Journal of Lower Genital Tract Disease最新文献

{"title":"Psychotherapy and Psychotherapeutic Techniques for the Treatment of Vulvodynia: A Systematic Review and Meta-Analysis.","authors":"Janice F Queiroz, Ayane C A Sarmento, Antonio C Q Aquino, Amaxsell Thiago Barros de Souza, Kleyton Santos de Medeiros, Megan L Falsetta, Ana Katherine Gonçalves","doi":"10.1097/LGT.0000000000000881","DOIUrl":"10.1097/LGT.0000000000000881","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the effectiveness of psychotherapy and psychotherapeutic techniques for reduction of vulvar pain and the improvement of sexual function and psychological adjustment in vulvodynia.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, PsycInfo, and Clinical Trial Databases were searched on July 19, 2024. The authors included randomized controlled trials comparing psychotherapy interventions and psychotherapeutic techniques for vulvodynia. The risk of bias was assessed using the Cochrane Risk of Bias (RoB 2.0) tool. RevMan 5.4 was used for data synthesis. The Grading of Recommendations Assessment Development (GRADE) and Evaluation method was used to assess the strength of the evidence.</p><p><strong>Results: </strong>A total of 1,884 articles were retrieved. Eight studies met the eligibility criteria and were included in the systematic review, comprising 689 participants. Two studies were included in the meta-analysis, these with 143 participants. When comparing the Acceptance and Commitment Therapy (ACT) with the control group, the mean difference (MD) in the pooled analysis for the Chronic Pain Acceptance Questionnaire did not differ significantly between ACT therapy and other therapies for posttreatment assessment (MD = 0.77; 95% CI = 3.45-4.99). Only 1 study was at high risk of bias due to a lack of clarity about the outcome measurement process. The GRADE rating for the certainty of the evidence for vulvar pain acceptance using ACT was considered low.</p><p><strong>Conclusions: </strong>Psychotherapy significantly improves vulvar pain, psychological adjustment, and sexual function in women with vulvodynia. Additionally, this meta-analysis showed that ACT and other psychotherapeutic interventions improve psychological adjustment through pain acceptance. However, more rigorous studies are needed to improve the quality of evidence and inform clinical practice.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"280-287"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Incidence of Vaginal Intraepithelial Neoplasia 2+ in Patients With Previous Hysterectomy Cervival Intraepithelial Neoplasia 3+ Between 2005-2015: A Population-Based Study.","authors":"Sabrina Piedimonte, Bronwen R McCurdy, Joan Murphy, Dustin Costescu, Carolyn Barg, Yingzi Li, Tina Karapetyan, Julia Gao, Rachel Kupets","doi":"10.1097/LGT.0000000000000894","DOIUrl":"10.1097/LGT.0000000000000894","url":null,"abstract":"<p><strong>Objectives: </strong>In light of the rarity of vaginal cancer, the role of vaginal vault testing following hysterectomy for preinvasive or early cervical cancers is unclear. The objective was to determine the subsequent risk of VaIN2/3, and invasive vaginal cancer following hysterectomy, and to potentially identify individuals at higher risk who may benefit from vaginal vault testing.</p><p><strong>Methods: </strong>The authors performed a population-based retrospective study using administrative databases to identify the study population. They identified patients who between 2005-2015 underwent hysterectomy after cervival intraepithelial neoplasia 3+ (CIN3+)/adenocarcinoma in situ (AIS) and calculated the rate of VAIN2 and invasive vaginal cancer. Exclusion criteria are as follows: <21 years and CIN3+ diagnosis prior to 2005. Patients were followed until 2021.</p><p><strong>Results: </strong>During the study period, 6,230 patients underwent hysterectomy for a diagnosis of CIN3+/AIS. The subsequent rates of VaIN2/3, in situ, and invasive cancer were 1.9% (119/6,230) and 0.3 (18/6,230), respectively. Of these, most (84.7%) were made within 5 years of hysterectomy and remained stable over time (2.0% in 2005-2009, 2.4% in 2010-2015). However, only 54% of patients had vault cytology after hysterectomy; among these, 8.2% were abnormal of which 22.8% were diagnosed with VAIN2+. In addition, the risk of VaIN2+ was 5.8% when there was residual CIN3+ versus 2.1% when absent.</p><p><strong>Conclusions: </strong>Individuals with evidence of CIN3+/AIS at time of hysterectomy are at elevated risk of developing VAIN 2+, with the highest risk occurring within 5 years from surgery. Vault cytology within 1 year of surgery will identify most cases of VAIN2+, but further data monitoring and integration of HPV testing will be required to determine this screening strategy.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":"29 3","pages":"239-242"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off-Label Use of Imiquimod for Lower Female Genital Tract Diseases: A Systematic Review.","authors":"Flavia Silvestri, Giulio Tosti, Francesca Pepe, Sara Gandini, Mario Preti","doi":"10.1097/LGT.0000000000000888","DOIUrl":"10.1097/LGT.0000000000000888","url":null,"abstract":"<p><strong>Objectives: </strong>Imiquimod (IMQ) is an immunomodulatory topical drug with antiviral and antitumoral activity. Given its effectiveness and safety, IMQ is broadly off-label used for many vulvovaginal conditions as monotherapy and in association with other therapeutic approaches. However, standardized dose regimens and the total duration of therapy are still debated. This review aimed to summarize the current evidence on off-label uses of IMQ in different vulvovaginal conditions and compare its effectiveness to other gold standard treatments.</p><p><strong>Methods: </strong>The literature review used PubMed/MEDLINE and ClinicalTrial.gov as primary sources, including articles from January 2000 to June 2024.</p><p><strong>Results: </strong>Overall, 105 articles were included, of which 26 articles on vulvar Paget disease, 36 articles on vulvar intraepithelial neoplasia, 20 articles on vaginal intraepithelial neoplasia, 6 articles on vulvovaginal melanoma, and 17 articles on other conditions (molluscum contagiosum, herpes simplex type II infection, plasma cell vulvitis, and candidiasis). Most treatments included IMQ as monotherapy, or in combination and/or in alternative to other approaches, such as surgery, laser, human papillomavirus vaccination, systemic therapies (antiviral drugs, steroids), local therapies (1% cidofovir, 5% 5-fluorouracil, photodynamic therapy), and observation. The most frequent dose regimen was 3 times/week for 12-16 weeks. Outcomes widely varied among different conditions.</p><p><strong>Conclusion: </strong>Off-label topical IMQ represents a noninvasive and effective option for treating lower genital tract conditions as monotherapy or in association with other treatments. The IMQ therapy must be personalized based on physician and patient preference.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":"29 3","pages":"251-262"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Comorbidities in Male Patients With Lichen Sclerosus: A Case-Control Study.","authors":"Fabiola Cassaro, Pietro Impellizzeri, Carmelo Romeo, Salvatore Arena","doi":"10.1097/LGT.0000000000000882","DOIUrl":"10.1097/LGT.0000000000000882","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"293"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional Study on the Detection of HPV Infections for Cervical Cancer Screening Using a Self-Sampling Device.","authors":"Marta Arnáez de la Cruz, Anna Martin Marti, Stela Álvarez Fernandez, Marta Gurrea Soteras, Maria Dolores Comes García, Heidi Mauricio Aviñó, Julia Haba Moya, Santiago Domingo Del Pozo, Mireya Prieto Rodríguez","doi":"10.1097/LGT.0000000000000884","DOIUrl":"10.1097/LGT.0000000000000884","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluates a new vaginal self-sampling device for high-risk human papillomavirus (HR-HPV) detection compared to clinician-collected samples using real-time polymerase chain reaction (PCR).</p><p><strong>Methods: </strong>A total of 345 women aged between 23 and 72 were enrolled in this study. After receiving information about the study, women were provided with a vaginal collecting device to collect self-sample, and then a medical professional collected the cervical sample. All the clinician-collected samples were processed using the Cobas 4800 HPV assay, and the self-samples were processed with the automated MAIS extraction system. These results were used to compare the new device's performance to the clinician-collected cervical samples. All the clinician-collected samples were also analyzed with a new HPV screening assay to compare the performance of this assay on 2 different types of samples.</p><p><strong>Results: </strong>Overall agreement for detecting any HR-HPV between clinician-collected samples and self-samples was 93.7% with a Cohen κ coefficient of 0.842. As both assays allow to identify genotypes 16, 18 and to detect the same 12 HR-HPV genotypes in a pool, the authors analyzed the agreement between self- and clinician-collected samples by genotypes and it was shown to be also excellent for HPV16 and the pool of other HR-HPV.</p><p><strong>Conclusions: </strong>This self-sampling device has demonstrated detection rates that are comparable to those of samples collected by clinicians.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"218-222"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Vulvar HSIL and Penile Neoplasias in Anogenital Lichen Planus: A Case-Control Study.","authors":"Niina K Hieta, Lotta Tapana, Jenni M Söderlund, Jutta K Huvila, Lauri A I Talve, Marjut A M Haataja","doi":"10.1097/LGT.0000000000000879","DOIUrl":"10.1097/LGT.0000000000000879","url":null,"abstract":"<p><strong>Objective: </strong>Lichen planus (LP) is a chronic inflammatory skin disease that may affect the skin, scalp, nails, and mucosa. The aim of this study was to investigate the risk of genital premalignant and malignant conditions in patients with anogenital LP (agLP).</p><p><strong>Methods: </strong>The authors identified 60 male and 56 female patients with agLP by searching the biobank archives for a genital or perianal skin biopsy showing LP between 2004 and 2020. They also included 10 randomly selected age- and sex-matched controls for each patient. The risks of genital cancers and their precursors were evaluated.</p><p><strong>Results: </strong>The incidence of agLP was 1.54 per 100,000 men and 1.36 per 100,000 women. There was no statistical difference between male and female incidence ( p = .5721). The odds ratio (OR) for high-grade squamous intraepithelial lesion (HSIL) of the vulva was 31.2 (95% CI = 2.46-1645.00; p = .01). The OR for penile neoplasias could not be calculated because control patients had no neoplasias, but the difference was suggestive of statistical significance (95% CI = 1.90-infinite; p = .008). The mean age at the time of diagnosis of agLP was 59.9 years (median 62 years) in female patients and 40.8 years (median 33 years) in male patients. The difference in the mean ages of female and male patients was statistically significant (95% CI = 11.92-26.13; p < .001).</p><p><strong>Conclusions: </strong>Patients with agLP may have an increased risk for vulvar HSIL and penile neoplasia.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"288-292"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awards Presented as Part of the ASCCP 2025 Scientific Meeting on Anogenital & HPV-Related Diseases.","authors":"","doi":"10.1097/LGT.0000000000000897","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000897","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":"29 3","pages":"295"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor: Comorbidities in Male Patients With Lichen Sclerosus: A Case-Control Study.","authors":"Niina K Hieta, Marjut A M Haataja, Lotta Tapana","doi":"10.1097/LGT.0000000000000883","DOIUrl":"10.1097/LGT.0000000000000883","url":null,"abstract":"","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"294"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges With Diagnosis of Labial Agglutination Due to Lichen Sclerosus.","authors":"Esha Ghosalkar, Samantha Epstein, Allison Epstein, Melissa Mauskar, Rachel Pope","doi":"10.1097/LGT.0000000000000874","DOIUrl":"10.1097/LGT.0000000000000874","url":null,"abstract":"<p><strong>Objective: </strong>Labial adhesion (LA) lacks a clear etiology but is associated with low estrogen levels and lichen sclerosus (LS). Genitourinary Syndrome of Menopause is a contributor due to low estrogen, needing surgical resection if symptoms persist after topical estrogen use. Early diagnosis and treatment of LS can decrease the risk of development of LA. The objective is to investigate LS prevalence as an etiological factor and evaluate the necessity for enhanced biopsy rates in LA patients.</p><p><strong>Methods: </strong>TrinetX provided data from 80 global health care centers, focusing on patients with LA using ICD-10-CM coding. The cohort was stratified based on vulva surgery 2 years post-LA diagnosis to establish a causal relationship.</p><p><strong>Results: </strong>A total of 11,875 women over the age of 18 were diagnosed with LA from 2000 to 2023. Of those, 3,673 (30.93%) underwent a surgical procedure on the female genital system within 2 years. Demographic data included a mean age of 45 years, 67.9% identified as White, 6.53% as Black/African American, 20.52% unknown, and 2.45% other races. Of the 3,673 total women, 11% had a documented biopsy prior to or with the surgery, leading to 11% (395 women) being diagnosed with LS. Limitations include inconsistent medical coding, uncertain causality between conditions, and potential data inconsistencies from the national database.</p><p><strong>Conclusions: </strong>Labial adhesion has a complex etiology, yet is associated with LS, emphasizing the need for biopsy in management when the first-line estrogen cream approach fails. Future studies on LA etiologies can improve approaches to female sexual health care disorders, enhancing patient care.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"269-272"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASCCP Clinical Guidance Document Standardization.","authors":"Jenna Z Marcus, Christine Conageski, Akiva P Novetsky, David P Chelmow","doi":"10.1097/LGT.0000000000000896","DOIUrl":"10.1097/LGT.0000000000000896","url":null,"abstract":"<p><strong>Abstract: </strong>The American Society for Colposcopy and Cervical Pathology (ASCCP) provides practice guidance for clinicians caring for patients with lower genital tract conditions. The ASCCP wants to ensure that its library of guidance documents is current, evidence based, and easy for clinicians to use. Guidance documents should present clear, actionable evidence-based management recommendations where the quality of the evidence and the strength of the recommendation are clearly identified. This document explains ASCCP's new standard document types and the processes for their development and maintenance, as well as the process for selecting new topics.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"263-268"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}