Search Results (457)

Introduction: Obstructed HemiVagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome, also known as Herlyn–Werner–Wunderlich syndrome, is a rare congenital Müllerian duct anomaly, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Symptoms typically appear shortly after menarche and include dysmenorrhea and pelvic pain. The psychological burden associated with fertility and reproductive outcomes in women with OHVIRA syndrome remains poorly investigated. Materials and methods: A 30-year-old primigravida with left renal agenesis and a history of vaginal abscess, dysmenorrhea, and chronic pelvic pain received a delayed OHVIRA syndrome diagnosis. The patient had previously been informed that spontaneous conception and an uncomplicated pregnancy were highly unlikely because of her congenital gynecological condition, resulting in significant fertility-related anxiety and psychological distress. Under careful supervision and counseling, she conceived successfully, and the pregnancy progressed without complications; an elective cesarean section was performed at term. A literature search using the PubMed and Embase databases was conducted between November 2025 to April 2026 to identify studies reporting reproductive outcomes and psychological aspects in patients diagnosed with OHVIRA syndrome and other Müllerian anomalies. Results: Evidence-based counseling contributed to improvement of quality of life and reduction of pregnancy-related anxiety of the reported patient with OHVIRA syndrome. A limited number of studies discuss the mental burden and fertility-related anxiety of patients with OHVIRA syndrome and other Müllerian anomalies. Conclusions: Spontaneous conception and uncomplicated pregnancy are possible for women with OHVIRA syndrome. The psychological burden associated with congenital gynecological conditions remains under-recognized and requires further investigation. Comprehensive counseling and interdisciplinary care are essential to improve reproductive education, mental health support, and pregnancy outcomes in patients with congenital gynecological anomalies. Full article

The gut–vagina axis has emerged as a growing area of interest in female health due to its potential role in mediating physiological processes via interactions between distinct microbiomes, including microbial migration, hormonal and immune regulation, and metabolite exchange. Recent advances in microbiome research suggest bidirectional communication between gut and vaginal communities, with potential effects on microbial composition, immune responses, hormonal balance, and metabolic activity in both sites. In this review, we outline the most promising features of the gut–vaginal relationship, emphasize the significance of their plausible bidirectional communication, and discuss how these interactions may affect local and systemic health. Full article

Neuroendocrine differentiation in tumors of the female genital tract is an uncommon but diagnostically consequential finding. Its interpretation is challenging because neuroendocrine marker expression does not necessarily define a neuroendocrine neoplasm. Focal or aberrant staining for synaptophysin, chromogranin A, CD56 or INSM1 may occur in otherwise conventional gynecologic carcinomas, whereas true poorly differentiated neuroendocrine carcinomas represent aggressive tumors with distinct prognostic and therapeutic implications. This narrative review examines neuroendocrine differentiation across the cervix, endometrium, ovary, vagina and vulva from an integrated clinicopathologic perspective. We emphasize that neuroendocrine differentiation should be approached as a diagnostic and biological spectrum, ranging from incidental immunophenotypic expression to carcinoma with neuroendocrine differentiation, mixed neuroendocrine/non-neuroendocrine tumors, well-differentiated neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas. Morphology remains the diagnostic anchor, while immunohistochemistry, molecular context and clinicoradiologic correlation refine classification and help exclude mimics or metastatic disease. Site-specific interpretation is essential: cervical neuroendocrine carcinoma is commonly HPV-associated and clinically aggressive; endometrial tumors require integration with p53, mismatch repair, POLE and SWI/SNF-related contexts; ovarian lesions demand distinction between primary well-differentiated neuroendocrine tumors, poorly differentiated carcinomas and metastases; and vaginal or vulvar tumors require careful exclusion of adjacent extension, cutaneous mimics and extragenital primaries. We propose a practical diagnostic framework that separates incidental marker expression from clinically meaningful neuroendocrine differentiation and links this distinction to reporting, prognosis and treatment. The central diagnostic question is not whether neuroendocrine markers are expressed but whether their expression defines a morphologically, biologically and clinically meaningful tumor category. Full article

This study developed two Causal Graphical Models (CGMs) to analyze the transitions associated with Bacterial Vaginosis (BV) and to identify key bacterial species at each stage. BV results from an imbalance in the vaginal microbiota, whose composition varies among women and across developmental stages. A previous CGM identified influential bacteria but did not address changes between microbiota states. Here, we extend that framework to capture these associations. Path Analysis, a structural equation modeling method based on observed variables that estimates effects through correlations and covariances, was applied to a dataset of 132 pregnant women (4–24 weeks of gestation) from Tabasco, Mexico, previously collected by third parties during healthy pregnancy campaigns and associated with BV diagnosis. Models were validated using statistical metrics and evaluation by a clinical microbiologist. The first model, representing the transition from normal microbiota (BV−) to an indeterminate state (I), identified Megasphaera Type 1 as significant. The second model, from I to bacterial vaginosis-positive (BV+), identified Atopobium vaginae and Bacterial Vaginosis-Associated Bacterium Type 2 as significant contributors. These findings highlight the importance of the intermediate state in dysbiosis progression and support the use of CGMs for studying microbiome dynamics. Full article

Characterizing the microbiota is essential to improve the understanding and management of urogenital disorders. Using 16S rDNA sequencing, this study investigated the urogenital microbiota, including urine, vaginal, and prostatic communities, in a litter of 10 healthy beagle puppies from 4 months of age until the completion of the first estrous cycle in females and 18 months in males. A further objective was to compare these microbial profiles with those of their dam. Significant differences were observed between urinary and genital microbiota in both sexes, evolving over time. Notably, in females, puberty and the first estrous cycle were associated with marked changes in the vaginal microbiota, outweighing individual variability. In contrast, urinary microbiota remained stable during female growth. In males, microbiota showed time-dependent and individual-specific progression, with distinct microbial communities identified in the urinary bladder and prostate. Shared genera between the dam and her offspring were observed, but inter-individual variability suggested a limited maternal influence. Further investigation is needed to clarify vertical transmission patterns. In conclusion, the urogenital microbiota of healthy dogs undergoes dynamic and distinct site-specific changes during early life. Full article

Background: The vagina undergoes important changes across the life course that are shaped not only by hormonal transitions but also by shifts in the vaginal microbial environment. Despite growing interest in the vaginal microbiome, research has disproportionately centered reproductive-aged populations, leaving the aging vagina comparatively understudied. Objective: This article examines the aging vagina through a life-course lens, with emphasis on microbial and clinical transitions associated with midlife and older adulthood. Key Content: The article highlights menopause-related changes and approaches for reducing stigma and missed clinical opportunities. Particular attention is given to menopause-related declines in estrogen, reduced glycogen availability, increased vaginal pH, and accompanying changes in microbial balance, as well as their relationship to dryness, irritation, genitourinary symptoms, and susceptibility to adverse outcomes. The article also provides health professionals with a practical educational framework for symptom recognition, patient communication, vaginal health assessment, menopause-related education, stigma reduction, and prevention of missed clinical opportunities. Conclusions: Positioning the aging vagina within life-course and microbial-health frameworks can strengthen prevention, improve symptom recognition, and support more age-inclusive, informed, and responsive care for older women. Full article

Background and Objectives: Renal cell carcinoma (RCC) exhibits heterogeneous and sometimes unpredictable metastatic behavior, involving both common and uncommon anatomic sites. Institutional analyses of histopathologically confirmed metastatic RCC may improve diagnostic recognition and clinical awareness. This study aimed to characterize the metastatic distribution and histopathologic features of RCC diagnosed in a single tertiary center over a five-year period. Materials and Methods: A retrospective review of the pathology database of the Department of Pathology, “Pius Brînzeu” Emergency County Hospital, Timișoara, was performed to identify all histologically confirmed cases of metastatic RCC diagnosed between January 2020 and December 2024. Case identification was based on pathology reports of metastatic lesions. In a subset of cases, corresponding pathology reports of the primary renal tumor were available and reviewed. Histopathological data collected included WHO/ISUP grade, tumor necrosis, sarcomatoid and/or rhabdoid differentiation, vascular invasion, surgical margin status, tumor size, and pathological T stage (pT). Exploratory analyses were performed to assess associations between metastatic site and selected histopathological features. Results: Thirty-two cases of metastatic RCC were identified, all demonstrating clear cell morphology. The mean patient age was 62.9 years, with a marked male predominance. Among cases with available primary tumor data, high WHO/ISUP grade and adverse histopathologic features were frequently observed. The most common metastatic sites in our institution were the brain and bone, followed by the adrenal gland, lymph nodes, and liver. Less frequent metastatic involvement included the pancreas, testis, vagina, skin, and peritoneum. Exploratory analyses did not demonstrate statistically significant associations between metastatic site and tumor grade, necrosis, or sarcomatoid/rhabdoid differentiation; however, descriptive trends were observed, including the association of brain metastases with high-grade tumors and the high prevalence of tumor necrosis across metastatic sites. Conclusions: This pathology-based retrospective series highlights the broad metastatic spectrum of RCC, including both typical and rare anatomic sites. The predominance of clear cell morphology and the frequent association with adverse histopathologic features support the link between aggressive tumor biology and metastatic disease. Although no statistically significant associations were identified, the observed patterns suggest potential relationships between metastatic distribution and tumor characteristics, warranting further investigation in larger studies. Full article

Congenital anomalies of the reproductive system represent a heterogeneous group of structural and functional abnormalities affecting both male and female genital organs. These anomalies typically arise during embryogenesis and may remain asymptomatic until they are incidentally identified during evaluation for infertility, recurrent pregnancy loss, or disorders of sexual development. In females, abnormalities include Müllerian duct anomalies and congenital malformations of the uterus, cervix, vagina, and ovaries, such as Mayer–Rokitansky–Küster–Hauser syndrome, septate, unicornuate, bicornuate, and didelphys uteri, and ovarian agenesis and undescended ovaries. In males, congenital conditions such as anorchia, cryptorchidism, hypospadias, ejaculatory duct obstruction, and ejaculatory dysfunction may be associated with impaired spermatogenesis and reduced fertility. Early recognition of these conditions may facilitate timely clinical evaluation and individualized management, which can include surgical correction, hormonal therapy, and reproductive counseling. When appropriate, early diagnosis may support multidisciplinary care, with the aim of optimizing sexual development, preserving reproductive potential, and reducing long-term morbidity associated with congenital anomalies. However, the clinical impact of early detection varies depending on the type and severity of the anomaly. A systematic and multidisciplinary approach may contribute to improved reproductive outcomes and better overall reproductive health in affected individuals. Further research is needed to better define the optimal timing and clinical utility of systematic evaluation strategies in this patient population. Full article

Milk production in dairy herds is determined by both intrinsic and extrinsic factors, with reproductive efficiency serving as a primary determinant. Infectious, nutritional, and management-related challenges can reduce this efficiency. Following parturition, cows are more susceptible to clinical disorders due to a temporary loss of integrity in the cervix, vagina, and vulva, which allows environmental bacteria to ascend and alter the vaginal microbiota. These microbial changes may disrupt endocrine responses related to conception and contribute to repeat breeder cow syndrome (RBCS), which is defined as failure to conceive after three or more inseminations. This study investigated associations among cultivable vaginal bacteria, circulating progesterone and glucose concentrations, and reproductive performance in 30 fourth-parity Holstein cows with a body condition score of 3.5. Cows were classified by reproductive history as repeat breeders (RBCS; n = 14) or controls (CTL; n = 16). Vaginal mucosal samples were collected at insemination and cultured on blood agar and MacConkey media under aerobic and microaerobic conditions. Bacterial identification was conducted using Gram staining and standard biochemical assays. Blood samples were collected at insemination, on day 5 post-insemination, and every two days thereafter to measure progesterone and glucose concentrations. Fertility outcomes were analyzed using PROC GLIMMIX, and hormonal data were analyzed using mixed models with repeated measures. The bacterial genera identified included Bacillus, Escherichia coli, Staphylococcus, Klebsiella, Proteus, Streptococcus, and Actinomyces. Progesterone and glucose concentrations did not differ significantly between groups (p > 0.05). However, the fertility rate (p < 0.05; CTL:87.50% vs. RBCS:57.14%) and number of attempts to conceive (p < 0.001; CTL:2.5 vs. RBCS:6.7) differed statistically between treatments. A higher prevalence of S. hyicus was detected in RBCS cows, and E. coli, S. hyicus, and Proteus spp. were more frequently detected in non-pregnant cows. These findings suggest that the identified cultivable vaginal bacteria are associated with reproductive status in dairy cows. Full article

Hormonal fluctuations across female life stages drive numerous transcriptomic and epigenetic changes, yet the effects of sex hormones on mucosal immunity, particularly in the vaginal epithelium, remain poorly understood. The vaginal mucosa undergoes cyclical remodeling during the ovulatory cycle under the influence of estrogens and progesterone produced mainly in the ovary. The ovary can also be a source of testosterone, and in postmenopausal women, as well as transgender men receiving hormone therapy, phenotypic changes in the vagina due to increased testosterone have been observed. However, the consequences of testosterone dominance in this tissue in terms of resilience and inflammation have not been well characterized. The goal of this study was to identify the histological and immunological changes within the vaginal epithelial cell barrier in an estrogen- vs. testosterone-dominant environment using an established in vitro reconstructed vaginal epithelial tissue model. Compared to estradiol, exposure to testosterone resulted in a thinner tissue with alterations in the cornification, although no impairment in the epithelial barrier was detected. Each hormone also resulted in a unique RNA expression profile, including increased expression of tight junction genes and decreased expression of chemokines and their receptors in testosterone compared to estradiol exposure. These data have implications for women’s health, including menopause, transgender men using gender-affirming hormone therapy, and other conditions associated with high testosterone in the vaginal compartment. Full article

Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, also known as Herlyn–Werner–Wunderlich syndrome (HWWS), is a rare Müllerian malformation. Gynaecologic malignancies reported in association with OHVIRA syndrome/HWWS are exceptional and scattered across isolated case reports and small case series, leading to significant challenges for screening, early diagnosis, and optimal management. The primary aim of this study was to comprehensively review and synthesize the clinicopathologic features, treatment approaches, and reported outcomes of patients with OHVIRA-associated gynaecologic neoplasms. Methods: A systematic review of published cases of gynecologic malignancies in OHVIRA/HWWS was conducted using PubMed/MEDLINE and Scopus from database inception through January 2026. To expand the current evidence, an illustrative novel institutional case is also presented and integrated into the analysis. Results: A total of 21 cases were identified and analysed; reported tumours predominantly involved the lower genital tract (vagina/cervix), with a recurrent representation of adenocarcinoma, particularly clear cell histology, and a frequent origin from the obstructed or non-visible compartment when side was described. Endometrial and ovarian involvement was uncommon. Conclusions: The anatomical complexity of OHVIRA syndrome creates a diagnostic blind spot that warrants heightened clinical suspicion, rigorous MRI-based anatomic delineation, and side-specific evaluation in symptomatic patients. By synthesizing the available literature, this review underscores the necessity for tailored, multidisciplinary management and proactive surveillance strategies in this rare population. Full article

Background and Objectives: After the publication by Haylen et al. introducing the MUSPACC (midline uterosacral plication anterior colporrhaphy combination) procedure, we implemented this technique in our clinical practice for the treatment of cystocele and vaginal vault prolapse (VVP). The aims of this study were to evaluate peri- and postoperative complications, as well as vaginal and urinary symptoms, including patient satisfaction 3 months postoperatively. Materials and Methods: A retrospective analysis was conducted on 58 women who underwent MUSPACC over a five-year period. Patient-reported outcomes were assessed using three prolapse-related items from the International Consultation on Incontinence–Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF), administered preoperatively and at three months following surgery. Demographic characteristics, as well as perioperative and postoperative complications, were obtained through review of medical records. Results: At follow-up, patients demonstrated improvement in vaginal symptoms, with the mean preoperative ICIQ-VS score decreasing from 15.2 to 1.16. Among those with preoperative urinary incontinence (UI), 42.1% became completely dry after MUSPACC procedure alone. Three patients (15%) developed de novo UI. Perioperative complications occurred in one patient. The postoperative complication rate was 20.7% (12/58), including one patient who experienced a postoperative fistula between the right ureter and vagina. No further surgeries were required. Overall, 96.4% of patients were satisfied postoperatively. Conclusions: MUSPACC procedure appears to be an effective treatment for VVP and cystocele, with improvement in vaginal and urinary symptoms, high patient satisfaction, and a low rate of serious complications. Routine perioperative cystoscopy is now performed for immediate detection and management of urinary tract injuries. Full article

Background: Bowel surgery is a key component of advanced deep endometriosis management, with anastomotic leakage representing the most serious postoperative complication. This study aimed to identify risk factors for dehiscence after lower colorectal anastomosis and to determine effective preventive measures. Methods: This retrospective/prospective study included 425 consecutive patients aged 37.7 ± 6.0 years with laparoscopical bowel resection due to multiorgan complex deep endometriosis. All bowel surgeries were performed with use of indocyanine green (ICG). Many technical aspects of surgery and preventive procedures were analyzed which could impact leakage risk of surgery. Results: Endometriotic nodules were resected with segmental bowel resection (n = 294; 69.8%), discoid bowel resection (n = 84; 20.0%), and shaving procedure (n = 43; 10.2%). A total of 12 dehiscence events occurred (2.8%), including intraperitoneal leakage (n = 1; 0.2%), rectovaginal fistula (RVF) (n = 10; 2.3%), and rectoureteral fistula (n = 1; 0.2%); no rectovesical fistulas were observed. RVF developed only following segmental resections. Protective measures used during lower bowel procedures included fibrin glue (n = 375; 88.2%), omental flaps (n = 86; 20.2%), reinforcing sutures (n = 33; 7.8%), protective stomas (n = 25; 5.9%), and ghost stomas (n = 14; 3.3%). Among patients who developed RVFs, 90% had no protective stoma, and these cases were predominantly associated with low (from 6 to <8 cm; n = 4/77; 5.2%) and very low (from 5 to <6 cm; n = 4/10; 40%) anastomoses. In very low anastomoses (n = 4), 1 RVF occurred despite a protective stoma but there existed other strong risk factors, such as levator ani infiltration and vagina opening, whereas 3 others RVF developed in patients without a protective stoma. Notably, in ultra-low anastomoses (<5 cm), protective stomas prevented the anastomosis in 100%, and no fistula was observed (n = 3). The following factors were associated with the increased rate of RVF: segmental resection (p = 0.0355), low and very low anastomosis (p = 0.0010), lateral infiltration of the levator (p < 0.0001), concomitant hysterectomy or vaginal opening (p = 0.051), and prolonged operative time (p = 0.0010), Clostridioides difficile infection (p = 0.0001). Conclusions: RVFs occurred mainly after segmental resection (no other type of bowel resection), with very low anastomosis (5–6 cm from anal verge), in patients with levator ani infiltration and concomitant vaginal or uterine surgery; in such situations, discoid resection is the safer option. Despite the complexity of procedures, preventive strategies maintained a low overall RVF rate; no RVFs occurred in ultra low anastomoses (<5), indicating effective prevention with protective stomas. Full article

TFF1 is a secretory polypeptide that is typical of mucous epithelia belonging to the trefoil factor family (TFF) of lectins. Originally, TFF1 was discovered as an estrogen-responsive gene in breast cancer cell lines. However, its major physiological expression site is the stomach where it exists mainly in a monomeric form, with minor amounts of homodimeric as well as heterodimeric forms, such as a high-molecular-mass complex with IgG Fc binding protein (FCGBP). For the first time, we characterized different low-molecular-mass forms of TFF1 in human post-menopausal vaginal specimens, i.e., monomeric and dimeric forms. Attempts to identify high-molecular-mass forms of TFF1, such as TFF1-FCGBP, failed. Based on its known anti-inflammatory effects, TFF1 could play an important role in the homeostasis of vaginal microbiota, which is normally predominated by Lactobacillus spp. Due to its lectin activity, TFF1 might also be capable of binding to members of the vaginal microbiota or to vaginal fungal pathogens. This points to a potential role for TFF1 in the vagina’s innate immune defence and could be of clinical relevance particularly after menopause, e.g., for the treatment of bacterial vaginosis or vulvovaginal candidiasis, as here vaginal dysbiosis is often observed as a consequence of estrogen deficiency. Full article

Foot rot is a major infectious cause of lameness in dairy cows and can severely compromise production performance and animal welfare. However, it remains unclear whether foot rot is accompanied by microbiota alterations beyond the hoof, particularly in the vagina and milk. We conducted a case–control study of 24 Holstein cows (12 with clinical foot rot and 12 healthy controls). Hoof swabs, milk, and vaginal swabs were collected and analyzed using 16S rRNA gene amplicon sequencing, alongside quantitative PCR. Microbial community composition differed between cows with foot rot and healthy controls across hoof (R² = 0.26), vaginal (R² = 0.072), and milk (R² = 0.16) samples (Bray–Curtis, PERMANOVA, p < 0.001). Simpson diversity was lower in the hoof and vaginal microbiota (p < 0.05) but not in milk (p = 0.13). Differential abundance analysis identified enrichment of Fusobacterium in hoof and vaginal samples (p < 0.001), and absolute qPCR confirmed a higher vaginal load of Fusobacterium necrophorum in cows with foot rot (p < 0.05). Milk samples from foot rot cows showed enrichment of Clostridium and Porphyromonas. Co-occurrence network analysis revealed reduced microbial connectivity in foot rot-affected cows (average degree: 4.98 vs. 6.70) and increased network fragmentation (14 vs. 9 modules), suggesting lower ecosystem stability. Overall, foot rot was associated with microbiota shifts across the hoof, vagina, and milk, highlighting the potential value of integrated management strategies that consider extra-hoof microbial alterations. Full article