The composition of vaginal microbiome in menopause and cancer survivor women changes dramatically leading to genitourinary syndrome of menopause (GSM) in up to 70% of patients. Recent reports suggest that laser therapy may be valuable as a not hormonal therapeutic modality. The aim of the present study was to evaluate the effects of fractional CO laser treatment on the vaginal secretory pathway of a large panel of immune mediators, usually implicated in tissue remodeling and inflammation, and on microbiome composition in postmenopausal breast cancer survivors. The Ion Torrent PGM platform and the Luminex Bio-Plex platform were used for microbiome and immune factor analysis. The significant reduction of clinical symptoms and the non-significant changes in vaginal microbiome support the efficacy and safety of laser treatment. Moreover, the high remodeling status in vaginal epithelium is demonstrated by the significant changes in inflammatory and modulatory cytokine patterns. Laser therapy can be used for the treatment of GSM symptoms and does not show any adverse effects. However, further studies will be needed to clarify its long-term efficacy and other effects.
Introduction In polycystic ovarian syndrome (PCOS) women, the changes in body appearance (mainly obesity and hirsutism) may influence the feminine identity of the patients with consequent depression and sexual disturbances. Aim To evaluate if lean PCOS patients present an increased incidence of depression and sexual dysfunction in comparison with controls and if clitoral volume and vascularization are influenced by circulating androgens levels. Methods 25 lean PCOS women (Group I) and 18 healthy nonhirsute volunteers (Group II) were submitted, on day 3–5 of the cycle, to ultrasonographic and Doppler analyses, and to hormonal and biochemical evaluations. Main Outcome Measures Utero-ovarian and clitoral ultrasonographic analysis, and color Doppler evaluation of the uterine, stromal ovarian, and dorsal clitoral arteries. Hormonal and nitrites/nitrates plasma concentrations were analyzed. Each woman filled in the 2-factor Italian McCoy female questionnaire (MFSQ) and the Beck's Depression Inventory questionnaire (BDI). Results Androgens resulted, as expected, more elevated in PCOS patients than in controls. However, the ultrasonographic (US) assessment of the clitoral body volume evidenced no significant differences between PCOS (0.72 ± 0.41 mL) and control (0.62 ± 0.20 mL) patients. The resistances registered at the level of the dorsal clitoral artery did not show any difference between Group I (PI = 1.55 ± 0.40) and Group II (PI = 1.79 ± 0.38). The 2-factor Italian MFSQ and the BDI did not show any difference between PCOS women and controls. Conclusions In PCOS women, probably, the moderate hirsutism and hyperandrogenism do not induce the sense of loss of feminine identity and have no impact on sexual self-worth and sexual satisfaction.
Background and Objectives:Uterine arteriovenous malformation (AVM) is characterized by shunts between the myometrial arteries and veins. Treatment is based on the severity of uterine bleeding and ranges from conservative medical approaches to embolization of affected arteries. The aim of study was to evaluate the feasibility and safety of hysteroscopy for management of uterine AVM.Methods:This was a retrospective study of a cohort of 11 cases occurring between March 2012 and December 2015 in our Regional Center of Excellence in Hysteroscopy, University of Florence. The diagnosis of AVM was made by transvaginal ultrasonography with high-definition flow in patients with mild to moderate symptoms. In all cases, we used the hysteroscopic platform Gynecare VersaPoint II (Ethicon, Somerville, New Jersey, USA), equipped with a 4-mm electrosurgical loop and associated with the SPIES (Storz Professional Image Enhancement System) system (Karl Storz, Tuttlingen, Germany).Results:All patients were successfully treated with operative hysteroscopy with no reported complications. No patient had residual disease detected by ultrasonography performed after a month. At this writing, of the 11 patients treated with operative hysteroscopy, 4 had achieved a pregnancy that carried to term, 1 was pregnant at 20 wk, and 1 had a miscarriage in the first trimester.Conclusions:Hysteroscopy is a feasible and safe alternative treatment modality for AVM. Patients treated with surgical hysteroscopy have high fertility outcomes, a 100% success rate after the first treatment, no complications related to the surgical procedure, and a short hospital stay.
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