OBJECTIVE: To observe the clinical efficacy of acupuncture based on "status-target coherence" theory combined with Kegel exercises for vaginal laxity syndrome (VLS). METHODS: Sixty-six patients with VLS were randomized into an observation group (33 cases, 2 cases dropped out, 1 case was discontinued) and a control group (33 cases, 5 cases dropped out). The observation group was treated with acupuncture combined with Kegel exercises, acupuncture was applied to bilateral Ciliao (BL32), Zhongliao (BL33), Sanyinjiao (SP6), etc. The control group was treated with Kegel exercises. Both acupuncture and Kegel exercises were performed once every other day, three times a week for 12 weeks. Before and after treatment, the vaginal laxity questionnaire (VLQ) score, pelvic floor muscle strength (vaginal resting pressure, vaginal systolic pressure, vaginal contraction duration), degree of vaginal laxity and sexual satisfaction questionnaire (SSQ) grade were observed in both groups. RESULTS: After treatment, the VLQ score, vaginal resting pressure, vaginal systolic pressure, vaginal contraction duration in the observation group were elevated compared with those before treatment (P<0.05), and SSQ grade was improved (P<0.05); and the above indexes in the observation group were better than those in the control group (P<0.05). There were no significant difference before and after treatment in the degree of vaginal laxity in the two groups (P>0.05). CONCLUSION Acupuncture based on "status-target coherence" theory combined with Kegel exercises can effectively enhance the strength of pelvic floor muscles, improve the symptoms of vaginal laxity, and improve the satisfaction of sexual life, and its therapeutic effect is better than Kegel exercises alone.
Humans ; Female ; Adult ; Vagina/physiopathology* ; Acupuncture Therapy ; Exercise Therapy ; Young Adult ; Middle Aged ; Treatment Outcome ; Acupuncture Points ; Combined Modality Therapy ; Vaginal Diseases/therapy*

Clear cell adenocarcinoma of the female urethra is extremely rare. Because the primary urethral carcinomas are rare, standard diagnostic algorism and management has not been established yet. We report a case of clear cell adenocarcinoma of the proximal urethra in a 76-year-old female. She was presented with voiding difficulty for several years after pubovaginal sling operation due to stress urinary incontinence twelve years ago. Before this period, she had managed with medication for detrusor hypocontractility. Recently she complained bloody vaginal discharge, and her vaginal examination revealed palpable mass on the anterior vaginal wall. Pelvic MRI showed a 5×4.5cm sized tumor surrounding the proximal urethra which was mimicking prostate with no lymphadenopathy. Biopsy of the mass confirmed it to be clear cell adenocarcinoma. She underwent anterior pelvic exenteration and ileal conduit with bilateral pelvic lymph node dissection. The patient received adjuvant radiotherapy and chemotherapy as treatment. We should carefully evaluate patients with voiding symptom after anti-incontinence surgery and multimodal treatment should be applied for locally advanced urethral carcinoma.
Adenocarcinoma, Clear Cell* ; Aged ; Biopsy ; Combined Modality Therapy ; Drug Therapy ; Female* ; Gynecological Examination ; Humans ; Lymph Node Excision ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Pelvic Exenteration ; Prostate* ; Radiotherapy, Adjuvant ; Urethra* ; Urinary Diversion ; Urinary Incontinence ; Vaginal Discharge

Child, Preschool ; Diagnosis, Differential ; Female ; Gonadotropin-Releasing Hormone ; therapeutic use ; Humans ; Hysteroscopy ; Pediatrics ; Puberty, Precocious ; diagnosis ; therapy ; Uterine Hemorrhage ; diagnosis ; etiology ; therapy ; Vaginal Diseases ; diagnosis ; etiology ; therapy

Because sex hormones influence the lower urinary tract, menopause can cause several urinary diseases including overactive bladder, stress urinary incontinence and recurrent urinary tract infection. However, the results of many clinical studies have indicated that menopausal hormone replacement therapy is not effective for the treatment of previous diseases, especially via the oral route. Although estrogen vaginal cream or pessary is an effective treatment for overactive bladders and can prevent recurrent urinary tract infection, its beneficial effects only last for the duration of the treatment. If patients with previous mentioned urologic disease have other local symptoms and conditions, such as atrophic vaginitis and dyspareunia, local estrogen replacement therapy will be helpful in relieving the local symptoms. However, the potential for breast cancer or return of withdrawal of bleeding, patient's age, adverse effect of systemic administration, estrogen-progesterone combination therapy, and effectiveness among other treatment modalities must be considered before a treatment decision can be made. In this article, we will review the current issues on the relationship among urinary tract and sex hormone and menopause, and the effectiveness of menopausal hormone replacement therapy for the treatment of overactive bladders, stress urinary tract incontinence and recurrent urinary tract infection.
Atrophic Vaginitis ; Breast Neoplasms ; Dyspareunia ; Estrogen Replacement Therapy ; Estrogens ; Female ; Gonadal Steroid Hormones ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Menopause ; Pessaries ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence ; Urinary Tract ; Urinary Tract Infections ; Urologic Diseases ; Vaginal Creams, Foams, and Jellies

OBJECTIVETo study the effects of Kuntai Capsule (KTC), a Chinese herbal preparation, on the quality of life (QOL), breast distending pain and vaginal bleeding in women at early stage of menopause.

METHODSA total of 104 women at early stage of menopause, 54 had their uterus existed (Ue) and 50 in-existed (Ui), were enrolled, and they were randomized to the KTC group and the control group, with equal cases of Ue and Ui in each. The KTC group was treated with KTC 4 capsules twice a day; the control group treated with premarin 0.45 mg per day and for those of Ue 2 mg medroxyprogesterone additionally, with the remedies medicated orally for 1 year. All the testees were asked to record everyday their own condition of breast pain and vaginal bleeding and followed-up every 3 months to fulfill the Menopause Specific Quality of Life questionnaire. Ultrasonic examination on pelvis and breast as well as endocrine hormone assays of estradiol (E2) and follicle-stimulating hormone (FSH) were performed before and after the medication term.

RESULTSEffects of treatment in the two groups were different insignificantly in terms of QOL. The women were benefited in vasomotor and physical domains from the 3rd month of medication, and the psychosocial domain was also improved (for Ui initiating from the 3rd month and for Ue from the 6th month). In the domain of sexual life, KTC showed its favorable effect only on Ue beginning from the 9th month, but not on Ui; while all subjects in the control group had their sexual life improved from the 3rd month. In domain of breast pain, the occurrence at various time points between the two groups was insignificantly different, only that the severity in Ue of the control group was more significant from the 1st to 3rd month than that in the KTC group. As for the domain of vaginal bleeding, the uterine membrane was basically normal in both groups either before or after medication, but the incidence and lasting days from the 1st to 3rd month in Ue of the KTC group were significantly lower than those of the control group. Levels of E2 and FSH were not significantly changed after medication in the KTC group, while in the control group, E2 significantly increased and FSH significantly decreased in the women of Ue (P <0.05).

CONCLUSIONKTC could evidently improve the QOL of women at the early stage of menopause, and is of high safety, with less adverse reaction of breast pain and vaginal bleeding, and shows few impact on sexual hormones.

Adult ; Breast ; pathology ; physiology ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hemorrhage ; drug therapy ; pathology ; Humans ; Menopause ; drug effects ; psychology ; Middle Aged ; Pain ; drug therapy ; pathology ; Quality of Life ; Vaginal Diseases ; drug therapy ; pathology ; psychology

OBJECTIVESTo validate our revised syndromic algorithms of the management of sexually transmitted diseases and determine their sensitivity, specificity, positive predictive value and cost-effectiveness.

METHODSPatients with either urethral discharge, vaginal discharge or genital ulcer, were selected during their first visits to three urban sexually transmitted disease clinics in Fujian Province, China. They were managed syndromically according to our revised flowcharts. The etiology of the syndromes was detected by laboratory testing. The data were analyzed using EPI INFO V6.0 software.

RESULTSA total of 736 patients were enrolled into the study. In male patients with urethral discharge, the sensitivities for gonococcal and chlamydial infections were 96.7% and 100%, respectively, using the syndromic approach. The total positive predictive value was 73%. In female patients with vaginal discharge, the sensitivity was 90.8%, specificity 46.9%, positive predictive value 50.9%, and negative predictive value 89.3% for the diagnosis of gonorrhea and/or chlamydial infection by syndromic approach. In patients with genital ulcer, the sensitivities were 78.3% and 75.8%, specificities of 83.6% and 42.9%, and positive predictive values of 60.0% and 41.0% for the diagnosis of syphilis and genital herpes, respectively, using the syndromic approach. Cost-effectiveness analysis indicated that the average cost of treatment for a patient with urethral discharge was RMB 46.03 yuan using syndromic management, in comparison with RMB 149.19 yuan by etiological management.

CONCLUSIONSThe syndromic management of urethral discharge was relatively effective and suited clinical application. The specificity and positive predictive value for syndromic management of vaginal discharge are not satisfactory. The revised flowchart of genital ulcer syndrome could be suitable for use in clinical settings. Further validation and revision are needed for syndromic approaches of vaginal discharge and genital ulcer.

Adolescent ; Adult ; Algorithms ; Cost-Benefit Analysis ; Female ; Health Care Costs ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Sexually Transmitted Diseases ; diagnosis ; therapy ; Urethral Diseases ; therapy ; Vaginal Discharge ; therapy