Vaginal agenesis.

Vaginal agenesis is not rare. Many ingenious procedures have been devised for its correction; some are simple, and some are complicated. Not enough emphasis has been placed on the emotional aspects when patients with this problem are treated. Proper timing of the operation and selection of the best procedure are discussed. We feel that procedure of choice is the simplest, least dangerous one which will give good results in the individual patient. Rather than using the same routine procedure in each patient, we fitted the treatment to each patient. Our experience, particularly with the simple vulvovaginoplasty technique, is given. Postoperative support and encouragement are needed to have a successful outcome.     

Vaginal laser surgery.

Vaginal epithelial lesions including endometriosis, cysts, septae, human papillomavirus (HPV) disease, and vaginal intraepithelial neoplasia (VaIN) can be successfully treated by laser surgery. The carbon dioxide laser with a wavelength of 10,600 nm is the ideal laser for these clinical applications. Pretreatment evaluation using colposcopically directed biopsies is mandatory. Adherence to surgical techniques including the selection of a delivery system, control of thermal injury, depth of destruction and bleeding, as well as determination of treatment margins and therapeutic endpoints are critical for optimal clinical outcome. After treatment of HPV disease and VaIN, long-term follow-up is essential for this group of patients who are at risk for invasive cancer.     

Vaginal bromocriptine--clinical and biochemical effects.

Adverse effects occur in over 50% of women taking oral bromocriptine, causing at least 10% to discontinue treatment. Although the drug is absorbed from the vagina and reportedly caused no side-effects in one patient intolerant of oral bromocriptine, long-term clinical effects of daily vaginal administration have not been assessed. We have now given bromocriptine vaginally for up to 2 years to 31 hyperprolactinemic and five normoprolactinemic women, 17 of whom were intolerant of oral bromocriptine. The drug was well absorbed from the vagina and a daily dosage of 2.5 mg lowered serum prolactin levels in 28 of the hyperprolactinemic women (in 11 to within normal limits), restored menstrual cyclicity, and abolished galactorrhea; one of the four infertile women conceived. Minor side-effects occurred in only three women. Vaginal administration is clinically effective, avoids the adverse effects of oral therapy and could be the first-line treatment for patients requiring bromocriptine.     

Vaginal birth and natural outcome.

Vaginal delivery is reviewed from a urogynecologic perspective. The birthing process is recognized to be clearly traumatic to the pelvic floor. Directed study is suggested as a means by which predisposing factors for injury may be identified. Ultimately we may be better able to select the optimal mode of delivery for all women.     

Vaginal douching. Who and why?

Despite the long history of vaginal douching and its estimated practice by more than 67 million U.S. women, little is known about who those women are or why they douche. We addressed these questions by studying 618 women from urban gynecology practices. Fifty-nine percent had douched at some time, with the most frequent reason given as hygiene. The solutions used were evenly divided between commercial and home preparations. Three characteristics stood out among the women who douched: lower socioeconomic status, greater risk of sexually transmitted diseases and symptoms suggestive of vaginal infection. These characteristics were most common among women who douched frequently. The results suggest that douching has a strong cultural component but also raise the possibility that douching may be done in response to a perceived infection, possibly one transmitted through sexual contact.     

Vaginal fibroma. Case report

A case of a vaginal fibroma in a 50-year-old woman is presented. The tumor presented as a solid mass in the upper third of the anterior vaginal wall. Intravenous pyelography (IVP) and cystoscopy excluded any association of the mass with the urinary tract. Surgical excision of the tumor was easily accomplished and histopathological examination established the diagnosis of a fibroid tumor of the vagina.     

Vaginal malignancies in childhood and adolescence.

Throughout the years 1978-1998, 13 patients, 9 months to 16 years of age, were treated for vaginal malignancy at the Medical City Hospital, Baghdad, Iraq. The majority were found to have an embryonal sarcoma, an endodermal sinus tumour or a clear cell adenocarcinoma. Most were treated by genital resection combined with triple cytotoxic therapy. We have eight survivors for more than 3 years following surgery. This study also illustrates the potential curability of these tumours with preservation of urinary function.