Herpes Simplex of the Lower Genital Tract in the Female

Summary: An "epidemic" of vaginal herpes simplex in 18 gynaecological patients in the 3-year period, January 1968 to February 1971, is presented. The basis of diagnosis has been in most cases an acute illness (13 of 18 patients), a positive cytology report (13 of 17 patients) and a positive herpes simplex virus culture report (13 of 15 patients).
Early in the series the clinical picture was of a significant illness in which the cervix was primarily involved. The clinical picture then changed, the patients more commonly presenting with acute vulvitis and either marked dysuria or retention of urine.
The implication of this infection to the fetus in the last weeks of pregnancy and its relationship to invasive carcinoma of the cervix is discussed.     

Placental Pathology in Patients Using Cocaine: An Observational Study

Objective: Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users.Methods: Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups.Results: Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%.Conclusion: Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.     

SARS-CoV-2 Pneumonia Affects Male Reproductive Hormone Levels: A Prospective,Cohort Study

BackgroundSARS-CoV-2 which causes coronavirus disease 2019 (COVID-19) binds to angiotensin-converting enyzme 2 (ACE2) and enters the host cell. ACE2 protein is expressed highly in the testis.AimThe aim of this study was to compare male reproductive hormones such as total testosterone (TT), luteinizing hormone (LH), follicular stimulant hormone (FSH), and prolactin between patients with COVID-19, age-matched cases with non–COVID-19 respiratory tract infection, and age-matched controls.MethodsThis was a prospective cohort study and included 262 men aged between 20 and 65 years. The study comprised 3 groups including patients with COVID-19 (n = 89), cases with non–COVID-19 respiratory tract infection (n = 30), and age-matched controls (n = 143). All cases were evaluated using TT, LH, FSH, and prolactin. Correlations between TT and clinical parameters of patient groups were investigated using Pearson's correlation test.OutcomesThe primary outcome of the study was detection of the difference of TT, FSH, LH, and prolactin levels between the groups. Secondary outcome was to correlate TT and hospitalization time and oxygen saturation on hospital admission (SpO2) of patients.ResultsThe mean age of study groups was 49.9 ± 12.5 years, 52.7 ± 9.6 years, and 50 ± 7.8 years, respectively (P = .06). Serum TT levels was median 185.52 ng/dL in patients with COVID-19, median 288.67 ng/dL in patients with non–COVID-19 respiratory tract infection and median 332 ng/dL in control cases, (P < .0001). The proportion of patients with testosterone deficiency in group 1, group 2, and group 3 was 74.2%, 53.3%, and 37.8%, respectively (P < .0001). Serum LH levels (P = 0.0003) and serum prolactin levels (P = .0007) were higher in patients with COVID-19 and patients with non–COVID-19 respiratory tract infection than control cases. Correlation analysis revealed significant negative correlation between serum TT levels and hospitalization time of patients with COVID-19 (r = –0.45, P < .0001). In addition, a significant positive correlation was observed between SpO2 and serum TT levels in patients with COVID-19 ( r = 0.32, P = .0028).Clinical ImplicationsPhysicians may consider to evaluate male patients with COVID-19 for concomitant androgen deficiency.Strengths & LimitationsStrengths include the evidence about the alteration of male reproductive hormones under COVID-19. Limitations include the analysis limited to one general hospital, only a single measurement of TT was available, free and bioavailable testosterone levels were not evaluated.ConclusionThis study demonstrates COVID-19 is associated with decreased level of TT and increased level of LH and prolactin. More serious COVID-19 causes more reduction in TT levels and prolongs hospitalization period.Kadihasanoglu M, Aktas S, Yardimci E, et al. SARS-CoV-2 Pneumonia Affects Male Reproductive Hormone Levels: A Prospective, Cohort Study. J Sex Med 2021;18:256–264.     

Puerperal Infections of the Genital Tract: A Clinical Review

Puerperal genital tract infections, although less common in the 21^st century, continue to affect maternal mortality and morbidity rates in the United States. Puerperal genital tract infections include endometritis as well as abdominal and perineal wound infections. These infections interrupt postpartum restoration, increase the potential for readmission to a health care facility, and can interfere with maternal‐infant bonding. In addition, unrecognized or improperly treated genital tract infection could extend to other sites via venous circulation or the lymphatic system and increase the risk of severe complications or sepsis. Midwives are leaders in education, low rates of intervention, and prompt recognition of deviation from normal. Because puerperal genital tract infection usually begins after discharge, detailed education for women will encourage preventative health care, prompt recognition, and treatment.     

Pregnancy in Women Aged 35 Years and Above: A Prospective Observational Study

Abstract

Pregnancy is affected by maternal age from conception till delivery. Various studies have been conducted globally to study this effect; few in developing countries. Maternal age is increasing in developing countries as well, so we have conducted this study.

Method

This was a prospective observational study consisting of 1,263 women booked at Jehangir hospital during a period of 2 years, fulfilling inclusion criteria and consenting for the study. They were divided into two groups; women aged 35 years and above and women less than 35 years of age. Pregnancy outcomes were studied in terms of antepartum, intrapartum and postpartum complications. Neonatal outcomes were studied in terms of birth weight and NICU admissions. Data was analyzed statistically using statistical package for social sciences version 17, by applying Chi square test and Fisher exact test. A p value below 0.05 was considered significant.

Results

Women aged 35 years and above constituted 9.63 % of the total study population. Most were multigravidae. Rate of assisted conception was significantly higher among women aged 35 years and above; early pregnancy loss was also high in this group. Pre-eclampsia and abruption were significantly higher among them. Neonatal outcomes were comparable.

Conclusion

Women with advanced maternal age are at higher risk of complications from conception till delivery and should be provided close supervision for better pregnancy outcome.     

Low-Dose Aspirin Does Not Increase Implantation Rates in Patients Undergoing Intracytoplasmic Sperm Injection: A Prospective Randomized Study

Purpose: The aim was to evaluate the effect of aspirin on pregnancy and implantation rates in an unselected group of patients undergoing intracytoplasmic sperm injection (ICSI). Methods: Two hundred and seventy-nine patients were randomized to receive 80 mg of aspirin (n = 139) or no treatment (r = 136) starting from the first day of controlled ovarian hyperstimulation. Results: Duration of stimulation, gonadotropin consumption, peak estradiol, number of oocytes retrieved, fertilization rate, cleavage rate, and number of embryos transferred were similar in the two groups. Implantation and clinical pregnancy rates were 15.6% and 39.6% versus 15.1% and 43.4% in aspirin treated and untreated groups, respectively (P > 0.05). Conclusions: Low-dose aspirin administration does not improve implantation and pregnancy rates in an unselected group of patients undergoing ICSI.     

原发性生殖器恶性黑色素瘤15例临床分析

目的：探讨原发性生殖器恶性黑色素瘤的诊断、治疗特点及影响预后的因素。方法：对我院收治的１５例原发性生殖器恶性黑色素瘤的临床资料进行回顾性分析。结果：发生于外阴、阴道，宫颈的黑色素瘤分别为４例、９例、２例。１１例行手术切除辅以化疗加免疫疗法，４例行化疗和免疫等疗法。１５例中，１例失访，５例生存＜１年，７例＜２年，２例＞３年，其中１例存活１９年。结论：原发性生殖器恶性黑色素瘤预后差。其治疗以手术为主，并辅以化疗和免疫疗法的综合治疗。     

Male‐to‐Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

BackgroundPatients with male‐to‐female gender dysphoria (GD) require multidisciplinary assessment and management. Nowadays, more and more patients decide to undergo genital reassignment surgery (GRS) to have aesthetic and functional external female genitalia. Different techniques of this procedure have been described. Orchiectomy, penile disassembly, creation of a neovaginal cavity, repositioning of urethral meatus, and clitorolabioplasty may be identified as the five major steps in all of these techniques.MethodsWe conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male‐to‐female GD at our department between November 2008 and August 2013 with a minimum follow‐up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department.ResultsFollow‐up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases.ConclusionsGRS can provide good functional and aesthetic outcomes in patients with male‐to‐female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina. Raigosa M, Avvedimento S, Yoon TS, Cruz‐ Gimeno J, Rodriguez G, and F ontdevila J. Male‐to‐female genital reassignment surgery: A retrospective review of surgical technique and complications in 60 patients. J Sex Med 2015;12:1837–1845.     

Role of Serum High-Sensitivity C-Reactive Protein as a Predictor of Therapeutic Response to Tadalafil in Patients With Erectile Dysfunction: A Prospective Observational Study

IntroductionHigh-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, is known to be elevated in patients with erectile dysfunction (ED). However, its role in predicting therapeutic response to phosphodiesterase-5 inhibitors is incompletely understood.AimThe aim of this study was to understand the relationship among hs-CRP, mechanism of ED, and therapeutic response of ED to tadalafil, a phosphodiesterase-5 inhibitor.MethodsA total of 282 men (mean age 36.6 ± 12.0 years) with ED were included. All subjects underwent detailed evaluation, including estimation of a 6-item abbreviated version of the International Index of Erectile Function (IIEF-6) score, penile Doppler studies, and measurement of hs-CRP. IIEF-6 scoring and hs-CRP measurement were repeated after 6 weeks of tadalafil therapy (10 mg/day). The patients were categorized into vasculogenic and nonvasculogenic ED groups based on penile Doppler findings.Main Outcome MeasureThe main outcome measure was the therapeutic response to tadalafil, in relation to the mechanism of ED and hs-CRP levels.ResultsVasculogenic ED was much less common (23.8% of the subjects) than non-vasculogenic ED. Subjects with vasculogenic ED were older, had higher prevalence of cardiovascular risk factors, had more severe (mean IIEF-6 score 9.2 ± 4.6 vs 14.8 ± 4.7; P < .001) and longer duration ED, and responded less favorably to therapy (response rate 10.4% vs 75.0%; P < .001). Those showing improvement with tadalafil had lower hs-CRP at baseline (median 1.5 mg/L [interquartile range 0.9?2.3] vs 2.0 mg/L [interquartile range 1.1?3.1; P = .034]) and had proportionately greater reduction in its level. However, on multivariate analysis, only shorter duration of ED (P = .008), non-vasculogenic origin (P = .025), and higher IIEF-6 score at baseline (P = .013) were independent predictors of response to treatment.Clinical ImplicationsSerum hs-CRP is elevated in patients who are less likely to respond to vasodilator therapy but does not have an independent predictive value for this purpose.Strengths & LimitationsThis is the largest study to evaluate the relationship among the mechanism of ED, serum hs-CRP level, and therapeutic response of ED to tadalafil. All patients underwent a penile Doppler study to characterize the type of ED. The limitations were nonrandomized nature of the study and nearly 22% dropout rate.ConclusionSerum hs-CRP level is higher in vasculogenic ED compared with non-vasculogenic ED, and is associated with poorer response to tadalafil therapy. However, this association is not independent of underlying risk factors and mechanism of ED.Jamaluddin, Bansal M, Srivastava GK, et al. Role of Serum High-Sensitivity C-Reactive Protein as a Predictor of Therapeutic Response to Tadalafil in Patients With Erectile Dysfunction: A Prospective Observational Study. J Sex Med 2019;16:1912–1921.     

A Comparative Randomized Prospective Study to Evaluate Efficacy and Safety of Combination of Tamsulosin and Tadalafil vs. Tamsulosin or Tadalafil Alone in Patients with Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia

IntroductionLower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and erectile dysfunction are common disorders of advancing age.AimTo evaluate the efficacy and safety of tamsulosin and tadalafil in patients with LUTS due to BPH.MethodsIn this prospective randomized study, 133 men complaining of LUTS due to BPH were included. Forty-five patients received tamsulosin 0.4 mg/day alone (Group A), 44 patients received tadalafil 10 mg/day (Group B), and combination therapy (tamsulosin and tadalafil both) was instituted in 44 patients (Group C). After a 2-week medication free run-in period, they were evaluated for International Prostatic Symptom Score (IPSS), International Index of Erectile Function score (IIEF5), quality of life (IPSS QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR) volume, and safety parameters before and at 3 months of treatment.Main Outcome MeasuresThere were primary (IPSS, IPSS QoL index, Qmax, and PVR) and secondary (erectile function [EF] domain scores from IIEF5) efficacy end points. Safety assessment included laboratory tests and patient's reporting of adverse event.ResultsA significant improvement in IPSS score was observed in all the 3 groups A, B, and C (−50.90%, P < 0.05; −33.50%, P < 0.05; and −53.90%, P < 0.05, respectively). IIEF5 score increased significantly in these three groups (+39.28%, P < 0.05; +45.96%, P < 0.05; and +60.23%, P < 0.05, respectively). A significant increase in Qmax and decrease in PVR were also observed (33.99%, P < 0.05; 29.78%, P < 0.05; and 37.04%, P < 0.05) and (−60.90%, P < 0.05; −49.45%, P < 0.05; and −62.97%, P < 0.05, respectively). The QoL scores improved significantly (−73.35%, P < 0.05; −70.26%, P < 0.05; and −79.65%, P < 0.05, respectively). Side effects were dyspepsia, heartburn, headache, flushing, myalgia, and backache. Adverse effect dropout was 3.7%. No participant experienced any severe or serious adverse events.ConclusionsIn patients with LUTS due to BPH, tamsulosin and tadalafil alone or in combination cause a significant improvement in patients with LUTS. Their EF also improves with these medications. The improvement is better with combination therapy compared with single agent alone. Singh DV, Mete UK, Mandal AK, and Singh SK. A comparative randomized prospective study to evaluate efficacy and safety of combination of tamsulosin and tadalafil vs. tamsulosin or tadalafil alone in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. J Sex Med 2014;11:187–196.     

Assessment of Neonatal Cord Blood SARS-CoV-2 Antibodies after COVID-19 Vaccination in Pregnancy: A Prospective Cohort Study

Introduction Maternally derived antibodies are a key element of neonatal immunity. So far, limited data has shown transplacental transmission of antibodies after coronavirus disease 2019 (COVID-19) vaccination with BNT162b2 in the third trimester. Our aim was to detect vertically transferred immunity after COVID-19 vaccination with BNT162b2 (Comirnaty, BioNTech-Pfizer) or mRNA-1273 (Spikevax, Moderna) in the first, second or third trimester of pregnancy, and investigate the impact of maternal characteristics on umbilical cord antibody titre in newborns after delivery. Study Design Women who gave birth in our department and were vaccinated against COVID-19 during pregnancy were enrolled in CRONOS Satellite, a subproject of the German COVID-19-Related Obstetric and Neonatal Outcome Study. The titre of immunoglobulin G (IgG) antibodies to the receptor-binding domain of the SARS-CoV-2 spike protein was quantified in umbilical cord blood using the SARS-CoV-2 IgG II Quant immunoassay. Correlations between antibody titre and variables, including week of pregnancy when vaccinated, interval between vaccination and delivery, age and body mass index (BMI) were assessed with Spearmanʼs rank correlation. A follow-up was conducted by phone interview 4 – 6 weeks after delivery. Results The study cohort consisted of 70 women and their 74 newborns. Vaccine-generated antibodies were present in all samples, irrespective of the vaccination type or time of vaccination. None of the parameters of interest showed a meaningful correlation with cord blood antibody concentrations (rho values < 0.5). No adverse outcomes (including foetal malformation) were reported, even after vaccination in the first trimester. Conclusions Transplacental passage of SARS-CoV-2 antibodies from mother to child was demonstrated in all cases in the present study. It can therefore be assumed that the newborns of mothers vaccinated at any time during pregnancy receive antibodies via the placenta which potentially provide them with protection against COVID-19. This is an additional argument when counselling pregnant women about vaccination in pregnancy. Key words: SARS-CoV-2 vaccine, pregnancy, booster shot, vertical immunity     

A Prospective Study on the Association Between Lower Urinary Tract Symptoms (LUTS) and Erectile Dysfunction: Results from a Large Study in Elderly Chinese in Southern China

IntroductionAlthough many cross-sectional studies have been conducted on the association between lower urinary tract symptoms (LUTS) and erectile dysfucntion (ED), no studies were prospective in Asia.AimThe relationship between LUTS and ED is examined using a prospective cohort of 2000 Chinese men.MethodsBaseline and 4-year data from a large prospective cohort study of 2000 Chinese elderly men were analyzed. A total of 1,736 subjects were included in the current analysis after excluding those with history of bladder or prostate cancer, or urological surgery, and those who used alpha blockers or anti-androgen.Main Outcome MeasuresLUTS were measured at baseline by the International Prostatic Symptom Score and ED was measured using one question on impotence at the end of 4 years.ResultsA dose–response relationship was observed for the relationship between baseline severity of LUTS and severity of ED at follow-up with those who had more severe LUTS at baseline with an increased odds of having more severe ED (odd ratio [OR] = 1.86, confidence interval [CI]: 1.16–2.97 for mild LUTS at baseline; OR = 2.95, CI: 1.81–4.81 for moderate LUTS at baseline; and OR = 3.82, CI: 2.00–7.27 for severe LUTS at baseline). Other baseline factors that were statistically significantly associated with ED included body mass index (OR = 1.13, CI: 1.01–1.26), hypertension (OR = 1.30, CI: 1.02–1.65) and diabetes (OR = 1.44, CI: 1.07–1.93).ConclusionThe presence of LUTS is associated with ED with more severe LUTS being associated with higher degree of ED in men. Wong SY, Leung JC, and Woo J. A prospective study on the association between lower urinary tract symptoms (LUTS) and erectile dysfunction: Results from a large study in elderly chinese in southern China. J Sex Med 2009;6:2024–2031.     

An Evaluation of the Counselling Given to Patients Having a Therapeutic Abortion

The results of a questionnaire evaluating patient's reactions to counselling for their therapeutic abortion are reported. Most considered that counselling was necessary and that it provided support throughout the abortion process. The counselling appeared to relieve anxiety for many patients, but seemed to be less effective for patients who were not of European origin.     

Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective,Observational Study

IntroductionEjaculatory dysfunctions other than premature ejaculation are commonly encountered in specialized clinics; however, their characterization in community‐dwelling men is lacking.AimThe aim of this study was to evaluate the prevalence, severity, and associated distress of four ejaculatory dysfunctions: delayed ejaculation (DE), anejaculation (AE), perceived ejaculate volume reduction (PEVR) and/or decreased force of ejaculation (DFE) as a function of demographic and clinical characteristics in men.MethodsObservational analysis of 988 subjects presenting with one or more types of ejaculatory dysfunctions other than premature ejaculation who screened for a randomized clinical trial assessing the efficacy of testosterone replacement on ejaculatory dysfunction. Demographic and clinical characteristics were assessed as potential risk factors using regression analysis.Main Outcome MeasuresThe main outcome measures used were ejaculatory dysfunction prevalence and scores (3‐item Men's Sexual Health Questionnaire Ejaculatory Dysfunction‐Short Form [MSHQ‐EjD‐SF]), and bother (MSHQ‐EjD‐SF Bother item) and sexual satisfaction/enjoyment (International Index of Erectile Function Questionnaire Q7, Q8) as a function of subject's age, race, body mass index (BMI) and serum testosterone levels (measured by liquid chromatography tandem mass spectrometry).ResultsMean (standard deviation [SD]) age of the participants was 52 years (11). Eighty‐eight percent of the men experienced more than one type of ejaculatory dysfunction and 68% considered their symptoms to be bothersome. Prevalence of the ejaculatory dysfunctions was substantial across a range of age, race, BMI, and serum testosterone categories. Prevalence of PEVR and DFE were positively associated with age (<40 years vs. 60–70 years: PEVR: odds ratio [OR], 3.05; 95% confidence interval [CI], 1.32–7.06; DFE: OR, 2.78; 95% CI, 1.46–5.28) while DFE was associated with BMI (≥30 kg/m² vs. < 25 kg/m²: OR, 1.80; 95% CI, 1.062–3.05). All ejaculatory dysfunctions were more prevalent in black men.ConclusionThe majority of the participants experienced multiple ejaculatory dysfunctions and found them to be highly bothersome. Ejaculatory dysfunctions were prevalent across a wide range of demographic and clinical characteristics. Paduch DA, Polzer P, Morgentaler A, Althof S, Donatucci C, Ni X, Patel AB, and Basaria S. Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: a Prospective, Observational Study. J Sex Med 2015;12:2276–2286.