Search Results (167)

The vaginal microbiome (VM), a complex and dynamic microbial ecosystem, is now recognized as a central determinant of female reproductive and gynecologic health. Under homeostatic conditions, a Lactobacillus-dominant ecosystem maintains vaginal acidity, provides colonization resistance, and modulates mucosal immunity. Conversely, vaginal dysbiosis—characterized by Lactobacillus depletion and anaerobic or aerobic overgrowth—is associated with infectious vaginitis, increased susceptibility to sexually transmitted infections, and non-infectious conditions such as genitourinary syndrome of menopause. This review provides an integrated overview of the composition, functional characteristics, and host interactions of the VM across health and disease. We highlight major mechanisms by which microbial dysbiosis contributes to disease pathogenesis, including biofilm formation, altered microbial metabolism, and immune dysregulation. In addition, we discuss the translational potential of the VM as a source of diagnostic and prognostic biomarkers and as a target for emerging microbiome-dependent therapeutic strategies. Collectively, current evidence supports the view that vaginal dysbiosis is a heterogeneous and context-dependent state driven by distinct pathogen- and host-related mechanisms, underscoring the importance of prioritizing microbiome restoration rather than pathogen eradication alone. Full article

Background: Vulvovaginal candidiasis (VVC) is a significant public health concern characterized by increasing incidence and challenges in treatment. However, most studies investigating Candida spp. virulence factors and antifungal susceptibility predominantly rely on in vitro assays. While these assays are highly reproducible, they do not accurately replicate the complex vaginal microenvironment. To address this limitation, we developed an ex vivo model using porcine vaginal mucosa and a physiologically relevant volume of simulated vaginal fluid (SFV) to better mimic human vaginal conditions. Methods: Biofilm formation and fluconazole activity were assessed using the reference strain Candida albicans ATCC 90028 and two clinical isolates associated with VVC. Results were expressed as colony-forming units (CFU) and directly compared with in vitro assays conducted in Sabouraud dextrose broth (SDB) and SVF. Results: CFU analysis revealed that the ex vivo vaginal mucosa model supported more robust biofilm development, with counts ranging from 6.67 × 10⁷ to 7.20 × 10⁷ CFU/mL, compared to the in vitro SDB assay (3.58 × 10⁷ to 4.5 × 10⁷ CFU/mL). This suggests enhanced fungal growth under tissue-based conditions. Moreover, fluconazole achieved greater biofilm eradication in the ex vivo model (>70%) compared to the in vitro SDB assay (≤34.50%), which may indicate increased antifungal activity within a physiologically relevant environment. Conclusions: The ex vivo vaginal mucosa model offers a physiologically relevant platform for supporting C. albicans biofilm development and serves as a valuable alternative for preclinical screening of antifungal agents. Full article

Müllerian anomalies are anatomical variations of the female reproductive tract resulting from the incomplete development of the embryonic Müllerian ducts. The molecular mechanisms driving Müllerian duct development are complex and poorly understood, resulting in the largely unexplained aetiology of these conditions. WNT5A is a critical regulator of key developmental processes, including patterning, cell proliferation, and migration. Mutations of WNT5A have been associated with Robinow syndrome, a congenital condition characterized by skeletal and genital anomalies. In the mouse, WNT5A is necessary for the posterior development of the Müllerian duct, and ablation of Wnt5a results in vaginal agenesis. However, Wnt5a-/- uterine horns are hypoplastic and over 60% shorter than the wild type, suggesting specific functions in anterior Müllerian duct development. To better understand the role of Wnt5a, we performed single-cell RNA sequencing of developing Müllerian ducts. We found that the non-canonical Wnt PCP pathway was dysregulated in Wnt5a-/- mice. In addition, Wnt5a-/- Müllerian ducts were enriched in oviductal mesenchymal cells due to the transformation of the anterior uterine horns into oviducts. Our results indicate additional roles for Wnt5a during Müllerian duct development, prompting further investigations into uterine functions and anatomy in complex clinical cases of Müllerian anomalies including Robinow syndrome. Full article

Background: Deep infiltrating endometriosis (DIE) and, in particular, bowel endometriosis stand out for their complexity. While surgery for bowel endometriosis has proven to be effective, there is a lack of standardization concerning the technique used and the reported outcomes. Objectives: The objective is to perform a review aiming to summarize the state of the art of bowel endometriosis and to point out the gaps to be addressed by future research. We also propose a novel classification of surgical procedures to fill these gaps and improve management. Methods: A literature search was performed on PubMed from inception to October 2025. Results: The following three major procedures for the excision of bowel endometriosis have been proposed: the nodule shaving, the discoid excision, and the segmental intestinal resection. One further technique, NOSE (natural orifice specimen extraction), can be applied for the removal of the specimen in cases of discoid or segmental resection. To reduce surgical morbidity, current data support the choice of most conservative surgical options, namely nodule dissection and discoid resection, as well as the use of nerve-sparing techniques in case of segmental resection. Nonetheless, there is little evidence concerning the indication and the most appropriate technique to be used, including their relative risks and benefits in terms of pain control, urinary and gastrointestinal function, risk of future relapse, and fertility outcomes. Conclusions: Significant barriers in comparing surgical outcomes due to unclear definitions, lack of standardization, and incomplete reporting are some of the most relevant issues frequently encountered. To fill these gaps, we propose a new classification system for bowel surgery that describes the dimension and the number of the lesions, as well as the type of surgical technique used, supplemented by the information if vaginal opening was necessary for complete lesion resection. This proposition aims to open a discussion on this topic and boost focused research to evaluate the utility of a new classification in clinical practice. Full article

Background: Retained products of conception (RPOC) after term delivery are uncommon but may lead to persistent abnormal uterine bleeding and other complications. Hysteroscopic removal is considered the optimal management strategy, and technological advances have increasingly enabled operative procedures to be performed safely in an office setting. Clinical case: We report the case of a 43-year-old woman who presented with intermittent spotting four months after spontaneous vaginal delivery. Transvaginal ultrasound revealed a small, avascular hyperechoic intrauterine lesion consistent with retained amniochorionic tissue. She underwent office hysteroscopic removal using a 16 Fr bipolar mini-resectoscope under nitrous oxide (N₂O) buccal–nasal analgesia. The procedure was performed using a vaginoscopic, no-touch approach without speculum, tenaculum, or cervical dilation. Complete resection was achieved in a seven-minute procedure, with a postoperative pain score of 2/10 on the VAS and no complications. At 30-day follow-up, the patient was asymptomatic, and an ultrasound confirmed complete resolution. Conclusion: This case demonstrates that retained amniochorionic tissue can be safely and effectively treated in a fully ambulatory setting using mini-resectoscopic technology and N₂O analgesia. The combination of minimally invasive instruments, patient-centered procedural strategies, and well-tolerated analgesia supports the growing role of office operative hysteroscopy for selected complex intrauterine conditions. Full article

The vulvovaginal microbiome is a complex and dynamic ecosystem of microorganisms. The potential effects of common personal lubricants on its balance, which have implications for reproductive health, are still unknown. This study longitudinally assessed the impact of two commercially available lubricants on the composition and stability of the vaginal and vulvar bacteriome. Paired vaginal and vulvar swabs were collected at baseline and after repeated lubricant use, and the bacteriome was assessed using 16S rRNA gene amplicon sequencing. Alpha and beta diversity were assessed using Shannon entropy and Bray–Curtis dissimilarity, respectively. The results showed that the vaginal bacteriome was dominated by Lactobacillus and Firmicutes, while vulvar communities were more diverse and had higher abundances of Prevotella, Finegoldia, and Peptoniphilus. Both alpha and beta diversity measures indicated that the vaginal and vulvar bacteriome remained largely stable even after repeated lubricant use. Minor and non-significant changes in genus-level composition were observed, particularly in the vulvar samples. A moderate but significant correlation (Mantel r = 0.274, p = 0.001) was also observed between the vaginal and vulvar bacteriome. Overall, this study shows that short-term, repeated use of the water-based lubricant and the silicone-based lubricant tested in this study does not significantly disrupt the vaginal or vulvar bacteriome. Full article

Maintaining a quiescent uterus until labor is of utmost importance for a successful pregnancy and still represents the most challenging issue in clinical practice. Despite the existence of standard approaches (short-term use of tocolytic agents or preventive use of vaginal progesterone), whose efficacy is still controversial, several natural molecules have garnered attention in recent years as an effective therapeutic approach in high-risk pregnancies and beyond. Despite inflammatory activation, premature contractility depends on several factors, since myometrial quiescence is a complex mechanism not fully understood. Therefore, the synergistic activity of different natural molecules could be an innovative approach for acting simultaneously and maintaining uterine quiescence. Full article

Background/Objectives: Cervical cancer is one of the most common cancers among women of reproductive age, with 80% of the cases occurring in developing countries. Cervical cancer is largely preventable by effective screening programs. This study assessed the knowledge, attitudes, cultural beliefs, and screening practices related to cervical cancer among women in the rural community of Lutubeni, Eastern Cape Province. Methods: A descriptive cross-sectional study was conducted among 95 women aged 25 years or older attending Lutubeni Clinic. Data was collected using a structured, validated questionnaire covering demographics, reproductive health, knowledge of cervical cancer, attitudes, cultural perceptions, and screening practices. Statistical analysis involved descriptive summaries, chi-square tests, and binary logistic regression. Results: Most participants exhibited poor knowledge of cervical cancer symptoms (47.4%) and risk factors (61.1%), with only 3.2% demonstrating good overall knowledge. Vaginal bleeding (60.0%) and foul-smelling discharge (50.5%) were the most recognized symptoms. Only 40.0% were aware of human papillomavirus (HPV) vaccination. While 87.4% knew about cervical cancer screening, only 55.8% had ever been screened. Of these, 43.2% had screened only once, primarily at the clinic (33.7%), mostly initiated by health professionals (41.1%). Positive attitudes toward screening were observed in 52.6%, while 88.4% held cultural beliefs that hindered open discussion about sexual health. Statistically significant factors associated with screening uptake included educational level (p = 0.047), knowledge of symptoms (p = 0.04), risk factors (p < 0.0001), prevention (p < 0.0001), treatment (p = 0.001), and attitudes (p < 0.0001). Independent predictors of poor screening practice were holding an associate degree (OR = 0.04, p = 0.042), having good preventive knowledge (OR = 0.02, p = 0.012), and having negative attitudes (OR = 36.22, p = 0.005). Conclusions: High awareness alone does not guarantee participation in cervical cancer screening in rural South Africa. Interventions must address cultural barriers, stigma, and negative perceptions while strengthening health education that links HPV vaccination with screening awareness. The unexpected association between associate degree attainment and poor screening underscores the complexity of behavioral determinants and warrants further investigation in larger cohorts. Full article

Pelvic inflammatory disease (PID), although traditionally viewed as a sexually transmitted infection (STI), can also result from non-sexually transmitted microorganisms that display distinct epidemiologic and clinical characteristics. Unlike STI-related PID, these infections are less influenced by sexual behavior, often show a bimodal age distribution, and are linked to bacterial vaginosis (BV)-associated dysbiosis, iatrogenic uterine procedures, postpartum states, or inadequate access to timely screening and care. Non-STI-related PID is usually polymicrobial, predominantly involving BV-associated vaginal, enteric, or urinary commensals that ascend into the upper genital tract, while respiratory tract organisms, mycobacteria, and biofilm-associated pathogens may also play a role. Pathophysiological mechanisms include disruption of the endocervical barrier, mucus degradation, biofilm formation, hematogenous or iatrogenic seeding, and chronic cytokine-mediated inflammation and fibrosis. Clinical manifestations range from asymptomatic/subclinical disease to acute pelvic pain and tubo-ovarian abscess (TOA) and can progress to systemic infection and sepsis. Diagnosing non-STI PID is challenging due to nonspecific symptoms, negative STI tests, and inconclusive imaging findings, while management relies on broad-spectrum antimicrobials with surgery as needed. Given these complexities, this review aims to synthesize current knowledge on non-STI-related PID, clarify key considerations for its diagnosis, management, and prevention, and outline future perspectives to improve clinical outcomes. Full article

Background/Objectives: Patau syndrome (trisomy 13) is a rare genetic disorder with high mortality, and poor prognosis. Patients surviving beyond infancy usually present with severe psychomotor delays, failure to thrive, intellectual disabilities and seizures. Female sex and mosaic trisomy 13 are considered positive prognostic factors. Methods: Here we report an 8-year-old female patient with Patau syndrome, diagnosed prenatally, born prematurely at 35 + 4 weeks of gestation via vaginal delivery as a third child of 33 years old healthy and unrelated parents. The birth weight was 2087 g, Apgar scored 9 at 1 min and 10 at 5 min, also self-ventilating in room air since birth. The patient has several associated congenital abnormalities; however, medical adjustments such as multiple surgeries, PEG, hearing aids, glasses, anti-epileptic medications, and suction support the girl’s daily life. The patient attends a primary school with specialist support that fosters her physical and sensory development and promotes progress in communication. Despite the numerous obstacles she faces, the girl’s journey demonstrates remarkable growth and development with the support of an interdisciplinary care team. It highlights the critical role of personalized care and early intervention. Conclusions: Due to the increasing survival rates of patients with Patau syndrome, complex and multidisciplinary care is required for both the patients and their families to achieve the best possible outcomes and ensure proper care, growth, and development of the child. All medical procedures must be thoroughly assessed for potential complications and viable improvement in quality of life. Full article

Precocious puberty, characterized by the abnormally early onset of secondary sexual development, has been increasing in prevalence worldwide. Current pharmacological treatments, including GnRH agonists, are effective but associated with adverse effects, highlighting the need for safer alternatives. In this study, we investigated the preventive effects of an herbal extract complex composed of Eclipta prostrata and Hordeum vulgare (EHEC) on precocious puberty induced by danazol administration and a high-fat diet (HFD) in rat models. EHEC delayed vaginal opening (VO) and reduced ovarian maturation in both models. Furthermore, EHEC attenuated the elevation in hypothalamic GnRH mRNA expression observed in both models, without affecting body weight. These findings suggest that EHEC modulates the hypothalamic–pituitary–gonadal axis and may serve as a potential natural therapeutic agent for the prevention of precocious puberty. Full article

Background: Levofloxacin is a broad-spectrum third-generation fluoroquinolone with bactericidal activity against Streptococcus species. We aimed to investigate the susceptibility rates of levofloxacin, the genetic determinants contributing to resistance, the serotype distribution, and the population structure of levofloxacin-resistant Streptococcus agalactiae (GBS) isolates. Methods: Antibiotic susceptibility testing was conducted according to the EUCAST criteria. PCR-serotyping, determination of mutations in the quinolone resistance-determining regions (QRDRs), and multi-locus sequence typing (MLST) were performed on all levofloxacin-resistant strains. Results: Among the 328 GBS isolates, 11.9% exhibited resistance to levofloxacin. We categorized the samples into two main groups: vaginal (64.1%) and extra-vaginal. The latter was further subdivided into invasive (10.3%) and non-invasive (25.6%) ones. The most common serotypes identified were V (30.8%) and III (25.6%). All examined resistant strains possessed missense mutations in the QRDR of parC (Ser79Phe/Tyr and Asp83Asn), whereas 59.0% of them exhibited additional mutation in gyrA (Ser81Leu and Glu85Lys/Ala). The MLST results disclosed six clonal complexes: CC19(64.1%), followed by CC1 (10.3%), CC452 (7.7%), and CC459 (5.1%), and CC12 and CC23, represented by single strains. Conclusions: We observed a growing resistance to fluoroquinolones that appears to exceed the average in Europe. More than half of the isolates exhibited the accumulation of mutations within the QRDRs. Rigorous monitoring is needed to prevent the emergence of MDR GBS and preserve the effectiveness of the newer generations of fluoroquinolones. Full article

Objective: This narrative review aims to summarize current evidence on the epidemiology, risk factors, clinical patterns, and therapeutic strategies for urinary incontinence in menopausal women. Background: Urinary incontinence (UI) is a common, multifactorial condition that disproportionately affects women, with prevalence rising during pregnancy and post menopause. While stress urinary incontinence (SUI) predominates in younger and early postmenopausal women, urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) become increasingly prevalent with age and duration following menopause. Additional determinants, such as obesity, comorbidities, polypharmacy, and menopausal symptoms, burden further contribute to symptom severity and persistence. Materials and Methods: For the materials and methods, we used over 150 specialized studies and meta-analyses published in the specialized literature on this subject, of which 99 are mentioned in the bibliography of this narrative review. These materials are some of the most significant and up-to-date that address this complex topic. Content: This narrative review discusses the impact of menopause-related hormonal decline on the genitourinary tract, highlighting the role of estrogen deficiency in genitourinary syndrome of menopause (GSM). It addresses distinct patterns of UI across life stages, including pregnancy and the early and late postmenopause periods, and explores modifiable risk factors such as body mass index. Specific attention is given to nocturnal incontinence, medication-related effects, and coital incontinence, which significantly impair sexual health and quality of life. Therapeutic strategies are presented in a stepwise manner: conservative measures (pelvic floor muscle training), hormonal approaches (local vaginal estrogen), combination regimens, and surgical interventions, including midurethral slings, colposuspension, bulking agents, and neuromodulatory techniques. Future perspectives: Emerging modalities such as balneotherapy and energy-based therapies show promise but require further investigation. Conclusions: Urinary incontinence in menopausal women is best addressed through an individualized, multimodal approach that integrates conservative, hormonal, minimally invasive, and surgical options. Combination therapies demonstrate superior efficacy in addressing both continence and GSM-related symptoms. Future research should refine patient selection, optimize multimodal treatment algorithms, and prioritize long-term outcomes and quality-of-life measures in clinical decision-making. Full article

The rising resistance of bacterial and fungal strains, particularly in biofilm form, is diminishing the efficacy of available therapies and poses a major threat to human health. This highlights the need for new antimicrobial agents. A review of biological studies has shown that 2,7-naphthyridine derivatives exhibit a wide spectrum of pharmacological properties, including antimicrobial activity, which has contributed to the development of new compounds containing this scaffold. In this work, the obtained compounds were tested to assess their ability to eradicate biofilm formed by selected reference strains of opportunistic pathogens: Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans as well as towards normal microbiota representative, referred to as the Lactobacillus crispatus. The tested 2,7-naphthyridine derivatives showed selective antimicrobial activity, exclusively against S. aureus. 10j demonstrated the highest, among tested compounds, activity on this pathogen (MIC = 8 mg/L), while compound 10f exhibited ~100-fold stronger activity (MIC = 31 mg/L) than the majority of the library compounds. The in vitro assessment on fibroblast cell lines demonstrated low cytotoxicity of both compounds 10f and 10j, which was subsequently confirmed in vivo using the Galleria mellonella larval model, where no signs of systemic toxicity were observed during the 5-day observation period. Due to the structural similarity of the compounds 10f and 10j to typical gyrase/topoisomerase IV inhibitors, molecular dynamics simulations were performed on a ternary complex containing protein, DNAds, and a 1,5-naphthyridine inhibitor (PDB ID: 6Z1A). Molecular dynamics of the gyrase–DNA ternary complex supported stable binding of both hydrazone derivatives, with 10j showing slightly more favorable MM/GBSA energetics driven by electrostatics and halogen bonding, consistent with its ~4-fold lower MIC versus 10f. Taken together, our data highlight compound 10j as a promising microbiota-sparing antibacterial candidate, particularly suitable for selective interventions against S. aureus, for instance in vaginal infections, where targeted eradication of the pathogen without disturbing protective commensals is highly desirable. Full article

Background: Retained products of conception (RPOC) can be managed via hysteroscopic removal using mechanical or electrosurgical techniques. Electrosurgery introduces greater technical complexity and may reflect more adherent or vascular tissue, yet preoperative predictors for its necessity remain poorly defined. Objective: The objective of this study was to evaluate clinical outcomes and identify preoperative predictors associated with the use of electrosurgery during hysteroscopic removal of RPOC. Methods: In this retrospective cohort study conducted at a single tertiary center, we reviewed 551 cases of hysteroscopic RPOC removal performed between January 2008 and December 2022. Patients were categorized based on intraoperative use of electrosurgical instruments. Clinical, sonographic, and operative data were compared between groups. Multivariate logistic regression was used to identify independent predictors of electrosurgical use. Results: Electrosurgical intervention was required in 84 patients (15.2%). Compared with those treated without electricity, these patients were older (33.2 ± 6.4 vs. 31.2 ± 5.8 years, p = 0.004), more likely to be smokers (15.4% vs. 8.1%, p = 0.033), and had higher rates of prior hysteroscopy (5.9% vs. 1.0%, p = 0.002). Electrosurgical use was more common following vaginal delivery than abortion (57.1% vs. 24.8%, p < 0.001), particularly when manual placental removal was performed (23.8% vs. 5.7%, p < 0.001). Larger RPOC size and positive Doppler flow were also associated with the use of electrosurgery. On multivariate analysis, maternal age, postpartum RPOC, manual placental removal, and Doppler vascularity remained independent predictors. No significant differences were observed in short-term postoperative complications. Conclusions: Older age, postpartum RPOC, manualysis, and vascularity on ultrasound are preoperative predictors for the need of electrosurgical intervention during hysteroscopic removal of RPOC. Identifying these factors may improve surgical planning and patient counseling. Future prospective studies incorporating advanced hysteroscopic technologies are warranted. Full article