Search Results (6)

Background/Objectives: Perimenopause, impacting 80–90% of women, encompasses a range of vasomotor, urogenital, cognitive, and psychiatric symptoms associated with the fluctuation and gradual reduction of gonadal hormones. Moreover, the onset or worsening of sleep disturbances is prevalent during the menopausal transition. This narrative review seeks to elucidate the pathogenetic processes behind sleep disturbances during perimenopause and the main therapeutic options. Methods: The electronic databases PubMed, Scopus, Google Scholar, Web of Science, and Embase were queried for publications up to May 2024. Longitudinal, observational, case–control, and cross-sectional studies, as well as reviews and meta-analyses, were included in the review in order to explore the prevalence of sleep disorders during perimenopause, the pathogenetic mechanisms underlying the association between menopausal transition and sleep disorders, and the available non-pharmacological and pharmacological treatment options. Results: Sleep disturbances are common among perimenopausal women and include insomnia, sleep-related breathing disorders, and movement disorders. Fluctuations in estrogen and progesterone affect sleep quality, while vasomotor symptoms can disrupt sleep. Circadian changes, decreased melatonin production, and physiological changes associated with aging and mood disorders further exacerbate sleep disturbances. Conclusions: Managing sleep disorders in perimenopause requires an individualized approach, considering the multifactorial nature of these disturbances and providing background knowledge about the relationship between reproductive hormonal changes and sleep. Non-pharmacological treatments should be considered the first-line therapy; hormone therapy or non-hormonal pharmacological treatments can be considered according to the patients’ specific needs and risk factors. However, there is still a lack of standards on the appropriate management and treatment of sleep disorders in perimenopause. Full article

(1) Background: Microbiota could be related to tumorigenesis through the persistence of an inflammatory state, also at the endometrial level. Inflammation, in fact, is involved in the promotion of genetic instability and in a favorable microenvironment for tumor growth. One pathway could be the disruption of the epithelial/mucosal barrier, with the activation of cytokines. The microbiota also seem to favor other involved patterns, such as insulin resistance and increased adipose tissue. (2) Methods: The online search for this review was based on keywords such as “endometrial cancer” and “microbiota” on the main online scientific database. Our objective is a narrative up-to-date review of the current literature on gynecological microbiota; we analyze the possible correlations with known modifying and promoting oncological factors (i.e., Body Mass Index- BMI, menopause, pH), with particular attention to vaginal and uterine microorganisms respective to the development of endometrial cancer in comparison to healthy women. (3) Results: Various species and distributions of bacteria could be related to tumorigenesis and induce alterations in cell signaling and cycle pathways, including those in the gynecological field. (4) Conclusions: In the literature, the different composition of uterine and vaginal microbiota has been analyzed in the past years, and their diversity and actions seem to correlate with possible oncological effects. Full article

(1) Background: Vulvodynia is characterized by vulvar pain for at least three months and may have related variables, one of these being pelvic floor hypertonus. The purpose of this study was to compare the therapeutic effectiveness of two weekly sessions of pelvic floor rehabilitation and 5 mg of vaginal diazepam daily vs. pelvic floor rehabilitation alone in individuals with vulvodynia. (2) Methods: A single-center, not-blind, randomized study enrolled 20 vulvodynic patients: A total of 10 were treated with dual therapy (intravaginal diazepam and pelvic floor rehabilitation), and 10 were treated with only pelvic floor rehabilitation. All of them underwent a pelvic floor ultrasound examination and VAS pain and Marinoff scale assessments before the beginning of therapy as well as three and six months later. (3) Results: The elevator plate angle ranged from 8.2 to 9.55 (p = 0.0005), hiatal area diameter ranged from 1.277 to 1.482 (p = 0.0002), levator symphysis distance ranged from 3.88 to 4.098 (p = 0.006), anorectal angle ranged from 121.9 to 125.49 (p = 0.006), Marinoff scale ranged from 2.3 to 1.4 (p = 0.009), and VAS scale ranged from 5.8 to 2.8 (p < 0.001). (4) Conclusions: This pilot study demonstrates that the suggested treatment improves the hypertonicity of the pelvic floor, as measured by ultrasound parameters, correlating with a reduction in symptomatology. Full article

Background: Hemangiomas are aberrant proliferations of blood vessels and the most frequent benign pediatric soft tissue tumors. Although they are common, genital localization is rare. This study aimed to assist doctors in the diagnosis, management, and treatment of pediatric vulvovaginal hemangiomas by conducting a review of the literature. Methods: We conducted a literature review including papers published between August 2009 and May 2023. Results: While most hemangiomas are usually indolent and resolve with time, in some cases, especially cervicovaginal and uterine ones, they might present with severe symptoms like heavy bleeding and need further instrumental investigation for diagnosis, like CT or MRI. As for the treatment, many options are available, with medical therapy or expectant management being the first choice. Conclusions: Vulvovaginal pediatric hemangiomas are rare and require more research on how to detect and manage these lesions, especially the symptomatic and the psychologically impacting ones. For the time being, treatment should be personalized based on the patient’s situation and clinician’s expertise. Full article

Background: In recent years, several interesting case reports have been published which describe the possible role of SARS-CoV-2 infection or vaccination in the etiopathogenesis of Lipschütz ulcer. Our aim is to analyze this association and provide a rapid algorithm that is of support to gynecologists and dermatologists both in the diagnosis and in setting up the therapy. To do so, in this paper, we describe an interesting case of acute vulvar ulcer triggered by SARS-CoV-2 infection and review the related literature. Methods: We conducted a literature review including papers published between October 2021 and April 2023, and we described the case of a patient referred to our clinic with Lipschütz ulcer and SARS-CoV-2 infection. Results: In almost all cases analyzed, a correlation with SARS-CoV-2 infection or vaccination was found; ulcers usually manifest after 2 to 4 weeks and are associated with flu-like symptoms. A concordance in review papers, as well as in our case report, was also found about the treatment, which is mainly symptomatic. Conclusions: Previous infection or vaccination for SARS-CoV-2 should be included as possible etiopathogenetic factors in the onset of Lipschütz ulcer. Full article

Neurological complications in pregnancy and the puerperium deserve particular attention from specialists due to the worsening of the clinical picture for both the mother and the fetus. This narrative review of existing data in the literature aims to analyze the most common “red flag symptoms” attributable to neurological complications such as pre-eclampsia (PE), eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), cerebral vasoconstriction syndrome (RCVS), stroke, CVS thrombosis, pituitary apoplexy, amniotic fluid embolism and cerebral aneurysm rupture, with the aim of providing a rapid diagnostic algorithm useful for the early diagnosis and treatment of these complications. The data were derived through the use of PubMed. The results and conclusions of our review are that neurological complications of a vascular nature in pregnancy and the puerperium are conditions that are often difficult to diagnose and manage clinically. For the obstetrics specialist who is faced with these situations, it is always important to have a guide in mind in order to be able to unravel the difficulties of clinical reasoning and promptly arrive at a diagnostic hypothesis. Full article