Importance Gynecologists are experts in providing care to women with vulvovaginal complaints. Cysts located in the vagina and vulva can cause pain and irritation and incite concern. Given the relatively low prevalence of these cysts in the population, helpful diagnostic and management information for providers is scarce. Objective This article will detail the epidemiology, embryology, presentation, and management of vulvovaginal cysts. Evidence Acquisition We completed a comprehensive literature review for all available data and included case reports, case series, histological studies, and descriptive articles obtained from PubMed and relevant textbook chapters. Results In general, cystic lesions of the vagina and vulva are typically benign and asymptomatic and do not require intervention. Special attention should be paid to cysts arising in women older than 40 years and those that are fixed or associated with pain or bleeding. Cysts that require management may require imaging, often either with transvaginal ultrasound or magnetic resonance imaging. Surgical excision, when necessary, has a high success rate. Conclusions and Relevance Vaginal and vulvar cysts have a myriad of presentations and etiologies. A thorough understanding of these is helpful to guide decisions about further testing and management options. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completion of this CME article, the reader should be better able to assess the embryology underlying vulvovaginal cysts; describe the differing presentations of various vulvovaginal cysts; identify patient risk factors and clinical presentations that warrant further workup versus expectant management; and explain the benefits and pitfalls of various imaging modalities in imaging vulvovaginal cysts.
Objective: The American College of Obstetricians and Gynecologists does not provide a recommendation regarding the preferred vaginal preparation solution. We intended to compare the effectiveness of chlorhexidine versus iodine in decreasing vaginal bacterial counts. Methods:In this institutional review board-approved study, participants undergoing total hysterectomy via vaginal or laparoscopic approach were randomized to 4% chlorhexidine or 10% iodine for presurgical vaginal preparation. Swabs were collected from the vaginal mucosa before, then 30, 60, and 90 minutes after preparation. Our primary outcome was the number of positive cultures (≥5,000 bacteria) at 90 minutes. The secondary outcomes included the presence of selected pathogens, postoperative complications, and infections. The sample size of 71 per arm was calculated using P = 0.05, 80% power, and anticipating a 22% difference in positive cultures.Results: Between May 2018 and August 2019, 85 participants were randomized. The average age was 59.8 years (SD, 11.4), and the median Charlson Comorbidity Index score was 2 (minimum, 0; maximum, 6). Baseline bacterial counts were similar in both groups. Chlorhexidine demonstrated a lower percentage of positive cultures at 90 minutes (47.6% vs 85.4%; odds ratio, 10.6; P = 0.001). In addition, the median bacterial count in the chlorhexidine group was significantly lower than the iodine group (3,000 vs 24,000 colony-forming units, P < 0.001) at 90 minutes. No surgical site infections were identified in either group during the 30-day postoperative period, and there were no reported adverse reactions to either solution.Conclusions: Chlorhexidine resulted in substantially lower bacterial counts after preparation compared with iodine. Gynecologic surgeons may consider switching to 4% chlorhexidine for vaginal preparation before hysterectomy.
Objective This study was conducted to assess the utility of a mirror in improving pain and vulnerability during a pelvic examination. Methods In this prospective, institutional review board-approved, 2-cohort trial, all “new” patients presenting to a urogynecology office were offered to have a mirror or no-mirror present during their pelvic examination. Patients completed 100-mm visual analog scales regarding pain, anxiety, knowledge, control, embarrassment, and vulnerability before and after examination. The primary outcome was difference in level of pain and vulnerability between groups. Secondary outcomes included comparisons from baseline to postexamination scores within groups, patient satisfaction, and examination duration. A sample size of 68 participants in each arm was planned. Results From April 2019 to May 2020, 147 participants were enrolled. Two participants were excluded, 145 were included in the final analysis; 74 in the no-mirror group and 71 in the mirror group. The average age was 55.9 (±13) years, and the groups were overall similar. There was no difference in primary outcomes of pain or vulnerability, but the mirror group showed improved levels of control (P = 0.006) and knowledge (P = 0.018) following examination. All participants reported high satisfaction, and those that selected a mirror reported strong preference for future use. Conclusions Patients who chose to use the mirror did not demonstrate a difference in pain or vulnerability scores; however, they exhibited benefit to their sense of control and knowledge after the pelvic examination. Although the mirror did not benefit all patients, this is a simple option that could improve the examination experience for some. Clinical Trial Registration: ClinicalTrials.gov, NCT03785548
Objective This study aimed to determine if routine assessment of patients after onabotulinumtoxinA injections for overactive bladder is necessary to detect clinically significant voiding dysfunction. Methods This retrospective cross-sectional cohort study analyzed patients who underwent intravesical injection of onabotulinumtoxinA for overactive bladder during a 4-year period. Patients were included for analysis if they returned for an office follow-up visit within 1 month of administration. Baseline demographic data; procedural details; postvoid residual volumes; abnormal postprocedure voiding symptoms, including urinary frequency, pain, or inability to void; urinary tract infections; and initiation of intermittent self-catheterization were recorded. Descriptive statistics, point-biserial and Pearson correlation analyses were performed. Results Two hundred thirty-seven injections were included in our analysis. Fifteen encounters, from 13 patients, required the initiation of intermittent self-catheterization (6.3%). The median postvoid residual in those treated with intermittent self-catheterization was 300 mL (min, max: 200, 750 mL); all had received 100 units of onabotulinumtoxinA. The most common symptom among those requiring intermittent self-catheterization was urgency (n = 13; 87%), whereas 93% (n = 14) had at least 1 bothersome symptom. Correlation analyses showed a weak positive correlation with elevated postvoid residual volume and a history of prolapse repair (r = 0.269, P = 0.004), and prior pelvic surgery (r = 0.205, P = 0.029). Conclusions Clinically relevant urinary retention that required intermittent self-catheterization after onabotulinumtoxinA injection for overactive bladder occurred in 6.3% of participants in this sample. The vast majority of patients who required intermittent self-catheterization described symptoms that they were able to self-identify.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.