New Perspectives on the Normal Vagina and Noninfectious Causes of Discharge

Powell, Ann‐Marie; Nyirjesy, Paul

doi:10.1097/grf.0000000000000124

Cited by 12 publications

(8 citation statements)

References 34 publications

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“…This runs counter to current notions about Bacteroides , an anerobic bacteria which is considered a commensal of the gastrointestinal tract and has been implicated in BV [ 73 , 74 ]. However, not all vaginal discharge should be considered abnormal [ 75 , 76 ], and therefore it would not be a contradiction for Bacteroides to be associated with a decreased prevalence of “healthy” vaginal discharge (such as cervical mucous released during ovulation) and an increased prevalence of clinical BV. Distinctions such as these will become increasingly important as the scientific community attempts to attain a more nuanced understanding of connections between the microbiome and true clinical disease.…”

Section: Resultsmentioning

confidence: 99%

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

et al. 2018

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The vaginal microbiome plays an influential role in several disease states in reproductive age women, including bacterial vaginosis (BV). While demographic characteristics are associated with differences in vaginal microbiome community structure, little is known about the influence of sexual and hygiene habits. Furthermore, associations between the vaginal microbiome and risk symptoms of bacterial vaginosis have not been fully elucidated. Using Bayesian network (BN) analysis of 16S rRNA gene sequence results, demographic and extensive questionnaire data, we describe both novel and previously documented associations between habits of women and their vaginal microbiome. The BN analysis approach shows promise in uncovering complex associations between disparate data types. Our findings based on this approach support published associations between specific microbiome members (e.g., Eggerthella, Gardnerella, Dialister, Sneathia and Ruminococcaceae), the Nugent score (a BV diagnostic) and vaginal pH (a risk symptom of BV). Additionally, we found that several microbiome members were directly connected to other risk symptoms of BV (such as vaginal discharge, odor, itch, irritation, and yeast infection) including L. jensenii, Corynebacteria, and Proteobacteria. No direct connections were found between the Nugent Score and risk symptoms of BV other than pH, indicating that the Nugent Score may not be the most useful criteria for assessment of clinical BV. We also found that demographics (i.e., age, ethnicity, previous pregnancy) were associated with the presence/absence of specific vaginal microbes. The resulting BN revealed several as-yet undocumented associations between birth control usage, menstrual hygiene practices and specific microbiome members. Many of these complex relationships were not identified using common analytical methods, i.e., ordination and PERMANOVA. While these associations require confirmatory follow-up study, our findings strongly suggest that future studies of the vaginal microbiome and vaginal pathologies should include detailed surveys of participants’ sanitary, sexual and birth control habits, as these can act as confounders in the relationship between the microbiome and disease. Although the BN approach is powerful in revealing complex associations within multidimensional datasets, the need in some cases to discretize the data for use in BN analysis can result in loss of information. Future research is required to alleviate such limitations in constructing BN networks. Large sample sizes are also required in order to allow for the incorporation of a large number of variables (nodes) into the BN, particularly when studying associations between metadata and the microbiome. We believe that this approach is of great value, complementing other methods, to further our understanding of complex associations characteristic of microbiome research.

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Section: Resultsmentioning

confidence: 99%

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

et al. 2018

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“… 40 Nevertheless, most instances of vaginal discharge are normal and physiological unless accompanied by odor, discomfort, or pruritus. 44 Misperceptions about the vaginal discharge associated with vaginal progesterone administration for LPS can lead to reluctance on the part of some health care professionals to recommend various vaginally administered progesterones. 45 In the current audit, despite reporting vaginal discharge, most patients stated that they perceived the progesterone vaginal tablet to be comfortable, convenient, and easy to use.…”

Section: Discussionmentioning

confidence: 99%

A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest<sup>®</sup>) for luteal phase support during IVF treatment

Heine

Sellar

Whitten³

et al. 2017

PROM

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PurposeThe aim of this audit was to assess the overall experience and patient convenience of vaginal progesterone tablets (Lutigest®, marketed as Endometrin® in the USA) used for luteal phase support (LPS) during in vitro fertilization (IVF) treatment.Patients and methodsThis questionnaire-based audit included responses from 100 patients undergoing IVF treatment at six IVF clinics in the UK from September 2015 to November 2016. Fourteen days after starting progesterone supplementation for LPS during their IVF treatment, patients rated overall experience and perceived convenience of the prescribed progesterone by completing a questionnaire.ResultsOf the 100 patients included, 96 received vaginal progesterone tablets for LPS. Overall, 53.1% (51/96) indicated that the progesterone tablets were “very easy” to use; 42.7% (41/96) and 44.8% (43/96) found it “very convenient” or “neither convenient or inconvenient” to administer the tablet, respectively. Overall experience with using progesterone tablets was rated as “very comfortable” by 34.4% (33/96) and “neither comfortable or uncomfortable” by 56.3% (54/96) of patients. The applicator was used by 93.8% (90/96) of patients to administer the tablet, and 86.5% (83/96) indicated that the applicator was easy to clean for repeated use. A total of 33 patients had a previous IVF cycle during which they were prescribed vaginal progesterone pessaries for LPS. Compared with progesterone pessaries, the majority found treatment with progesterone tablets to be more comfortable (60.6%; 20/33) and more convenient (57.6%; 19/33) and indicated that the progesterone tablet was their preferred progesterone formulation for LPS (60.6%; 20/33).ConclusionThese findings offer insights into real-world patient experiences with the progesterone vaginal tablet formulation. The results suggest overall patient convenience, ease, and comfort with using progesterone vaginal tablets for LPS. The majority of patients found progesterone vaginal tablets more convenient and comfortable to use compared with progesterone pessaries.

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“…There are differences in the composition of normal bacteria in menopausal women. Estrogen is known to play an important role in glycogen deposits and maturation of vaginal epithelium [13]. Hummelen, et al in 2011 observed that the microbiota in menopausal women was dominated by L. iners and L. vaginalis.…”

Section: Etiopatogenesismentioning

confidence: 99%

“…Meanwhile, normal vaginal flora in peri-menopausal women is dominated by L. gasseri or L. jensenii [13].…”

Section: Etiopatogenesismentioning

confidence: 99%

Etiology, Diagnosis, and Treatment of Leukorrhea

et al. 2021

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The most frequently reported complaints in the urogenital organ system is leukorrhea, also known as fluor albus. Leukorrhea is a discharge secreted from the genital organs, mostly occur in female. Leukorrhea has a significant incidence rate and varies according to many factors such as hormone and infection. Leukorrhea can be physiological in female, but when excess discharge is accompanied by other characteristics, the leukorrhea is considered pathological. This genital discharge also occurs in male for pathological reasons, mainly caused by infection. Several pathogenic infections, whether transmitted through secual contact or not, are the etiology of complaints of leukorrhea. Some specific pathogens will cause different symptoms in the two sex groups. To make a diagnosis, it is important for the examiner to carry out a detailed and coherent history, especially regarding sexual contact and a history of risky sexual behavior. Although some infections are asymptomatic, complications may occur if infections are not treated properly as early as possible. The management of leukorrhea is based on an examination and treatment algorithm with syndromic approach.

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New Perspectives on the Normal Vagina and Noninfectious Causes of Discharge

Cited by 12 publications

References 34 publications

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest<sup>®</sup>) for luteal phase support during IVF treatment

Etiology, Diagnosis, and Treatment of Leukorrhea

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New Perspectives on the Normal Vagina and Noninfectious Causes of Discharge

Cited by 12 publications

References 34 publications

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

Associations between sexual habits, menstrual hygiene practices, demographics and the vaginal microbiome as revealed by Bayesian network analysis

A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest<sup>&reg;</sup>) for luteal phase support during IVF treatment

Etiology, Diagnosis, and Treatment of Leukorrhea

Contact Info

Product

Resources

About

A questionnaire-based audit to assess overall experience and convenience among patients using vaginal progesterone tablets (Lutigest<sup>®</sup>) for luteal phase support during IVF treatment