Objective: To evaluate changes in female sexual function after treatment of symptomatic vaginitis, compare outcomes across different vaginitis etiologies, and identify predictors of persistent female sexual dysfunction. Methods: This prospective observational study included sexually active women diagnosed with bacterial vaginosis, vulvovaginal candidiasis, or trichomoniasis between January and June 2024 at a tertiary care hospital. Female sexual function was assessed using the Female Sexual Function Index (FSFI) before treatment and 1 month after treatment. Changes in FSFI scores were analyzed, and multivariable logistic regression identified independent predictors of persistent female sexual dysfunction. Results: A total of 158 women were included: 38 (24.0%) with vulvovaginal candidiasis, 75 (47.5%) with bacterial vaginosis, and 45 (28.5%) with trichomoniasis. Women with trichomoniasis were significantly younger and had lower body mass index than the other groups (both P <.001). The prevalence of FSD decreased from 80.4% to 27.2% after treatment (absolute reduction, 53.2 percentage points). Overall FSFI scores and all domain scores improved significantly (all P <.001). Daily pad use (OR=2.427, 95% CI: 1.007–5.851; P =.048) and smoking (OR=2.551, 95% CI: 1.069–6.088; P =.035) were independently associated with persistent FSD. Study limitations included the single-center design and short follow-up. Conclusions: Symptomatic vaginal infections are associated with impaired female sexual function. Appropriate treatment significantly improves sexual function and reduces the prevalence of female sexual dysfunction. Routine assessment of sexual health may contribute to more comprehensive management of women with vaginitis.
OBJECTIVE:To describe clinical response and safety of intralesional corticosteroid therapy for adult patients with persistent or refractory hyperkeratotic vulvar lichen sclerosus after histologic exclusion of neoplasia. METHODS:This was a descriptive case series of 3 adult women with vulvar lichen sclerosus and persistent hyperkeratotic plaques despite topical corticosteroid therapy. All patients underwent vulvar biopsy before intervention to exclude human papillomavirus-associated vulvar intraepithelial neoplasia, human papillomavirus-independent vulvar intraepithelial neoplasia, or squamous cell carcinoma. A single session used 0.25 mL triamcinolone acetonide 40 mg/mL diluted 1:1 with 0.25 mL 2% lidocaine (final concentration, 20 mg/mL; total dose, 10 mg) delivered through 4 to 6 points with a 0.5-mL insulin syringe and 0.30×8-mm needle. There was no comparator. Outcomes were clinical resolution, symptoms, Vulvar Quality of Life Index (VQLI) score, photographs, and adverse events. No statistical analysis was performed because of the descriptive design and small sample size. RESULTS:All patients showed complete clinical resolution at 4 months and no repeat infiltration. VQLI scores decreased from 35 to 12, 31 to 8, and 22 to 10, respectively. At March 2026 follow-up (median: 11 mo; range: 10 to 12), no clinical recurrence or local/systemic adverse events were observed or reported. The main limitations were the small number of cases, lack of a control group, descriptive design, and short follow-up. CONCLUSIONS:Intralesional triamcinolone may be a useful rescue therapy for selected patients with persistent or refractory hyperkeratotic vulvar lichen sclerosus, provided that neoplasia is excluded and long-term surveillance is maintained.
OBJECTIVE:To evaluate the recurrence of cervical intraepithelial neoplasia grade 2 or worse or carcinoma (CIN2+) after conization by post-treatment human papillomavirus (HPV) genotype, timing of HPV detection, and cone margin status. MATERIALS AND METHODS:We analyzed a retrospective cohort of unvaccinated women treated by conization for CIN2+ or carcinoma (2010-2024) with HPV genotyping performed more than 4 months after excision. Results were categorized as HPV16, HPV18, another 12 high-risk types pooled (hrHPV), or negative, and as early (4-12 mo) or late (>12 mo) after conization. Recurrence was histologically confirmed, and adjusted incidence rate ratios (aIRRs) were estimated using Poisson regression. RESULTS:Among 2,628 women with genotyping, early HPV16 detection had the highest CIN2+ recurrence rate, 294 per 1,000 person-years (py). Compared with early HPV16, recurrence was lower among women with the other 12 hrHPV types pooled (34 per 1,000 py; aIRR: 0.13; 95% CI: 0.06-0.26) and among those with HPV-negative results (2 per 1,000 py; aIRR: 0.01; 95% CI: 0.00-0.02). With late detection, recurrence remained highest among women with HPV16 positivity (321 cases per 1,000 py), whereas the recurrence rate associated with the pooled other 12 hrHPV genotypes was twice as high as that observed with early detection (74 cases per 1,000 py). Positive margins were associated with higher recurrence risk, primarily among women with early post-excision HPV positivity. CONCLUSIONS:Post-treatment HPV genotyping reveals marked heterogeneity in CIN2+ recurrence risk. This pattern may improve risk-stratified screening and may help interpret recurrence reductions reported after HPV16-containing vaccination.
OBJECTIVES/PURPOSES OF THE STUDY:This study aimed to describe and evaluate the feasibility and technical considerations of a modified loop electrosurgical excision procedure (LEEP) employing Foley catheter traction to enhance cervical stabilization and specimen integrity during excision. METHODS:This single-center retrospective feasibility study included patients who underwent LEEP for cervical dysplasia between January 2019 and November 2024. Patients treated using the modified LEEP technique constituted the feasibility group. A descriptive comparator group consisted of patients who underwent standard LEEP during the same period. Perioperative, pathologic, and postoperative outcomes were analyzed. RESULTS:A total of 123 patients underwent LEEP during the study period, of whom 108 met the inclusion criteria. No specimen fragmentation was observed in the modified technique group, whereas a small number of fragmented specimens occurred in the standard technique group. Margin positivity rates and postoperative outcomes appeared comparable between groups. The study was not designed or powered for formal comparative inference. CONCLUSIONS:The modified LEEP technique employing Foley catheter traction appears feasible and reproducible, with favorable technical characteristics related to cervical stabilization and specimen handling. These findings are hypothesis-generating and support the need for prospective studies to further evaluate this technique in routine clinical practice.
OBJECTIVE:Preventive strategies for bacterial vaginosis (BV) include sexual partner treatment, short-term consolidation therapy, and long-term maintenance interventions. This systematic review and network meta-analysis (NMA) compares the efficacy of these approaches and evaluates effect modification by baseline recurrence risk. PATIENTS AND METHODS:Randomized-controlled trials (from inception to January 31, 2026) evaluating interventions to prevent BV recurrence in nonpregnant women were categorized into 3 analyses: partner treatment (pairwise meta-analysis), consolidation therapy, and long-term prevention (random-effects NMA). Certainty of evidence was evaluated using GRADE and CINeMA. RESULTS:Partner treatment significantly reduced BV recurrence rates [incident rate ratio (IRR) =0.76, 95% CI=0.60-0.98; moderate-certainty evidence] compared with placebo/no treatment. In consolidation therapy, acidifying agents [risk ratio (RR)=0.22, 95% CI=0.08-0.62; moderate-certainty evidence], vaginal probiotics (RR=0.37, 95% CI=0.15-0.93; moderate-certainty evidence), and oral probiotics (RR=0.45, 95% CI=0.21-0.96; low-certainty evidence) reduced early recurrence or persistence compared with placebo. In long-term prevention, vaginal probiotics were the only intervention achieving statistical significance overall (IRR=0.74, 95% CI=0.58-0.96; moderate-certainty evidence). Among women at low baseline risk, oral probiotics (IRR = 0.49, 95% CI=0.28-0.85) and acidifying agents (IRR=0.48, 95% CI=0.24-0.96) were most effective. Among women at high baseline risk, vaginal probiotics (IRR=0.70, 95% CI=0.52-0.93) and intermittent antibiotic suppression (IRR=0.39, 95% CI=0.21-0.73) showed the greatest reduction in recurrence. CONCLUSIONS:Partner treatment, consolidation with probiotics or acidifying agents, and long-term vaginal probiotic maintenance reduce BV recurrence. Vaginal Lactobacillus preparations and acidifying agents represent the most evidence-supported nonantibiotic approaches for recurrence prevention.
