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Observational cohort study of the effect of a single lubricant exposure during transvaginal ultrasound on cell-shedding from the vaginal epithelium.

ABSTRACT: The outer layers of the vaginal epithelium (VE) are important because they accumulate glycogen which, under optimal conditions, Lactobacillus spp. consume to grow and acidify the vaginal microenvironment with lactic acid. We hypothesized that exposure to lubricant, for example in the conduct of a transvaginal ultrasound (TVUS), may contribute to the shedding of mature epithelial cells, exposing immature cells. Cervicovaginal fluid (CVF) was sampled at four time points by menstrual cup (Softdisc™) from 50 women referred for TVUS, during which a controlled volume of lubricant was applied to the TVUS wand. Samples were collected (1) immediately before TVUS and (2) 6-12 hours, (3) within one week, and (4) two weeks after TVUS. Clinical vaginal lubricants are similar to commercial lubricants, and often have a high osmolality or pH, and contain bactericides such as methylparaben and propylparaben. The number and maturity of epithelial cells in each CVF sample were measured by quantitative and differential fluorimetry (maturity index, MI). Comparisons of cell-counts and maturity were made by paired Wilcoxon signed-rank tests. Among women with a high pre-TVUS MI (> 3), there was a decrease in median cell-count and mean MI in the sample collected 6-12 hours after TVUS (p<0.001, n = 26 and p < 0.001, n = 26, respectively). For these women, cell-count and MI remained lower in the sample collected within the subsequent week (p<0.001, n = 29 and p<0.01, n = 29, respectively), and MI remained lower in the sample collected within two weeks of TVUS (p<0.01, n = 25), compared to the pre-TVUS sample. Among participants with a low pre-TVUS MI (< 3), cell-count was higher in the sample collected within two weeks of TVUS compared to the pre-TVUS sample (p = 0.03, n = 15), but no significant changes in MI were observed. Results were similar when restricted to reproductive-age women. This preliminary data indicates hypertonic vaginal lubricants may increase vaginal epithelial cell shedding.

SUBMITTER: O'Hanlon DE

PROVIDER: S-EPMC8092793 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundLimited data suggest that personal lubricants may damage the vaginal mucosal epithelium, alter the vaginal microbiota, and increase inflammation. We compared vaginal cytokine profiles and microbiota before and after vaginal lubricant use and condomless vaginal sex.MethodsReproductive-age women were recruited to a 10-week observational cohort study and were asked to self-collect vaginal samples and behavioral diaries daily. This nested case-control analysis utilized samples collected before and after self-reported condomless sexual activity with lubricants (22 case participants) and without lubricants (22 control participants). Controls were matched to cases on race/ethnicity. Microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3-V4 regions. Cytokine concentrations were quantified using a magnetic bead 41-plex panel assay and read using a Bio-Plex 200 array reader. Wilcoxon signed-rank tests were used to assess baseline differences in vaginal cytokines between cases and controls as well as differences pre- and post-exposure. Linear mixed effects models were used to examine differences in relative post-to-pre change in each individual cytokine between matched cases and controls. Similar analyses were conducted for the microbiota data.ResultsMean age was 29.8 years (SD 6.8), and 63.6% were African American. There were few statistically significant changes in cytokines or microbiota before and after exposure in cases or controls. In mixed-effects modeling, the mean relative post-to-pre change of cytokines was higher in cases vs. controls for macrophage derived chemokine (MDC) (p = 0.03). The microbiota data revealed no significant changes when measured by similarity scores, diversity indexes and descriptive community state types (CST) transition analyses. However, post sexual activity, the mean relative abundance of L. crispatus decreased for those who used lubricants (particularly those who were L. iners-dominated prior to exposure).ConclusionsAlthough there were overall few differences in the vaginal microbiota and cytokine profiles of lubricant users and controls before and after condomless vaginal sex, there was a trend toward decreases in relative abundance of L. crispatus following use of lubricant. Future larger studies that take into account osmolarity and composition of lubricants may provide additional insights.

Project description:Objectives: Endometrial peristalsis (EP) in non-pregnant uterine can be assessed by visual assessment of transvaginal ultrasound (TVUS). However, visual assessment is subjective, and the outcome depends on the sonographers and video analysts. This study aimed to create a newly developed automatic analysis algorithm for measuring the EP compared to visual assessment. Methods: A retrospective analysis was performed using the datasets from in vitro fertilization and embryo transfer (IVF-ET), who underwent the evaluation of EP by TVUS within 5 days prior to transplantation. 158 cine TVUS images were used to develop the automated analysis algorithm, and 37 cine TVUS images were evaluated by both visual and automated analysis algorithms. The algorithm was developed by applying the optical flow technology and enabled objective analysis of the number, direction, and intensity of EP. Results: The number of peristaltic waves counted by visual assessment was 4.2 ± 2.3 (mean ± standard deviation) and 4.1 ± 2.1 for doctors one and two, respectively. The number of waves counted with the algorithm was 3.6 ± 2.1 at first evaluation and 3.7 ± 2.0 at repeated evaluation. A significant difference was found between the algorithm count and visual assessment (p = 0.001, 0.002, 0.003, 0.008). The ICC values for algorithm versus manuals ranged from 0.84 to 0.96 and 0.87 to 0.96. The numbers of the cervix-to-fundus (CF), fundus-to-cervix (FC), and both cervix-to-fundal and fundus-to-cervix (CF + FC) directions of EP counted by the algorithm were 50, 52, and 32, respectively. The numbers counted by visual assessment were 43, 45, and 46, respectively. The number of EP was the same in 87% of the two algorithm counts. The number was lower between the algorithm and visual analysis (79% with complete agreement). The EP intensity assessed by the algorithm was 2.6 ± 1.1, and the peristalsis velocity was 0.147 (0.07) mm/s. Conclusion: The fully automated analysis algorithm can be used to quantify uterine peristalsis comparable to visual assessment.

Project description:ObjectiveTo assess the value of transvaginal ultrasound parameters after cerclage placement in estimating the risk of spontaneous preterm birth.Study designThis is a retrospective cohort at a single tertiary care center from 2013 to 2016. Women carrying a singleton, nonanomalous fetus with cerclage in situ and at least one postcerclage transvaginal ultrasound from 160/7 to 256/7 weeks' gestation were included. In addition to abstracting maternal demographic and obstetric characteristics, two study investigators separately reviewed each of the images from the first transvaginal ultrasound after cerclage placement, masked to pregnancy outcomes. We measured the angle between the anterior uterine wall and cervical canal at the internal os and external os, closed canal length above and below the stitch, width of the anterior and posterior cervix at the level of the cerclage, and stitch distance from the cervical canal. The presence of additional ultrasound findings such as sludge and cervical funneling was also noted. The main outcomes were preterm birth < 34 weeks and preterm birth < 37 weeks. Transvaginal ultrasound parameters were compared between women with preterm birth and those without preterm birth using chi-square, Fisher's exact, and Wilcoxon's rank-sum tests, as appropriate. Log binomial regression was used to estimate the relative risk of preterm birth for all significant obstetric and ultrasound characteristics.ResultsA total of 102 women met inclusion criteria: 58% had history-indicated, 20% ultrasound-indicated, and 23% exam-indicated cerclages. Of these, 28 (27.5%) women delivered at < 34 weeks' gestation, and 48 (47.0%) women delivered at < 37 weeks' gestation. Preterm birth did not vary by race, maternal age, insurance, smoking, or gestational age of the earliest prior preterm birth (for multiparous women), but women who had preterm birth were more likely to have exam-indicated cerclage. There were several transvaginal ultrasound parameters associated with preterm birth < 34 weeks and preterm birth < 37 weeks. Of these, cervical length below the stitch, stitch distance from the cervical canal, straight cervical canal, funneling to or past the stitch, and presence of sludge had the greatest effect sizes.ConclusionRates of preterm birth are high postcerclage. In addition to measuring cervical length, utilization of postcerclage transvaginal ultrasound to evaluate the location of the cerclage within the cervix, the curvature of the cervical canal, and the presence of funneling and sludge may help identify women who are at the highest risk for preterm birth.

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Observational cohort study of the effect of a single lubricant exposure during transvaginal ultrasound on cell-shedding from the vaginal epithelium.

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