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Trichomonas
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
The clinical manifestations of trichomoniasis are unchanged in pregnant women. Infection is asymptomatic in up to 50% of women. The most common symptoms include vulvovaginal pruritus (7–11%), vaginal discharge (10–17%), dysuria (30–50%), and dyspareunia (10–50%). The most common signs are copious vaginal discharge (50–75%) (yellow/green in 5–20%, frothy in 10–50%), inflammation of vaginal mucosa (40–75%), vulvar erythema (10–20%) and abdominal pain (1–5%) [4].
Radiation Damage of the Reproductive Organs
Published in Kedar N. Prasad, Handbook of RADIOBIOLOGY, 2020
In the female, in contrast to the male, radiation not only destroys the radiosensitive gametogenic epithelium, but also much of the production of sex hormones. In general, in growing follicles, postirradiation damage to granulosa cells is seen before changes in oocytes. The female is more sensitive than the male on the criterion of sterility. Unlike the male, sterility in the female is immediate. Age is a very important factor in producing radiation-induced sterility. The younger individuals (less than 40 years) require larger doses than those over 40 years to induce menopause. The uterus is highly radioresistant. The response of the vaginal mucosa is similar to that of mucous membranes elsewhere in the body. The phases of acute erythema, moist desquamation, and mucositis are clinically similar to those in oral mucosa. The tissues of the vulva, labia, and clitoris are relatively more radiosensitive. The normal mammary glands are radioresistant.
The immune system of the genitourinary tract
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
David A. MacIntyre, Kenneth W. Beagley
The female reproductive tract has upper and lower components. The lower female reproductive tract structures (ectocervix, vagina, and vulva) enable sperm to enter the body and protect the internal genital organs from potential pathogens. From the vulva to the vagina, the epidermis transitions from keratinized to stratified, nonkeratinized squamous epithelium. The vaginal mucosa consists of three distinct layers; (1) the outer surface layer, which is lubricated by mucus produced primarily by the cervix; (2) the intermediate layer, which acts as an active site of glycogen production; and (3) the basal layer, made up of actively dividing cells. Internal reproductive structures include the endocervix, uterus, and fallopian tubes (see Figure 20.1, left). The ovary produces both gametes (ova) and sex hormones (estradiol and progesterone). The fallopian tubes attached to the upper part of the uterus provide passage for the ovum from the ovary to the uterus. Following fertilization of an egg by a sperm in the fallopian tubes, the fertilized egg then moves to the uterus, where it implants into the lining of the uterine wall. Each site in the female reproductive tract functions to insure passage of sperm to the site of fertilization, permit release of menstrual flow, as well as provide a route of passage of the baby at birth.
Metabolism of the areca alkaloids – toxic and psychoactive constituents of the areca (betel) nut
Published in Drug Metabolism Reviews, 2022
Oral exposure of areca alkaloids, especially arecoline, is associated with the development of pre-cancerous and cancerous lesions of the oral cavity. To acquire greater insight as to how arecoline and arecaidine traverse mucosal membranes, their diffusion kinetics were indirectly studied in human buccal and vaginal mucosal samples (Van der et al. 2001). Flux rates of reduced arecoline across buccal mucosa were significantly higher than those of reduced arecaidine (Van der et al. 2001). A similar pattern was observed in human vaginal mucosa (Van der et al. 2001). This observation is likely explained by the different ionization and lipophilic properties of the compounds, in which reduced arecoline has greater lipophilicity and is less ionized than reduced arecaidine under the tested conditions at pH 7.9 (Van der et al. 2001). A limitation of this study was that reduced analogues of arecoline and arecaidine, in which tritium was added across the double bond (abolishing the electrophilicity of the compounds), were used. Hence, their findings, although intriguing, may not directly translate to the in vivo condition.
Estradiol softgel inserts for the treatment of VVA symptoms: an expert opinion
Published in Expert Opinion on Drug Delivery, 2020
James H. Liu, Brian Bernick, Sebastian Mirkin
Menopause is characterized by recognizable changes in vaginal epithelial cytology, including a decrease in superficial and intermediate cells and an increase in parabasal cells, in contrast to the premenopausal state. The vaginal mucosa comprises 4 cellular layers, which are stratified squamous epithelium, elastic lamina propria, fibromuscular layer, and adventitia. A biofilm coats the vaginal epithelium in premenopausal women but is less evident in postmenopausal women [6]. Thinning of the epithelium during menopause facilitates drug delivery into the deeper tissue layers [6]. Vaginal pH is typically less acidic in menopause and increases above 5.0. All of these changes are associated with symptoms of VVA [6], so improvements in these parameters can demonstrate the efficacy of vaginally administered treatments for VVA symptoms.
Clinical management of vaginal bleeding in postmenopausal women
Published in Climacteric, 2020
The initial physical examination should include a detailed evaluation of the external and internal genitalia, aiming to determine the bleeding site and looking for suspicious lesions, skin lacerations, or the presence of foreign bodies. A detailed inspection of the vulva, the urethra, and the anus is also recommended. A vaginal speculum examination should be performed, inspecting the vaginal mucosa and looking for atrophic vaginitis or suspicious vaginal lesions. Cervical cytology, if indicated, should be collected as part of the evaluation. Any cervical visible macroscopic lesion suspicious for cancer must be biopsied. A bimanual examination should then be performed to evaluate uterine size, mobility, the presence of adnexal pathology, and cervical motion tenderness. It may be appropriate to collect a vaginal swab if the presence of a sexually transmitted infection is suspected. To conclude, a general physical examination should be performed to look for signs of systemic illness.