Venous malformations of the female lower genital tract

Objectives

Vascular malformations are rarely located in the female lower genital tract. We present the specific clinicopathologic features of venous malformation in the lower genital tract and highlight the surgical management of these lesions.

Study design

Between the years 1998 and 2008, 8 of 646 female patients were retrospectively defined as venous malformation in the lower genital tract according to the classification of the International Society for the Study of Vascular Anomalies (ISSVA). Clinical and pathologic information was analyzed according to the medical records and archived pathological sections.

Results

Venous malformations were located in the vagina in three women, and in two of these cases extended to the cervix, and were found at the vulva in five patients. The age of the patients ranged from 15 to 85. The clinical presentations were abnormal vaginal bleeding or vaginal mass in cases with cervicovaginal lesions, and non-specific vulvar nodules in women with vulvar lesions. The abnormalities were found shortly after birth and increased in size gradually thereafter, or become significantly enlarged during or following pregnancy. Postmenopausal episodes could occur, although rarely. Doppler ultrasound, MRI and angiography were available to help define the type of vascular anomalies. The therapeutic approach consisted of interventional embolization and surgical excision. In rare cases of refractory and diffuse cervicovaginal lesions, hysterectomy might be ultimately inevitable.

Conclusion

Venous malformations in the lower female genital tract are rarely reported. Their clinical presentations mimic other genital tract neoplasms, including malignancies. Surgical excision is the curative procedure and is helpful to reach a definite pathological diagnosis.     

先天性泌尿生殖道畸形合并泌尿生殖道瘘

先天性泌尿生殖道畸形合并泌尿生殖道瘘是一类少见的、复杂的先天性畸形,易误诊误治,需要对其有全面的认识和评估,并制定正确的治疗方案。     

Missed opportunities for diagnosis of female genital mutilation

Objective

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Methods

In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

Results

In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis.

Conclusion

Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.     

Sociodemographic factors associated with female genital cutting among women of reproductive age in Nigeria

Objectives: The aims of the study were to determine the prevalence of female genital cutting (FGC) among women of reproductive age in Nigeria and identify the sociodemographic factors associated with the practice.

Methods: A secondary analysis of the 2013 Nigeria Demographic and Health Survey was carried out in 38,948 women of reproductive age (15–49 years).

Results: The prevalence of FGC among respondents was almost 25%, most of whom (82%) had undergone the procedure when they were under 5 years of age. Traditional circumcisers performed 72.2% of all procedures. Type 2 was the common form (62.6%) of FGC. Almost a quarter of respondents (23.1%) wanted the practice to continue. Women aged 45–49 years were approximately twice as likely to have undergone FGC compared with women aged 15–19 years (odds ratio [OR] 2.41; 95% confidence interval [CI] 1.99, 2.92; p?p?p?Conclusions: Our findings have programmatic implications for ending the practice of FGC in Nigeria. Elimination efforts should be intensified among women of Yoruba ethnicity. To instigate behavioural change, communication interventions should particularly target residents in parts of Nigeria other than the North East zone.     

Factors determining whether Ethiopian women support continuation of female genital mutilation

Objective

To examine the factors influencing the opinions of women about whether female genital mutilation (FGM) should continue in Ethiopia.

Methods

Data from questionnaire surveys of women (n = 11 375) collected during the Ethiopia Demographic and Health Survey were analyzed. Factors influencing the opinions of women concerning whether FGM should continue as a practice in Ethiopia were examined using multiple logistic regression.

Results

Women who believed that FGM should continue were more likely to be aged 15-24 years (adjusted odds ratio [OR] 1.21; 95% confidence interval [CI],1.05-1.41); rural residents (OR, 2.73; CI, 2.38-3.12); Muslim (OR, 1.98; CI,1.80-2.17); married (OR, 1.26; CI, 1.09-1.46); uneducated (OR, 2.85; CI, 2.51-3.23); circumcised (OR, 3.46 CI, 2.94-4.06); and to have had no exposure to mass media (OR,1.57; CI,1.41-1.75).

Conclusion

To change the opinions of women regarding FGM, specific education and prevention programs should be designed to target these demographic groups of women.     

Laparoscopic findings in female genital tuberculosis

OBJECTIVES: To evaluate the laparoscopic findings in genital tuberculosis (TB). METHODS: A total of 85 women of genital TB, who underwent diagnostic laparoscopy for infertility or chronic pelvic pain were enrolled in this retrospective study conducted in our unit at All India Institute of Medical Sciences, New Delhi, India from September 2004 to 2007. RESULTS: The mean age was 28.2 years and the mean parity was 0.24. Most women were from poor socioeconomic status (68.1%). Past history of TB was seen in 29 (34.1%) women with pulmonary TB in 19 (22.35%) women and extrpulmonary in 10 (11.7%) women. Most women presented with infertility (90.6% primary 72.9%; secondary 17.6%) while the rest had chronic pelvic pain (9.4%). The mean duration of infertility was 6.2 years. A total of 49 (57.6%) women had normal menses, while hypomenorrhea, oligomenorrhea, secondary amenorrhea and menorrhagia were seen in 25 (30.1%), 3 (3.5%), 5 (5.9%), and 2 (2.4%) women respectively. Diagnosis of genital TB was made by histopathological evidence of TB granuloma in 16 (18.8%) (Endometrial biopsy in 12.9%, laparoscopy biopsy in 5.9%) women, demonstration of acid fast bacilli (AFB) on microscopy in 2(2.3%), positive AFB culture in 2 (2.3%), positive polymerase chain reaction (PCR) in 55 (64.7%) and laparoscopic findings of genital TB in 40 (47.1%). The various findings on laparoscopy were tubercles on peritoneum (12.9%) or ovary (1.2%), tubovarian masses (7.1%), caseous nodules (5.8%), encysted ascitis in 7.1% women. Various grades of pelvic adhesions were seen in 56(65.8%) women. The various findings on fallopian tubes were normal looking tubes in (7.1%), inability to visualize in 12(14.1%), presence of tubercles on tubes in 3 (3.52%), caseous granuloma in 3 (3.52%), hydrosalpinx in 15 (17.6%) (Right tube 11.7%, left tube 5.9%), pyosalphinx in 3 (3.5%) on right tube and 2 (2.35%) in left tube, beaded tube in 3 (3.5%) on right tube, 4 (4.7%) in left tube with tobacco pouch appearance in 2 (2.35%) women. The right tube was patent in 9 (10.6%) while left tube was patent in 10(11.7%) cases only, while they were either not seen (absent in one case due to previous salphingectomy, inability to see due to adhesion in 14.12%) or blocked at various sites with cornual end being most common in 3 (3.5%) showing multiple block in right tube and 4.7% in left tube. CONCLUSION: There is a significant pelvic morbidity and tubal damage in genital tuberculosis.     

Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

Objective

To record and compare obstetric and neonatal complication rates in women with reversed and non-reversed type III female genital mutilation (FGM).

Methods

A retrospective observational study comparing cesarean delivery rates and neonatal outcomes of primiparous and multiparous women who had or had not undergone reversal of FGM III.

Results

Of the 250 women, 230 (92%) had an FGM reversal. Of these, 50 (21.7%) were primiparous (cesarean delivery rate 17/50; 34%) and 180 (78.3%) were multiparous (cesarean delivery rate 28/180; 15.6%). Of the 20 women who had not had an FGM reversal, 7 (35%) were primiparous (cesarean delivery rate 5/7; 71.4%) and 13 (65%) were multiparous (cesarean delivery rate 7/13; 53.8%). The cesarean delivery rates for primiparae and multiparae were 32.9% and 25%, respectively. Multiparous women with FGM III reversal had a lower possibility of cesarean delivery compared with the hospital multiparous population (P = 0.003) and multiparae who had not undergone FGM III reversal (P = 0.007). There was no significant association between Apgar scores or blood loss at vaginal delivery and FGM reversal.

Conclusion

Reversal of FGM III significantly reduced the increased risk of cesarean delivery seen with multiparae who have FGM III.     

Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes

Objective

To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings and prolapse meshes compared with therapeutic abstention.

Study design

An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings and prolapse meshes. To calculate the procedure's cost-effectiveness, an incremental analysis up to one year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as one month and one year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence.

Results

In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 €. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). The cost-effectiveness was 106.5 €/International Consultation Incontinence Questionnaire Short-form unit.

Conclusion

Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.     

Estimates of first-generation women and girls with female genital mutilation in the European Union,Norway and Switzerland

Background: Female genital mutilation (FGM) is the practice of partial or total removal of female genitalia for non-medical reasons. The procedure has no known health benefits but can cause serious immediate and long-term obstetric, gynaecological and sexual health problems. Health workers in Europe are often unaware of the consequences of FGM and lack the knowledge to treat women adequately.

Objective: Our goal was to estimate the number of first-generation girls and women in the European Union, Norway and Switzerland who have undergone FGM. Before migration from FGM-practicing countries began, FGM was an unknown phenomenon in Europe.

Methods: Secondary analysis of data from the 2011 EU census and extrapolation from age-specific FGM prevalence rates in the immigrants’ home countries to these data were used to provide our estimates. Estimates based on census and other demographic data were compared to our results for Belgium.

Results: In 2011 over half a million first-generation women and girls in the EU, Norway and Switzerland had undergone FGM before immigration. One in two was living in the UK or France, one in two was born in East-Africa.

Conclusions: For the first time, scientific evidence gives a reliable estimate of the number of first-generation women and girls in Europe coming from countries where FGM is practiced. The use of census data proves reliable for policy makers to guide their actions, e.g., regarding training needs for health workers who might be confronted with women who have undergone FGM, or the need for reconstructive surgery.     

Management of type III female genital mutilation in Birmingham,UK: A retrospective audit

Objectivesto audit clinical management of women with type III female genital mutilation (FGM) according to local guidelines. Secondary objectives were to describe the population that uses the service and compare obstetric outcomes of intrapartum deinfibulation and antenatal deinfibulation.Designretrospective audit.Settinga hospital midwifery-led FGM specialist service in Birmingham, UK.Participants253 women with type III FGM who gave birth between January 2008 and December 2009Methodsretrospective case analysis using patient records.Main outcome measuresproportion of women managed according to locally agreed criteria for the management of FGM; obstetric outcomes including perineal tears, episiotomy rates, estimated blood loss, infant APGAR scores and indications for caesarean section.Findings91 (36%) women booked into antenatal care after 16 weeks gestation. Only 26 (10.3%) were managed fully according to guidelines. The area with poorest performance was child protection, where the presence of normal genitalia was documented in only 52 (38.8%) of medical notes following birth of a female infant. The majority of women (214, 84.6%) had been deinfibulated in a previous pregnancy. Of the 39 infibulated at booking, only 9 (23.1%) were deinfibulated antenatally, the rest opted for intrapartum deinfibulation. Women who had intrapartum deinfibulation had a higher average blood loss and more tears than those deinfibulated antenatally, although this was not statistically significant.Conclusions and implications for practicealternative systems should be considered to improve documentation of child protection related information. Further research is needed to confirm or refute the adverse findings among those that delayed deinfibulation.     

Epidemiological and gynecological correlates with female genital mutilation among Beni-Suef University students; cross sectional study

Objective

This study aims to evaluate the prevalence of FGM/C among university students in Beni-Suef, Egypt and detect the possible socio-demographic and gynaecological associations.

女性生殖器官恶性淋巴瘤的诊治

女性生殖器官恶性淋巴瘤是结外淋巴瘤的一部分,可发生于卵巢、宫颈、外阴等部位。病理类型多为B细胞型非霍奇金淋巴瘤,确诊依赖病灶及淋巴结的病理和免疫组化检查。治疗原则以化疗及靶向治疗为主,辅以放疗和手术治疗。环磷酰胺+多柔比星+长春新碱+泼尼松(CHOP)为首选化疗方案,手术以获取足够病理确诊的组织为目的,不主张过大手术范围。以美罗华为代表的靶向药物在淋巴瘤中的疗效已被认可。预后相对良好。     

女性下生殖道畸形的诊治现状和发展方向

女性下生殖道畸形是一组先天性疾病,是胚胎期副中肾管和泌尿生殖窦发育停滞或分化异常而导致的生殖系统结构缺陷,部分患者合并泌尿系统及骨骼系统发育畸形,属罕少见病.主要包括MRKH综合征(Mayer-Rokitan-sky-Küster-Hauser syndrome,MRKHS)、阴道斜隔综合征(Herlyn—Werner...     

The impact of surgical treatment on the mental health of women with obstetric fistula

Obstetric fistula is estimated to affect 2 million women worldwide and has considerable social and psychological effects on affected individuals. In this prospective study, 51 consecutive women with obstetric fistula admitted to the Barhirdar Hamlin Fistula Centre in the north of Ethiopia were screened using the General Health Questionnaire (GHQ-28) for potential mental health disorder before and 2 weeks after fistula surgery. Prior to surgery, all women screened positive. By 2 weeks after, this had dropped to 36% ( P = 0.005). 27% of the 45 women who were cured of their incontinence screened positive, while all 6 of those with severe residual incontinence continued to screen positive. We conclude that surgical treatment of obstetric fistula results in marked improvements in mental heath.     

应用尿道球海绵体肌瓣修补女性复杂尿瘘的探讨

目的:探讨应用尿道球海绵体肌瓣修补女性复杂尿瘘的可行性。方法:经腹经会阴经阴道途径游离膀胱阴道瘘或尿道阴道瘘瘘口,彻底切除瘘口周围疤痕组织,缝合阴道侧瘘口。在大、小阴唇之间作切口,游离尿道球海绵体肌,保护来自后下方的供应血管,离断尿道球海绵体肌的阴蒂端,经小阴唇隧道将该肌置于膀胱(或尿道)侧瘘口及阴道侧瘘口之间,将尿道球海绵体肌蒂端缝合固定于周围器官。结果:应用尿道球绵体肌瓣转移术修补复杂膀胱阴道瘘7例,复杂尿道阴道瘘1例,同时行阴道疤痕切除置模术1例。所有病例术后未再发生阴道漏尿,无尿失禁和尿道狭窄,性生活正常。结论:尿道球绵体肌瓣转移术设计合理、操作简单、是治疗女性复杂尿瘘的理想术式。