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Alcazar JL, Para E, Tomaizhe A, Laza MV, Guerriero S. Vaginal wall thickness as potential biomarker of vaginal health. A proposal for standardized ultrasound measurement using three-dimensional transvaginal ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1366-1369. [PMID: 37646482 DOI: 10.1002/jcu.23547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023]
Abstract
Vaginal wall thickness could be used as a biomarker of vaginal health. We propose a standardized method using three-dimensional (3D) ultrasound for measuring vaginal wall thickness. Fill the vagina with gel. Insert the endovaginal transducer into the vagina up to the middle third. In the sagittal plane, visualizing the cervix and vaginal fornices, capture a 3D volume of the upper third of the vagina. Using tomographic ultrasound imaging function in the sagittal plane and the posterior vaginal fornix as the reference obtain at least three axial planes of the vagina, separated by 1 cm. Measure the vaginal wall thickness at a distance of 2 cm from the posterior vaginal fornix at 12, 3, 6, and 9 o'clock. The reproducibility of measurements was high. Measurements of vaginal wall thickness can be reliably performed.
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Affiliation(s)
- Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Elisa Para
- Department of Obstetrics and Gynecology, Hospital Universitario Sureste, Arganda del Rey, Spain
| | - Aida Tomaizhe
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Maria Victoria Laza
- Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, Badajoz, Spain
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula Monserrato, University of Cagliari, Cagliari, Italy
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Huang M, Wang Y, Xu J, Xiao H, Xie J. Assessing vaginal wall indexes in premenopausal versus postmenopausal women by transrectal linear array high-frequency probe. Eur J Med Res 2023; 28:390. [PMID: 37770918 PMCID: PMC10540317 DOI: 10.1186/s40001-023-01378-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/18/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE This study aimed to verify the feasibility of 2D measurement of full-layer thickness of vaginal wall and evaluation of its elasticity by shear wave elastic imaging using transrectal linear array high-frequency ultrasound and to investigate the differences of vaginal wall indexes in premenopausal versus postmenopausal women. METHOD From September to November 2022, a total of 87 women in the Department of Gynecology, Nanjing First Hospital were examined by a sonographer using transrectal linear array high-frequency ultrasound, including 34 women of reproductive age and 53 postmenopausal women. The vagina was divided into upper, middle, and lower segments, and the full-layer thickness of each part was measured. Then shear wave elastography (SWE) was used, and the average value of Young's modulus was used to evaluate the degree of vaginal elasticity. RESULTS Transrectal linear array high-frequency ultrasound can clearly display structures of vaginal wall; measurement of the full thickness of the vaginal wall and evaluation of the degree of vaginal elasticity were feasible. There was a statistically significant difference in the thickness of each part of the vaginal wall between pre- and postmenopausal women (P < 0.001); there was no significant difference in the vaginal Young's modulus of pre- and postmenopausal women (P = 0.073). CONCLUSION Transrectal linear array high-frequency ultrasonography is a non-invasive and feasible method to measure vaginal wall thickness (VWT) and elasticity. There are significant differences in VWT between pre- and postmenopausal women.
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Affiliation(s)
- Mengqi Huang
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China
| | - Yidan Wang
- Department of Ultrasonography, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China
| | - Jiajun Xu
- Department of Ultrasonography, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China
| | - Huiru Xiao
- Clinical Academic Department of Global Medical Imaging Products, Shenzhen Mindray Biomedical Electronics Co., Ltd, Shenzhen, 518055, People's Republic of China
| | - Jingyan Xie
- Department of Gynecology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China.
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Cucinella L, Tiranini L, Cassani C, Martella S, Nappi RE. Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy. Int J Womens Health 2023; 15:1261-1282. [PMID: 37576184 PMCID: PMC10422970 DOI: 10.2147/ijwh.s414509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks-24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS San Matteo Foundation, Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Clark AL. Genitourinary syndrome of menopause-I know it when I see it-or do I? Menopause 2023; 30:785-787. [PMID: 37498218 DOI: 10.1097/gme.0000000000002228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Amanda L Clark
- From Oregon Health & Science University and Kaiser Permanente Center for Health Research, Portland, OR
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Pereira GMV, Juliato CRT, de Almeida CM, Valente IS, de Andrade KC, Brito LGO. Measurement of the vaginal wall thickness by transabdominal and transvaginal ultrasound of women with vaginal laxity: a cross-sectional study. Int Urogynecol J 2022; 33:3563-3572. [PMID: 35384478 DOI: 10.1007/s00192-022-05184-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An objective diagnostic method to understand vaginal laxity (VL) is still missing. The aim of our study is to determine whether vaginal wall thickness (VWT) measured by ultrasound may differ according to the abdominal or vaginal techniques and to assess whether clinical variables are associated with vaginal measurements of women with VL. METHODS A cross-sectional study conducted at a tertiary hospital included 82 women aged ≥ 18 years with VL complaints assessed by the Vaginal Laxity Questionnaire. Women who reported severe comorbidities or vulvovaginal disorders, previous treatment for VL, and use of vaginal estrogen in the last 6 months were excluded. Participants reporting VL underwent transabdominal (TAUS) and transvaginal ultrasound (TVUS) and physical examination and answered validated questionnaires. Descriptive data were given as mean and standard deviation, median (range), and absolute and relative frequency. The significance level adopted for this study was 5%. Sample size calculation was not performed for the present study. RESULTS Mean age was 41.20 ± 8.64 years, and most participants were multiparous, with previous vaginal delivery and having vaginal intercourse. A statistically significant difference (up to 3 mm) between TAUS and TVUS measurements of the VWT was found in the proximal, middle-third, and distal compartments. A significant correlation was found between VWT and TAUS or TVUS in the mid-third and distal compartments. CONCLUSION A significant correlation was found between the VWT measurements in TVUS and TAUS. Our findings might give the health professional more possibilities for investigating VWT according to patient characteristics.
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Affiliation(s)
- Glaucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas-UNICAMP, Rua Alexander Fleming, 101-Cidade Universitária-Campinas, São Paulo, 13083-881, Brazil
| | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas-UNICAMP, Rua Alexander Fleming, 101-Cidade Universitária-Campinas, São Paulo, 13083-881, Brazil
| | - Cristiane Martins de Almeida
- Division of Imaging, Women's Hospital-Professor Doutor José Aristodemo Pinotti-CAISM-University of Campinas-UNICAMP, Campinas, Brazil
| | - Isabella Salvetti Valente
- Division of Imaging, Women's Hospital-Professor Doutor José Aristodemo Pinotti-CAISM-University of Campinas-UNICAMP, Campinas, Brazil
| | - Kleber Cursino de Andrade
- Division of Imaging, Women's Hospital-Professor Doutor José Aristodemo Pinotti-CAISM-University of Campinas-UNICAMP, Campinas, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas-UNICAMP, Rua Alexander Fleming, 101-Cidade Universitária-Campinas, São Paulo, 13083-881, Brazil.
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Türk S, Ertürk Coşkun AD, Vural F. Ultrasonographic measurement of vaginal thickness: Relation to menopausal status and genitourinary syndrome of menopause. J Obstet Gynaecol Res 2022; 48:2911-2917. [PMID: 35896166 DOI: 10.1111/jog.15368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the total vaginal wall thickness (TVT) and total mucosal thickness (TMT) measurements of premenopausal and postmenopausal women measured by ultrasonography and to determine the association of these measurements to findings and symptoms of genitourinary syndrome of menopause METHODS: Healthy volunteers, 80 postmenopausal and 80 premenopausal, were included. Ultrasonographic TVT and TMT measurements, vaginal health index (VHI) scores and pH values were recorded. The daily impact of vaginal aging (DIVA) scale was administered to women in the postmenopausal group. RESULTS TVT measurements of the postmenopausal group (6.55 ± 2.00 mm) were lower than the premenopausal group (10.37 ± 2.11 mm) (p: 0.000). TMT measurements of the postmenopausal group (1.46 ± 0.50 mm) were lower than the premenopausal group (2.19 ± 0.60 mm) (p: 0.000). The VHI scores of the postmenopausal group were significantly lower than the premenopausal group, the pH value was higher (p < 0.05). Considering all women TVT and TMT measurements were inversely correlated with pH values and positively correlated with total VHI scores. There was no significant correlation between any component scores of the DIVA scale and TVT, TMT, pH, and VHI total (p > 0.05). CONCLUSIONS TVT and TMT measurements in postmenopausal women are significantly lower than premenopausal women. Examination findings and thickness measurements are correlated. Transabdominal ultrasonography is a method that can be used in the evaluation of vaginal thickness which is not painful for the patient, is easy to apply and gives results consistent with the examination findings. However, measurements and examination findings do not correlate with the DIVA scores in postmenopausal women.
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Affiliation(s)
- Sema Türk
- Istanbul Medeniyet University Göztepe Prof Dr Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ayşe D Ertürk Coşkun
- University of Health Sciences Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fisun Vural
- University of Health Sciences Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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