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Background: Vestibulodynia (VBD) represents a summation and overlapping of trigger factors (infections, hormonal disturbances, allergies, genetic aspects, psychological vulnerability, and others) with broad individual variability. As there are no standard treatment options for VBD, the disease is still in need of appropriate therapeutic tools. Objectives: A prospective observational trial was performed to confirm the efficacy of a topical gel containing a spermidine–hyaluronate complex (UBIGEL donna™) as either a stand-alone or companion treatment through a multicenter study on a large sample population. Methods: For women with VBD (n = 154), the treatment consisted of approximately two months (4 + 4 weeks) of applications according to the posology of UBIGEL. Evaluation of symptoms was performed on relevant clinical endpoints: dyspareunia and vulvovaginal pain/burning by a visual scale (VAS); vestibular trophism by a vestibular trophic health (VeTH) score; vulvoscopy through a cotton swab test; and the level of hypertonic pelvic floor by a physical graded assessment of levator ani hypertonus. Results: A total of 154 patients treated with UBIGEL donna™ showed significant improvements across all five evaluated parameters, including pain, dyspareunia, swab test results, muscle hypertonicity, and vestibular trophism. Pain and dyspareunia scores decreased by 46.5% and 33.5%, respectively, while significant improvements were also observed in the other parameters (p < 0.0001). These improvements were consistent across various stratifications, including age and disease duration. Conclusions: The findings of the present study suggest that UBIGEL donna™ is effective in alleviating pain and dyspareunia, as well as reducing vestibular hypersensitivity in women with VBD. Although UBIGEL donna™ alone cannot serve as a comprehensive substitute for all recommended therapies, we suggest that multimodal therapy strategies may be crucial for attaining substantial improvement in any aspect of the condition. [ABSTRACT FROM AUTHOR]

Knowledge of female genital anatomy and physiology is often inadequate or incorrect among women. Precise patient–physician conversations can be inhibited by a reluctance or inability to speak accurately about the vulva and vagina, with the terms often being used interchangeably. There is a paucity of scientific evidence and clinical guidelines to support women and physicians in ensuring best practices in feminine hygiene. In this review, the unmet needs in the field are highlighted. Evidence is provided for the complex array of physiological and pathological systems, mechanisms and behaviours that either protect or, if inappropriate, predispose the vulva and vagina to infections, irritation or other conditions. The need for attention to perineal health is recommended, given the interdependence of perineal and vulvar microbiota and the risk of colonic pathogens reaching the vulva and the vagina. Differences in feminine hygiene practices can vary widely across the world and among varying age groups, and suboptimal habits (such as vaginal douching or the use of certain cleansers) can be associated with increased risks of vulvar and vaginal conditions. Critical areas for discussion when advising women on their intimate health include: advice surrounding aesthetic vulvar cosmetic trends (such as depilation and genital cosmetic surgery), bowel health and habits, and protection against sexually transmitted infections. Routine, once-daily (maximum twice-daily) washing of the vulva with a pH-balanced, mild cleanser is optimal, ideally soon after bowel voiding, when feasible. Due to the finely balanced ecosystems of the vulva, the vagina and the perineal area, a scientific and clinical perspective is essential when determining the most appropriate vulvar cleansers based on their components. Correct intimate care may contribute to improved genital and sexual health and overall well-being. An increased awareness of correct practices will empower women to be the advocates of their own intimate health. [ABSTRACT FROM AUTHOR]

Foetal PAPCs (pregnancy-associated progenitor cells) begin to cross the placenta in a scheduled manner from early pregnancy and colonise many maternal organs, both in mammals and humans, during each pregnancy. The maternal limbic system appears to be colonised with a 100% frequency when compared with other maternal organs. Once they arrive in the limbic system, foetal PAPCs differentiate into neurons and glial cells, resulting in the formation of new synapses with and among maternal neurons. This process is accompanied by major structural neurobiological alterations orchestrated by hormonal changes characteristic of gestation and involves the limbic system, reward areas, and other closely connected brain structures, i.e., the same areas colonised by foetal PAPCs. To correlate findings regarding microscopic and macroscopic changes induced by foetal stem cell migration into the maternal limbic system and hormonal surges during pregnancy with the biological basis of mother-child attachment dynamics, with a focus on the clinical implications this discovery has for normal, complicated, and assisted pregnancies. A literature review of evidence regarding the neuroanatomical correlation between the targeted, colonising migration of foetal PAPCs into the maternal brain and the structural neurobiological alterations within the affective areas related to attachment and reward was conducted. These findings suggest a synergic effect of cellular and morphological changes, with a common biological aim of conferring an adaptive advantage in motherhood, and with the foetus playing a surprisingly active role in modulating the mother's ability to love and care for it. Fetal stem cells migration into the maternal brain and the morphological alterations of the latter occurring during pregnancy appear to confer an adaptive advantage in motherhood, with the fetus playing a surprisingly active role in modulating the mother's ability to love and care for it. [ABSTRACT FROM AUTHOR]

To assess the relationship between combined contraceptive vaginal ring (CVR) and vaginal microbiome using 16S rRNA gene sequencing. We enrolled 20 women for 8 weeks in an open-label study using CVR (NuvaRing®) that delivered 15 mcg ethinylestradiol and 120 mcg etonogestrel daily. The vaginal microbiome was assessed at baseline and after 2 months by sequencing the 16S rRNA genes amplified from the total genomic DNA isolated from the sample. Bacterial distribution richness and equity did not significantly change after 2 months, and the dominant bacterial strain was Lactobacillus crispatus. Only one woman with a history of vestibulodynia and recurrent vulvovaginitis showed an increase in bacterial biodiversity, with a switch to the relative abundance of anaerobic bacteria. Our results suggest that CVR does not adversely affect the composition and structure of the vaginal microbiome. However, special care should be taken in patients with a history of vestibulodynia and/or recurrent vulvovaginal infections. Contraceptive vaginal ring does not adversely affect vaginal microbiome except in the case of recurrent vulvovaginal infections or vestibulodynia. [ABSTRACT FROM AUTHOR]