Laboratories (NCPHL). Vaginal swabs were sampled from participants after oral consent was obtained. The swabs were inoculated in Sabouraud glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48 h under aerobic conditions in order to perform a fungal culture. Candida species were determined by culturing on HiCrome Candida differential Agar at 35°C for 48 h to produce species-specific colours. Data on demographic, clinical, and risk factors were collected in a pre-designed questionnaire. Results: A total of 190 non-pregnant women were included. The prevalence of VVC was 22.1%. Candida albicans accounted for 16.3% and non-Candida albicans accounted for 5.8% of the isolates, mainly C. glabrata (3.2%), C. rugosa (1.05%), C. lipolytica (1.05%), and C. dubliniensis (0.53%). When VVC risk factors were considered, there were significant risk factors with age group 30-34 years (33.3%, odds ratio=2.1) and age group ≥35 years (62.5%, odds ratio=10.3), residence in a rural area (39.5%, OR=3.3), negative emotions (30.2%, OR=2.3), underwear replacement over 1 day (29.3%, OR=4.2), impure cotton underwear (29.4%, OR=4.9), while Condom use and vulvar cleaning before or after sexual life were found to be highly significant protective factors against VVC (p=0.008, 0.03, respectively). Conclusions: Guidelines for the management of VVC syndrome in Yemen should be revised to include a protocol specifically for women over 30 years of age. VVC undoubtedly poses a significant threat to women's reproductive health. Risk factors for VVC are varied, and include ages, health habits, history of the disease, and other aspects. It is necessary to take appropriate measures to avoid risk factors and to help reduce the prevalence of VVC among women of childbearing age. Keywords: Candida, Vulvovaginal candidiasis, VVC, Epidemiology, Risk factors, Sana’a, Yemen.
Introducción: las infecciones vaginales son frecuentes en todos los grupos de edad, pueden presentar una manifestación asintomática, compromiso local o sistémico.Objetivo: establecer la prevalencia de infecciones vaginales en mujeres embarazadas y no embarazadas que consultaron a un hospital de mediana complejidad de la ciudad de Cali.Métodos: se realizó un estudio descriptivo y retrospectivo basado en los reportes de las historias clínicas de pacientes con diagnóstico de vulvovaginitis infecciosa durante un período de un año. Las variables fueron evaluadas estadísticamente para determinar su grado de significancia en la patología..Resultados: se encontraron 534 registros con una edad promedio de 24 años (DS=10,553; edad min=14 años, máx.= 80 años) entre las mujeres que consultaron por infección vaginal. La vaginosis bacteriana fue más prevalente con un 18.5%, seguida de la vaginitis candidiásica (15.7%). Las mujeres diagnosticadas con vaginitis candidiásica presentaron un mayor riesgo de desarrollar hemorragias (1.1 %; OR: 3.436; p=0.016) y neoplasias (2.4%; OR 2.278; p=0.014). Las mujeres diagnosticadas con vaginosis bacteriana se relacionaron con un mayor riesgo de desarrollar enfermedad inflamatoria pélvica (2.2%; OR: 28.286). La prevalencia de mujeres embarazadas con infecciones vaginales fue del 20.8%, siendo la vaginitis candidiásica el motivo por el cual consultaron con mayor frecuencia.Conclusiones: en este estudio se demostró que las infecciones vaginales afectan a las mujeres en edades reproductivas y sus principales complicaciones derivan en la enfermedad inflamatoria pélvica, hemorragias y neoplasias; con predominio de la vaginosis bacteriana, especialmente, en mujeres de estratos socio-económicamente bajos como es nuestro grupo de estudio.
We conducted a survey among women attending an urban public sexually transmitted disease clinic to determine type and frequency of intravaginal cleansing practices. Both intravaginal washing and douching were frequent, performed mostly for routine hygiene, and associated with self-report of STI and bacterial vaginosis (douching) and bacterial vaginosis (intravaginal washing).
Genitourinary syndrome of menopause (GSM) is a common and distressing condition that may cause significant sexual pain in menopausal women. The diagnosis of GSM is based on symptoms, history, and a thorough physical examination, often confirmed by laboratory testing. Without estrogens and androgens, over time the vaginal and vulvar tissues drastically thin, the urethra protrudes and may telescope or prolapse, the introitus narrows, the labia minora resorb, and the vaginal pH increases. Research has shown that the majority of women are unaware that their genitourinary symptoms are caused by a lack of reproductive hormones or that safe and effective treatment options are available. Estrogen therapy has long been recognized as the most effective treatment for the relief of bothersome vaginal symptoms associated with menopause, but newer approved and experimental therapies have highlighted the importance of androgens.
Complement activation is essential for select physiologic processes during pregnancy; however, excess activation has been associated with an increased risk for preterm birth (PTB). African American (AA) women experience disproportionately higher rates of inflammation-associated PTB than other groups of women; thus, the purpose of this study was to explore the relationship between complement activation and perinatal outcomes among AA women. A plasma sample was collected between 8 and 14 weeks' gestation from a cohort of healthy AA women (N = 144) enrolled in a larger PTB cohort study. Medical record review was conducted to collect information on clinical factors (cervical length, health behaviors, gestational age at delivery). Multiple regression analysis was used to explore the relationships between complement marker (C3a/Bb) concentrations and the outcomes of interest after adjusting for baseline characteristics. C3a/Bb concentrations were not significant predictors of the gestational age at delivery, cervical length, or behavioral risk factors for PTB in this sample. Complement markers may not influence pregnancy outcomes among AA women in the same way as in predominantly white populations; however, more studies are needed to define complement dysregulation and the relationship with outcomes among AA women.
Background:
Vulvovaginal candidiasis is commonly diagnosed and has been associated in prospective studies with the acquisition of HIV. Little data is available on how the composition of the vaginal microbiota, and other risk factors, are associated with the molecular detection of Candida albicans - a common cause of vulvovaginal candidiasis.
Methods:
In a cross-sectional study, self-collected vaginal swabs were obtained from 394 non-pregnant, reproductive-age women. C. albicans was detected using PCR targeting C. albicans ITS1/2 region. Vaginal microbiota was characterized by 16S rRNA gene amplicon sequencing of the V3-V4 hypervariable regions and clustered into community state types (CSTs). Multiple logistic regression identified factors associated with C. albicans detection.
Results:
21% had C. albicans detected and 46% reported vaginal symptoms in the prior 60 days. There was a 2-fold increase in the odds of C. albicans if a woman was in a L. crispatus-dominated CST compared to CSTs with low-Lactobacillus levels (aOR: 2.05, 95% CI: 0.97-4.37). History of self-treatment with antifungals, L. crispatus relative abundance, and receptive oral sex were also significantly associated with C. albicans detection.
Conclusions:
A L. crispatus-dominated vaginal microbiota is thought to protect women from both development of bacterial vaginosis and incidence of sexually transmitted infections; however, our data suggest that L. crispatus is associated with increased C. albicans detection. Receptive oral sex may also be a risk factor for vaginal C. albicans colonization.
Genitourinary syndrome of menopause (GSM) is a relatively new term instead of the previously used term of vulvovaginal atrophy. It is common, but the problem is underestimated. There are a wide range of symptoms and signs in the urogenital area. Careful history taking and examination are the essential parts to identify the impact of GSM on quality of life. As the GSM is a chronic condition, it requires long-term therapy. The essential of the therapy should aim to maintain normal vulvovaginal physiology. The therapy of GSM includes lifestyle modifications and non-hormonal, hormonal, and laser treatments. This chapter summarizes the safety and effectiveness of available treatment modalities.
The study involved 49 patients aged 20 to 35 years old, seeking antenatal care with complaints about the presence of vaginal discharge, with a characteristic odor. Verification of the diagnosis of bacterial vaginosis was based on clinical, laboratory examination: Amsel criteria, direct microscopic study, polymerase chain reaction (PCR) in real time. Patients were divided into 2 groups, depending on the results of the clinical course and laboratory data. Group 1 consisted of 25 patients who during the PCR method in real time revealed the presence of moderate vaginal dysbiosis, with a predominance of anaerobic flora. To this group of patients Neo-Penotran® was administered for 7 days. The group 2 included 24 patients who during diagnosis by PCR revealed the presence of vaginal dysbiosis pronounced, with a predominance of mixed dysbiosis. To this group of patients, we administered a combined preparation of Neo-Penotran® Forte (7 days). The results obtained indicate the absence of relapse within 3 months after therapy. Therefore, during diagnosis and the verification of a diagnosis of bacterial vaginosis is necessary to estimate the degree of vaginal dysbacteriosis using, including but routine methods, polymerase chain reaction, real-time. Appointment of treatments for bacterial vaginosis should be commensurate with the violations of the habitat of the vagina.
The objective of The North American Menopause Society (NAMS) and The International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel was to create a point of care algorithm for treating genitourinary syndrome of menopause (GSM) in women with or at high risk for breast cancer. The consensus recommendations will assist healthcare providers in managing GSM with a goal of improving the care and quality of life for these women. The Expert Consensus Panel is comprised of a diverse group of 16 multidisciplinary experts well respected in their fields. The panelists individually conducted an evidence-based review of the literature in their respective areas of expertise. They then met to discuss the latest treatment options for genitourinary syndrome of menopause (GSM) in survivors of breast cancer and review management strategies for GSM in women with or at high risk for breast cancer, using a modified Delphi method. This iterative process involved presentations summarizing the current literature, debate, and discussion of divergent opinions concerning GSM assessment and management, leading to the development of consensus recommendations for the clinician.
Genitourinary syndrome of menopause is more prevalent in survivors of breast cancer, is commonly undiagnosed and untreated, and may have early onset because of cancer treatments or risk-reducing strategies. The paucity of evidence regarding the safety of vaginal hormone therapies in women with or at high risk for breast cancer has resulted in avoidance of treatment, potentially adversely affecting quality of life and intimate relationships. Factors influencing decision-making regarding treatment for GSM include breast cancer recurrence risk, severity of symptoms, response to prior therapies, and personal preference.
We review current evidence for various pharmacologic and nonpharmacologic therapeutic modalities in women with a history of or at high risk for breast cancer and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. Treatment of GSM is individualized, with nonhormone treatments generally being first line in this population. The use of local hormone therapies may be an option for some women who fail nonpharmacologic and nonhormone treatments after a discussion of risks and benefits and review with a woman's oncologist. We provide consensus recommendations for an approach to the management of GSM in specific patient populations, including women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.
The consequences of estrogen deprivation and therapeutic interventions such as radiation, chemotherapy and surgery have a significant negative impact on libido, sexual arousal, orgasmic function and the ability to have pleasurable intercourse. Evaluation and treatment of female sexual dysfunction is a significant unmet need in the breast cancer survivor in spite of the availability of safe and effective treatments.
Introduction:
Genitourinary syndrome of menopause (GSM) has a significant impact on the trophism of the genital and lower urinary tracts and can considerably impair sexual function. Fractional CO2 laser has a regenerative effect on vulvovaginal tissue trophism after menopause.
Aim:
To review the available literature on the effect of fractional CO2 laser on the sexual function of postmenopausal women affected by GSM.
Methods:
A database search was carried out using the terms CO2laser, vaginal atrophy, sexual function, dyspareunia, and genitourinary syndrome of menopause and excluding studies using other types of laser or including breast cancer survivors with vulvovaginal atrophy. For statistical analysis, the estimated overall laser effect was computed (when at least two studies were involved) and data type of generic inverse variance was computed using inverse variance as the statistical method, a random-effects model, and the difference in means as an effect measurement.
Main outcome measures:
Different methods of evaluating sexual function were reported and studies were grouped and analyzed accordingly. Subjective assessment for dyspareunia was evaluated with a 10-point visual analog scale. Patient-reported outcome for an overall perception of sexual function was evaluated with a Likert scale. The Female Sexual Function Index was used as a condition-specific questionnaire.
Results:
Six articles were considered for this review. A total of 273 women (mean age = 57.8 years) were treated with the same protocol in all studies. Compared with baseline, at the end of the treatment, dyspareunia significantly decreased in severity (P < .001), and the patient's perception of overall sexual function showed a statistically significant improvement (P < .001). At the last follow-up visit, the Female Sexual Function Index score for each single domain and overall score was significantly better than at entry (P < .001).
Conclusion:
Fractional CO2 laser can improve sexual function in postmenopausal women affected by GSM by restoring a better trophism in the lower genitourinary tract. Salvatore S, Pitsouni E, Del Deo F, et al. Sexual Function in Women Suffering From Genitourinary Syndrome of Menopause Treated With Fractionated CO2Laser. Sex Med Rev 2017;X:XXX-XXX.
Therapeutic Opportunities in the Vaginal Microbiome, Page 1 of 2
Abstract
The reproductive tract of females lies at the core of humanity. The immensely complex process that leads to successful reproduction is miraculous yet invariably successful. Microorganisms have always been a cause for concern for their ability to infect this region, yet it is other, nonpathogenic microbial constituents now uncovered by sequencing technologies that offer hope for improving health. The universality of Lactobacillus species being associated with health is the basis for therapeutic opportunities, including through engineered strains. The manipulation of these and other beneficial constituents of the microbiota and their functionality, as well as their metabolites, forms the basis for new diagnostics and interventions. Within 20 years, we should see significant improvements in how cervicovaginal health is restored and maintained, thus providing relief to the countless women who suffer from microbiota-associated disorders.
Objectif:
Analyser les données probantes et formuler des recommandations quant au dépistage et à la prise en charge de la candidose vulvovaginale, de la trichomonase et de la vaginose bactérienne.
Issues:
Parmi les issues évaluées, on trouve l'efficacité de l'antibiothérapie, les taux de guérison en ce qui concerne les infections simples et compliquées, et les implications de ces pathologies pendant la grossesse. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans MEDLINE, EMBASE, CINAHL et The Cochrane Library en juin 2013 au moyen d'un vocabulaire contrôlé (p. ex. « vaginitis », « trichomoniasis », « vaginal candidiasis ») et de mots clés (p. ex. « bacterial vaginosis », « yeast », « candidiasis », « trichomonas vaginalis », « trichomoniasis », « vaginitis », « treatment ») appropriés. Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date, mais les résultats ont été limités aux documents rédigés en anglais ou en français. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en mai 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques et auprès de sociétés de spécialité médicale nationales et internationales.
Valeurs:
La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
Over-the-counter personal lubricants are used frequently during vaginal and anal intercourse, but they have not been extensively tested for biological effects that might influence HIV transmission. We evaluated the in vitro toxicity anti-HIV-1 activity and osmolality of popular lubricants. A total of 41 lubricants were examined and compared to Gynol II and Carraguard as positive and negative controls for toxicity, respectively. Cytotoxicity was assessed using the XTT assay. The MAGI assay with R5 and X4 HIV-1 laboratory strains was used to evaluate antiviral activity. The effect of the lubricants on differentiated Caco-2 cell monolayers (transepithelial electrical resistance, TEER) was also measured. None of the lubricants tested showed significant activity against HIV-1. Surprisingly, four of them, Astroglide Liquid, Astroglide Warming Liquid, Astroglide Glycerin & Paraben-Free Liquid, and Astroglide Silken Secret, significantly enhanced HIV-1 replication (p<0.0001). A common ingredient in three of these preparations is polyquaternium-15. In vitro testing of a chemically related compound (MADQUAT) confirmed that this similarly augmented HIV-1 replication. Most of the lubricants were found to be hyperosmolar and the TEER value dropped approximately 60% 2 h after exposure to all lubricants tested. Cells treated with Carraguard, saline, and cell controls maintained about 100% initial TEER value after 2-6 h. We have identified four lubricants that significantly increase HIV-1 replication in vitro. In addition, the epithelial damage caused by these and many other lubricants may have implications for enhancing HIV transmission in vivo. These data emphasize the importance of performing more rigorous safety testing on these products.
The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV).
A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel's and Nugent's criteria.
A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole.
The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use.
Background:
Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition.
Methods and findings:
We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2) values 0.0%-16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001), respectively.
Conclusions:
This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors' Summary.
The purpose of the study was to examine intercenter variability in the interpretation of Gram-stained vaginal smears from pregnant women. The intercenter reliability of individual morphotypes identified on the vaginal smear was evaluated by comparing them with those obtained at a standard center. A new scoring system that uses the most reliable morphotypes from the vaginal smear was proposed for diagnosing bacterial vaginosis. This scoring system was compared with the Spiegel criteria for diagnosing bacterial vaginosis. The scoring system (0 to 10) was described as a weighted combination of the following morphotypes: lactobacilli, Gardnerella vaginalis or bacteroides (small gram-variable rods or gram-negative rods), and curved gram-variable rods. By using the Spearman rank correlation to determine intercenter variability, gram-positive cocci had poor agreement (0.23); lactobacilli (0.65), G. vaginalis (0.69), and bacteroides (0.57) had moderate agreement; and small (0.74) and curved (0.85) gram-variable rods had good agreement. The reliability of the 0 to 10 scoring system was maximized by not using gram-positive cocci, combining G. vaginalis and bacteroides morphotypes, and weighting more heavily curved gram-variable rods. For comparison with the Spiegel criteria, a score of 7 or higher was considered indicative of bacterial vaginosis. The standardized score had improved intercenter reliability (r = 0.82) compared with the Spiegel criteria (r = 0.61). The standardized score also facilitates future research concerning bacterial vaginosis because it provides gradations of the disturbance of vaginal flora which may be associated with different levels of risk for pregnancy complications.
To evaluate the effects of nonoxynol-9 (N-9) on the vaginal flora and epithelium, 48 women (16 in each group) were evaluated
by use of quantitative vaginal cultures and colposcopy. at baseline and at 0.5, 4, 24, 48, and 72 h after insertion of one
of three N-9 preparations (4% gel [Conceptrol], 3.5% gel [Advantage-24], or a 28% vaginal contraceptive film). The proportion
positive for H2O2+ or H2O2− lactobacilli did not change significantly with any of the preparations, but lactobacilli concentrations decreased transiently.
Both the proportion of women with Gardnerella vaginalis and the concentration of G. vaginalis decreased transiently. The proportion of women with Escherichia coli increased with the 4% gel, and the concentration increased with all preparations. The number with anaerobic gram-negative
rods increased, although the concentrations decreased. Symptoms and colposcopic abnormalities were rare. Changes in levels
of vaginal bacteria were transient after single applications of N-9, but adverse effects may be enhanced with frequent, chronic
use.
Recently, vaginal douching has been associated with many health risks in women. The aim of this study was to analyze the effect of commercial douche products against various vaginal microorganisms, including lactobacilli. Seven commercial douches were tested against eight Lactobacillus clinical isolates and three type strains from the American Type Culture Collection. BV-associated bacteria included six strains of five genera: Gardnerella, Mobiluncus, Mycoplasma, Peptostreptococcus, and Ureaplasma. Two isolates of group B Streptococcus, and three species of Candida were also tested. The minimal inhibition concentrations and minimal contact times for these products against vaginal microorganisms were determined in broth cultures. Four antiseptic-containing douche products showed a strong inhibitory effect against all vaginal microorganisms tested with a short contact time (less than 1 min). Three vinegar-containing douche products selectively inhibited vaginal pathogens associated with bacterial vaginosis, group B streptococcal vaginitis, and candidiasis, but not lactobacilli. The antimicrobial effects of the commercial douche products varied among different brands and microbial species tested.
The objective of this study was to measure the performance of the Affirm Ambient Temperature Transport System (ATTS) over
time and to estimate the length of time the system can preserve a vaginal specimen containing the three common organisms causing
vaginitis:Trichomonas vaginalis, Candida species, and Gardnerella vaginalis (one of the causative agents of bacterial vaginosis). Women with symptoms of vaginitis presenting to one of three clinical
centers were evaluated over a 4- to 8-week period. Four simultaneously obtained swabs were collected and tested by the Affirm
VPIII assay at time zero with and without a preservative reagent, at 24 h with reagent, and at either 48 or 72 h with reagent.
For each of the three organisms,Trichomonas, Gardnerella, andCandida, positivity at each time point was evaluated and compared to that at reference time zero with and without the ATTS. A total
of 940 specimens were obtained from the three clinical sites. Eight hundred three were positive for one or more of the three
organisms. Gardnerella had the highest overall positive rate (62%), followed by Candida with 18% andTrichomonas at 9%. The percent sensitivity versus control for Trichomonas ranged from 100% at time zero with and without reagent to 91% by 72 h. Gardnerella andCandida sensitivity remained at 100% for each time period. The Affirm VPIII ATTS system performed within 10% of the control swab
(no transport reagent) at all four time points (0, 24, 48, and 72 h) for Trichomonas, Gardnerella, andCandida.
The accuracy and suitability of use of a single intravaginal swab (SIS) for polymerase chain reaction detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and human papillomavirus infection was assessed in a cross-sectional study of 841 active-duty military women. The SIS, compared
with standard diagnostic tests, allowed detection of more gonorrhea, more chlamydial infection, and more trichomoniasis. Sensitivity
and specificity of SIS detection compared with adjudicated true-positive diagnoses were 95.8% and 97.8%, respectively, for
gonorrhea, 94.6% and 99.3% for chlamydial infection, and 92.2% and 98.2% for trichomonal infection. Results with SISs were
comparable to those with cervical swabs tested for human papillomavirus. Assay of clinician-collected and self-collected SISs
yielded prevalences similar to those of standard diagnostic tests for all sexually transmitted infections. Therefore, the
use of SISs is acceptable for the simultaneous diagnosis of multiple sexually transmitted infections and has potential for
use as a self-administered diagnostic tool with widespread applicability among women.
Vaginal douching is the process of intravaginal cleansing with a liquid solution. Douching is used for personal hygiene or aesthetic reasons, for preventing or treating an infection (1), to cleanse after menstruation or sex, and to prevent pregnancy (2). For at least 100 years, there have been conflicting views on the benefits or harm in douching. Although there is a broad consensus that douching should be avoided during pregnancy, there is less agreement regarding douching for hygiene and relief of vaginitis symptoms. Two earlier reviews of douching data in women (3) and adolescents (4) have concluded that douching is harmful and should be discouraged because of its association with pelvic inflammatory disease, ectopic pregnancy, and perhaps other conditions. Nonetheless, douching continues to be a common practice. We seek to review the evidence of the impact of douching on women’s health.
To determine the concordance between vaginal fluid Gram stains and pH obtained at speculum exam with similar stains and pH prepared from self-obtained vaginal swabs.
Using vaginal fluid Gram stain, 129 pregnant women were screened for bacterial vaginosis at 24 to 29 weeks' gestation. Two smears were collected from each woman during the same prenatal visit: the first was prepared from a self-obtained vaginal swab and the second from a physician-obtained speculum examination. Vaginal pH was recorded for each swab. Kappa coefficient was used to quantify agreement between the two sets of results.
When compared with the physician-obtained smear, the ability of the self-obtained Gram stain to diagnose bacterial vaginosis had a sensitivity of 77%, specificity of 97%, positive predictive value of 71% and negative predictive value of 97%. There was substantial agreement (weighted kappa=0.82) between the two techniques in the ability to determine the grade of vaginal flora.
When compared with physician-obtained vaginal smears, self-obtained smears have substantial agreement in the diagnosis of bacterial vaginosis.
The goal of a safer vaginal environment could be reached by identifying harmful vaginal practices and an effective microbicide, thereby increasing options for HIV prevention.
Logistic regression yields an adjusted odds ratio that approximates the adjusted relative risk when disease incidence is rare (<10%), while adjusting for potential confounders. For more common outcomes, the odds ratio always overstates the relative risk, sometimes dramatically. The purpose of this paper is to discuss the incorrect application of a proposed method to estimate an adjusted relative risk from an adjusted odds ratio, which has quickly gained popularity in medical and public health research, and to describe alternative statistical methods for estimating an adjusted relative risk when the outcome is common. Hypothetical data are used to illustrate statistical methods with readily accessible computer software.
Objectives: To evaluate the safety of 100 mg nonoxynol-9 (N-9) gel, a vaginal microbicide, on the genital mucosa of women from Malawi and Zimbabwe in preparation for a phase III efficacy study. Methods: HIV-uninfected women (180) were enrolled and randomized to either N-9 or placebo gel and instructed to insert gel into the vagina twice daily for 14 days. Follow up examinations were conducted at 7 and 14 days. Results: The number of adverse events in the N-9 gel group was higher than in the placebo group (40% versus 13%; P < 0.01). Reported number of any genital symptoms was significantly higher in the N-9 group (38% N-9, 13% placebo; P = 0.01). The number of total epithelial disruptions was higher in the N-9 group (20% versus 3%; P < 0.01); however, the number of genital ulcers and abrasions in the N-9 group was low (2% and 3%, respectively) and not different from that in the placebo group (1% and 2%, respectively). Conclusions: N-9 gel 100 mg caused a significant increase in the rate of genital symptoms and epithelial disruptions compared with placebo. The clinical significance of these epithelial disruptions is unknown. Although these findings alone were not sufficient to cancel the planned phase III study, when considered together with the negative results from the COL-1492 effectiveness trial of 52.5 mg N-9 gel, the decision was made to cancel the planned phase III trial of 100 mg N-9 gel.
Objectives: Lesions on the vaginal and cervical mucosa may facilitate transmission of HIV and other sexually transmitted diseases (STDs). We evaluated the relationship between intravaginal practices and the presence of colposcopic lesions in Zimbabwean women.
Methods: Users and nonusers of intravaginal practices were seen at enrollment, and at 1 and 6 months. Interviewing, counseling, and pelvic and colposcopic examinations were performed at each study visit. Specimens were collected at enrollment and 6 months.
Results: Colposcopic lesions were found at least once in 83% of the participants (n = 162), and in 66% of all exams (n = 430). Most lesions were classified as related to infection with human Papillomavirus (HPV) (58%) or another pathogen (20%), but 11% of lesions could have been caused by intravaginal practices (signal lesions). Intravaginal practices were not associated with an increased incidence in signal lesions (95 and 124 lesions per 100 person-years of follow-up for users and nonusers respectively; p = .290), nor with the presence of signal lesions in multivariate baseline (odds ratio [OR], 1.32; 95% confidence interval [CI], 0.37-4.72; p = .666) and six month transition models (OR, 1.67; 95% CI, 0.59-4.70; p = .333).
Conclusions: No associations between intravaginal practices and colposcopic lesions were found in this study. However, the potential effect of intravaginal practices on the cervical and vaginal mucosa, and on subsequent HIV and STD transmission, warrants further study. The usefulness of colposcopy as a research tool in areas with high prevalences of HIV and HPV is questioned.
(C) 2000 Lippincott Williams & Wilkins, Inc.
Background and Objectives:: Incidence of Candida vaginitis by age and racial or ethnic group is poorly described.
Goal:: Estimate incidence, cumulative probability of presumed C vaginitis by age, racial or ethnic group, and associated costs.
Study Design:: Random digit‐dialing survey of 2000 US women.
Results:: A total of 6.5 percent (95% CI, 5.4‐7.5%) of women older than 18 years reported a least one episode of presumed C vaginitis during the previous 2 months. Women reporting a 1‐year period with four or more episodes comprised 8.0% of the sample but accounted for 37.2% of women reporting episodes. Black women reported approximately three times more yeast infections in the previous 2 months (17.4%; 95% CI, 11.2‐23.5%) than white women (5.8%; 95% CI, 4.7‐6.9%).
Conclusion:: The high incidence and the propensity for recurrence underscore the need for a better understanding of the epidemiology and pathogenesis, and stress the need for the development of more accurate, rapid diagnostics and effective treatments.
To evaluate the association between vaginal douching and cervical Chlamydia trachomatis infection.
We analyzed cross-sectional data from a study conducted at Group Health Cooperative of Puget Sound, a nonprofit health maintenance organization in western Washington state. Participants were nonpregnant women Group Health enrollees between the ages of 18 and 34 years who were attending two primary care clinics either for nonurgent visits, primarily routine preventive health visits, or in response to an invitation from the study. Before the clinical examination, all completed a self-administered survey assessing demographic and behavioral characteristics, including the timing, frequency, products used, and reasons for douching. Chlamydial infection was ascertained via cell culture isolation of C trachomatis from endocervical specimens obtained at the same visit.
Chlamydia trachomatis was isolated from cervical cultures in 58 (3.4%) of 1692 study participants. Women who reported douching in the 12 months before their clinic visit had an increased likelihood of chlamydial infection compared with women who did not douche (prevalence odds ratio [OR] 2.29, 95% confidence interval [CI] 1.22, 4.30, after adjusting for confounding factors). The likelihood was higher for women who reported douching more often: OR 2.60 (95% CI 1.29, 5.24) for women who douched one to three times per month, and OR 3.84 (95% CI 1.26, 11.70) for those douching four times or more per month. These associations were slightly stronger when women who reported douching because of an infection were excluded from the analysis.
These results support the hypothesis that vaginal douching predisposes to acquisition of cervical chlamydial infection and are compatible with previous studies that report associations between douching and sequelae of chlamydial infection, including pelvic inflammatory disease, ectopic pregnancy, and infertility.
Logistic regression yields an adjusted odds ratio that approximates the adjusted relative risk when disease incidence is rare (<10%), while adjusting for potential confounders. For more common outcomes, the odds ratio always overstates the relative risk, sometimes dramatically. The purpose of this paper is to discuss the incorrect application of a proposed method to estimate an adjusted relative risk from an adjusted odds ratio, which has quickly gained popularity in medical and public health research, and to describe alternative statistical methods for estimating an adjusted relative risk when the outcome is common. Hypothetical data are used to illustrate statistical methods with readily accessible computer software.
Relative risk is usually the parameter of interest in epidemiologic and medical studies. In this paper, the author proposes a modified Poisson regression approach (i.e., Poisson regression with a robust error variance) to estimate this effect measure directly. A simple 2-by-2 table is used to justify the validity of this approach. Results from a limited simulation study indicate that this approach is very reliable even with total sample sizes as small as 100. The method is illustrated with two data sets.
To determine the sensitivity and specificity of Focus HerpeSelect ELISAs, sera or plasma samples from women aged 18-55 years were collected in ten cities from eight countries and tested by HerpeSelect HSV-1 ELISA (Focus-HSV-1) and by HerpeSelect HSV-2 ELISA (Focus-HSV-2). Sera with Focus-HSV-2-positive results were retested; 94% of the 3617 samples retested were positive. A subset of sera from each site was then selected, based on the HSV-2 results, and tested by Western blot (WB). The sensitivity and specificity were determined with samples from ten sites (n = 967) for Focus-HSV-1 and from seven sites (n = 675) for Focus-HSV-2. Focus-HSV-1 and WB results were concordant (both negative or both positive) for 97% of samples, with 99% sensitivity and 77% specificity. Specimens from Songkla, Thailand had 84% concordance with WB results for HSV-1, while three other sites had 100% concordance. Concordance of Focus-HSV-2 and WB was 92%, with 97% sensitivity and 89% specificity. Ibadan, Nigeria had 78% concordance. Focus-HSV-2 sensitivity and specificity in sites other than Ibadan were 97% and 93%, respectively. Raising the positive cut-off index value for HSV-2 from 1.1 to 3.5 yielded a sensitivity of 90% and a specificity of 96%. A sensitivity of 90% and a specificity of 98% were achieved for sites other than Nigeria with the higher cut-off. In summary, the sensitivity and specificity of the Focus-HSV-1 and Focus-HSV-2 tests varied by site. Performance data generated in one area may not be applicable to other populations.
To evaluate the safety of 100 mg nonoxynol-9 (N-9) gel, a vaginal microbicide, on the genital mucosa of women from Malawi and Zimbabwe in preparation for a phase III efficacy study.
HIV-uninfected women (180) were enrolled and randomized to either N-9 or placebo gel and instructed to insert gel into the vagina twice daily for 14 days. Follow up examinations were conducted at 7 and 14 days.
The number of adverse events in the N-9 gel group was higher than in the placebo group (40% versus 13%; P < 0.01). Reported number of any genital symptoms was significantly higher in the N-9 group (38% N-9, 13% placebo; P = 0.01). The number of total epithelial disruptions was higher in the N-9 group (20% versus 3%; P < 0.01); however, the number of genital ulcers and abrasions in the N-9 group was low (2% and 3%, respectively) and not different from that in the placebo group (1% and 2%, respectively).
N-9 gel 100 mg caused a significant increase in the rate of genital symptoms and epithelial disruptions compared with placebo. The clinical significance of these epithelial disruptions is unknown. Although these findings alone were not sufficient to cancel the planned phase III study, when considered together with the negative results from the COL-1492 effectiveness trial of 52.5 mg N-9 gel, the decision was made to cancel the planned phase III trial of 100 mg N-9 gel.
The objective of this study was to evaluate an intervention to reduce vaginal douching among adolescent and young women who report douching.
This study consisted of a randomized, controlled trial of 275 primarily black adolescent and young adults aged 14 to 23 years. All women participated in 3 15-minute individualized counseling sessions. The experimental group received interventions based on their stage of readiness for ceasing vaginal douching. The comparison condition emphasized healthy eating and nutrition. The primary outcome measure was douching cessation (i.e., no douching in the preceding 3 months) at the 6-and 12-month assessment; a secondary outcome was progression through the stages of change toward douching cessation.
Based on an intention-to-treat model, participants assigned to the douching intervention group were significantly more likely to report having stopped douching at 6 months (relative risk [RR], 1.34; 95% confidence interval [CI], 1.03-1.73) and at 12 months (RR, 1.60; 95% CI, 1.28-2.00). At baseline, 89.9% of all women reported no intention to stop douching. Also based on an intention-to-treat model, there were no differences in stage across the 2 groups at 6 months (P = 0.29); however, at 12 months, the difference between the intervention and comparison group was statistically significant (P = 0.008).
Stage-matched interventions can reduce douching among adolescent and young adult women.
Bacterial vaginosis (BV) is highly prevalent among African women and has been associated with adverse pregnancy outcomes, sexually transmitted diseases, and HIV-1.
The goal of this study was to analyze the relationship among intravaginal practices, bathing, and BV.
The authors conducted a cross-sectional study of HIV-1-seronegative Kenyan female sex workers without symptoms of vaginal infections.
Of 237 women enrolled, 206 (87%) reported vaginal washing using either a finger or cloth. Increasing frequency of vaginal washing was associated with a higher likelihood of BV (chi(2) test for trend, P = 0.05). In multivariate analysis, vaginal lubrication with petroleum jelly (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.4-5.6), lubrication with saliva (OR = 2.3, 95% CI = 1.1-4.8), and bathing less than the median for the cohort (14 times/week; OR = 4.6, 95% CI = 1.2-17.5) were associated with a significantly higher likelihood of BV.
Modification of intravaginal and general hygiene practices should be evaluated as potential strategies for reducing the risk of BV.
. Effect of intravaginal practices on the vaginal and cervical mucosa of Zimbabwean women.
- van de Wijgert
Diagnosis of bacterial vaginosis from self-obtained vaginal swabs.
- Strauss