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Background. Our aim was to evaluate the benefit of surgical resection of the venous malformation (VM) of the external female genitalia. Methods. Over the period of 2009-2019, 18 consecutive females underwent surgical resection for vulvar VM. Evaluations included preoperative Doppler ultrasound, MRI, and pre-and postoperative photographic imaging. The main outcomes were: residual pain, cosmetic distortion, residual VM, and quality of life. Results. Over a 10 year periods, 18 females, mean age 35 years (range 9-71) were included in this study. All patients were symptomatic: 16 had intermittent pain or discomfort, 1 had bleeding and 2 requested cosmetic treatment. Of these cases, there were 5 isolated vulvar VM, 12 associated VM: 3 of the clitoral hood, 3 troncular pelvic vein insufficiency and 12 of the lower limb. Eight patients had undergone previous procedures: 2 sclerotherapy treatments (1 to 3 sessions), 4 partial surgical resections. There were 18 single resections in the vulva (7 focal, 11 complete), 2 partial resections in clitoral hood and 2 had resection of a VM in the peritoneo-vaginal canal at the same time. The mean follow-up was 42. 9 months (range 6-120). Two patients were lost to follow-up at 6 months. For all patients, elimination of pain and soft tissue redundancy was achieved. Two patients had persistent discomfort and 2 requested cosmetic treatment. Conclusion. Surgical resection of vulvar VM can be the best approach with few postoperative complications, good functional and cosmetic results. Appropriate preoperative evaluation is required to identify isolated VM or VM associated with ovarian vein or internal iliac vein insufficiency requiring to be treated before surgery. [ABSTRACT FROM AUTHOR]

This research is aimed to evaluate the nonlinear mathematical model in predicting the age and weight of Kebumen Ongole Grade (PO) cattle at puberty. The data used in this research was weight recordings of (768) PO cattle, ranging from calf (< 1 month) to adult (60 months), collected by Kebumen PO cattle Breeder Association (ASPOKEB) from 2013 to 2015. These cattle were reared by a group of farmers located in six sub-districts: Mirit, Lembu Purwo, Ambal, Puring, Petanahan, and Klirong in Kebumen district, Jawa Tengah Province. Brody, Bertalanfy, Logistic and Gompertz mathematical models were used to analyze the data. The analysis showed that the R2 of the four models classify high in the category (R²>0.70). Mature weight (A) of PO cattle predicted by Logistic (349 kg) and Gompertz (358 kg) were most appropriate. Out of the four models, the Logistic model was the most accurate in predicting the weight at puberty (174 kg) of PO cattle, but all observed cattle are still in the follicular phase. [ABSTRACT FROM AUTHOR]

Importance: Many conditions that can affect women's health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality.Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for gynecologic conditions with pelvic examination for conditions other than cervical cancer, gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations.Evidence Review: The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition.Findings: Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women.Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women. (I statement) This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou smear, screening for gonorrhea and chlamydia). [ABSTRACT FROM AUTHOR]

Background: We undertook to study possible determinants of female sexual dysfunction (FSD) in a large cohort of female medical students from German-speaking countries. Methods: We conducted an online questionnaire-based anonymous survey in a cohort of >2600 female medical students enrolled at German-speaking universities. The questionnaire comprised the Female Sexual Function Index (FSFI) plus additional questions regarding contraception, sexual activity, age, height, weight, lifestyle, activity at work, sexuality and emotional interaction with a steady partner, pregnancy history and plans, health problems, and self-acceptance. Data analysis employed descriptive statistics, univariate and multivariate analyses, and standard nonparametric tests. Results: Of the 2612 respondents aged ≤30 years included in the analysis (mean age [standard deviation], 23.5 [2.5] years), 38.7% of the overall cohort and 33.5% of the sexually active subcohort (91.8% of all students) were at risk for FSD (FSFI score <26.55). Multivariate analysis revealed the following significant factors to be associated with the FSFI: alcohol consumption, level of fitness, use of contraception, steady relationship, and self-acceptance (overall cohort and sexually active subcohort); smoking (overall cohort only); and body mass index and activity at work (sexually active subcohort only). Conclusions: Almost 40% of German-speaking female medical students are at risk for FSD. Contraception, smoking, alcohol, steady relationship, physical fitness, and self-acceptance are significantly associated with the FSFI total score. Being in a steady relationship, better physical fitness, higher activity at work, and subjectively positive self-acceptance, in particular, are associated with higher FSFI total scores, that is, with less risk for sexual dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To develop a nursing diagnosis for the detection and prevention of FGM. Methods: The creation of this diagnosis is based on exhaustive bibliographic research of databases such as LILACS, CUIDEN, TESEO y Web of Sciencie; as well as other documentary sources from international entities. Results: Post Female Genital Mutilation Syndrome is defined as: Deterioration of a range of health domains as a result of female genital mutilation. This diagnosis belongs to domain 11: safety/protection and class 3: violence. The following defining characteristics are established for this diagnosis: Acute phase, chronic responses physical, sexuality, chronic obstetric alterations and psychological responses. Conclusions: Via the diagnosis presented herein, early detection might be procured by nursing professionals of those women and young girls having undergone this traditional practice, thereby being able to treat any possible resultant sequelae. [ABSTRACT FROM AUTHOR]

Cervicovaginal fluid plays an important role in the detection of many female genital diseases, but the lack of suitable collection devices in the market severely challenges test success rate. Appropriate clinical sampling devices for cervicovaginal fluid collection would help physicians detect diseases and disease states more rapidly, efficiently, and accurately. The objective of this study was to develop a readily usable sampling collection device that would eliminate macromolecular interference and accurately provide specimens for further studies. This study was designed to develop an effective device to collect cervicovaginal fluid from women with symptoms of endometrial lesions, women appearing in the clinic for a routine Papanicolaou smear, and/or women seeking a routine gynecologic checkup. Paper-based assay, ELISA, and qNano were used to provide accurate diagnoses. A total of 103 patients successfully used the developed device to collect cervicovaginal fluid. Some of the collected specimens were used to detect glycogen, lactate, and pH for determining pathogen infection. Other specimen samples were tested for the presence of female genital cancer by comparing interleukin 6 concentration and microvesicle concentration. We proposed a noninvasive screening test for the diagnosis of female genital diseases using a dual-material collection device. The outer, nonwoven fabric portion of this device was designed to filter macromolecules, and the inner cotton portion was designed to absorb cervicovaginal fluid. [ABSTRACT FROM AUTHOR]

Paediatric and adolescent gynaecology involves the care of young women and their special needs as their bodies change and grow into adulthood. Diagnosis and management of common problems in gynaecology in this age group requires knowledge regarding congenital reproductive anomalies, disorders of gender development, reproductive endocrinopathies, gender identity, and gynaecologic malignancies. Gynaecologic disease states in paediatric patients frequently present with vulval and vaginal manifestations, while those in the adolescent age range present as abdominal-pelvic pain and abnormal menstrual bleeding. A case-based learning of common childhood gynaecologic disorders and their treatment is presented. [ABSTRACT FROM AUTHOR]

Sexual function is an integral part of health and well-being. While sexual activity decreases with age, it continues to play an active role in our lives. Most men and women within the geriatric population want to talk about sexuality with their health care professionals but do not want to broach the topic first. Competency in taking a sexual history not only is critical to promoting healthy behaviors and reducing medical risks but also can enhance quality of life if appropriate adaptations are made and recommendations given. Including a routine, respectful, and informed sexual health assessment in the rehabilitation setting is part of providing comprehensive care. This article reviews the importance of sexual health within the geriatric population and concludes with specific guidelines on how to evaluate sexual function. [ABSTRACT FROM AUTHOR]

Sexual health contributes to emotional and physical well-being in postmenopausal women. Sexual dysfunction is multifactorial in etiology and is largely underdiagnosed. Genitourinary syndrome of menopause, a new term encompassing a constellation of symptoms, is common, progressive, and treatable. Disorders of sexuality, including hypoactive sexual desire disorder, are also common and clinicians should learn simple evaluation, which can aid in diagnosis and treatment of both genitourinary syndrome of menopause and hypoactive sexual desire disorder. [ABSTRACT FROM AUTHOR]

Sexuality is an integrated, unique type of personal expression that includes physiologic and psychological processes inherent in sexual development. A multidimensional construct, human sexuality encompasses a view of oneself as a female and presentation of oneself as a woman, sexual desire, sexual response, and sexual orientation. A woman's sexuality is an important aspect of her health throughout the life span. Through her sexuality, a woman expresses her identity and her need for emotional and physical closeness with others. No 2 women express sexuality in exactly the same way. Sexuality need not be limited by age, attractiveness, partner availability or participation, or sexual orientation Expressed positively, sexuality can bring much pleasure, but it also has the potential to cause great pain. It is imperative that the medical professional have a complete understanding of the importance of their role in addressing female sexual dysfunction in the biopsychosocial context. [ABSTRACT FROM AUTHOR]

Background: Human reproduction depends on an intact hypothalamic-pituitary-gonadal (HPG) axis. Hypothalamic gonadotrophin-releasing hormone (GnRH) has been recognized, since its identification in 1971, as the central regulator of the production and release of the pituitary gonadotrophins that, in turn, regulate the gonadal functions and the production of sex steroids. The characteristic peculiar development, distribution and episodic activity of GnRH-producing neurons have solicited an interdisciplinary interest on the etiopathogenesis of several reproductive diseases. The more recent identification of a GnRH/GnRH receptor (GnRHR) system in both the human endometrium and ovary has widened the spectrum of action of the peptide and of its analogues beyond its hypothalamic function.Methods: An analysis of research and review articles published in international journals until June 2015 has been carried out to comprehensively summarize both the well established and the most recent knowledge on the physiopathology of the GnRH system in the central and peripheral control of female reproductive functions and diseases.Results: This review focuses on the role of GnRH neurons in the control of the reproductive axis. New knowledge is accumulating on the genetic programme that drives GnRH neuron development to ameliorate the diagnosis and treatment of GnRH deficiency and consequent delayed or absent puberty. Moreover, a better understanding of the mechanisms controlling the episodic release of GnRH during the onset of puberty and the ovulatory cycle has enabled the pharmacological use of GnRH itself or its synthetic analogues (agonists and antagonists) to either stimulate or to block the gonadotrophin secretion and modulate the functions of the reproductive axis in several reproductive diseases and in assisted reproduction technology. Several inputs from other neuronal populations, as well as metabolic, somatic and age-related signals, may greatly affect the functions of the GnRH pulse generator during the female lifespan; their modulation may offer new possible strategies for diagnostic and therapeutic interventions. A GnRH/GnRHR system is also expressed in female reproductive tissues (e.g. endometrium and ovary), both in normal and pathological conditions. The expression of this system in the human endometrium and ovary supports its physiological regulatory role in the processes of trophoblast invasion of the maternal endometrium and embryo implantation as well as of follicular development and corpus luteum functions. The GnRH/GnRHR system that is expressed in diseased tissues of the female reproductive tract (both benign and malignant) is at present considered an effective molecular target for the development of novel therapeutic approaches for these pathologies. GnRH agonists are also considered as a promising therapeutic approach to counteract ovarian failure in young female patients undergoing chemotherapy.Conclusions: Increasing knowledge about the regulation of GnRH pulsatile release, as well as the therapeutic use of its analogues, offers interesting new perspectives in the diagnosis, treatment and outcome of female reproductive disorders, including tumoral and iatrogenic diseases. [ABSTRACT FROM AUTHOR]

Endometriosis is a gynaecologic disease characterized by endometrial tissue outside the uterine cavity. Commonly it affects the pelvic organs. When endometrial nodules or plaques are localized in sites other than the uterus or ovaries, it is termed extragenital endometriosis. Adequate pre-operative assessment is essential for treatment planning. MRI is a noninvasive method with high spatial resolution that allows the multiplanar evaluation of genital and extragenital endometriosis. Herein, we present a pictorial review of a variety of extragenital endometriosis cases, all of which can be encountered in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the role of peripheral blood markers as additional diagnostic tools to transvaginal ultrasound (TVU) findings in the diagnosis of endometriosis. Methods: This study included 40 patients undergoing laparoscopy for suspected endometriosis from January to December 2012. Preoperative levels of serum CA125, CA19-9, CEA and mRNA expression levels for survivin and VEGF were obtained. Real-time PCR was used to determine relative gene expression. A new diagnostic score was obtained by deploying the peripheral blood markers to the TVU findings. Statistical methods used were Chi-square, Fisher's, Student's t-test or the Mann - Whitney test. Results: There was a statistically significant difference in serum CA125, survivin and VEGF levels in patients with endometriosis and those without endometriosis (p<0.001, p=0.025 and p=0.009, respectively). False negative TVU findings were noted in 3/13 patients (23.1%) with peritoneal endometriosis without ovaries involvement. High sensitivity (93.3%), specificity (90.0%), PPV (96.6%), NPV (81.8%) and accuracy (92.5%) were obtained for a diagnostic score based on TVU and significant peripheral blood markers (CA125, survivin and VEGF). Conclusions: Determination of serum CA125, mRNA expression levels for survivin and VEGF along with TVU can contribute to higher accuracy of the noninvasive diagnostic tools for endometriosis. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the therapeutic efficacy of oral moxifloxacin for aerobic vaginitis (AV). We also identified factors that are associated with therapeutic efficacy. This prospective study enrolled general gynecological outpatients at Tianjin Medical University General Hospital between September 2012 and May 2014. Women diagnosed with AV ( n = 102) were recruited. All enrolled women were treated with oral moxifloxacin, 400 mg once daily for 6 days (one course). Therapeutic efficacy was evaluated based on microscopic criteria, and cure rates were calculated. Women who were microscopically improved (but not cured) received a second course of therapy. Women classified with microscopic failure were treated using other strategies. Univariate and multivariate logistic regression analysis was used to identify factors that may be associated with a cure after one course of therapy. After one course of therapy, 65.7 % (67/102) of women were cured, 29.4 % (30/102) of women were improved (but not cured), 4.9 % (5/102) of women failed to respond to the therapy. After two courses of therapy, 85.3 % (87/102) of women were cured, 9.8 % (10/102) of women were improved, 4.9 % (5/102) of women failed to respond to the therapy, and clinical improvement was achieved in additional women. In the multivariate logistic regression analysis, women with a baseline vaginal pH value of <5.0 had a 3.5-times higher chance of being cured, compared with those with a baseline vaginal pH value of ≥5.0 (OR, 3.503; 95 % CI, 1.278-9.601). Moxifloxacin is an effective therapeutic option for patients with AV. Most women with AV were cured with one course of moxifloxacin. For those with a higher vaginal pH value of ≥5.0 before treatment, two courses of therapy should be considered. [ABSTRACT FROM AUTHOR]

Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histology. Endometrial aspiration was performed by infant feeding tube in 10 cases and intra cath cannula in 45 cases. The slides were stained with rapid Papanicolaou (PAP) stain and Leishman stain. Results: Endometrial aspiration cytology showed 90% and 94.6% sampling adequacy with infant feeding tube and intra cath cannula, respectively. Intra cath cannula was very convenient to handle and superior to infant feeding tube in aspirating the endometrium. Of the two stains used, rapid PAP stain was less time-consuming and superior to Leishman stain in studying the nuclear details. Leishman stain was helpful in detecting cytoplasmic vacuoles of secretory endometrium. Overall diagnostic accuracy of endometrial cytology was 90.4% while that for morphological hormonal evaluation was 97.6%. It enjoyed a sensitivity of 91.66%, a specifi city of 88.23%, positive predictive value of 94.28%, and negative predictive value of 83.33%. Conclusion: Intra cath cannula emerged as an inexpensive, effective, and convenient device for endometrial aspiration. Endometrial aspiration proved to be a fairly effective, simple, and informative diagnostic modality. [ABSTRACT FROM AUTHOR]

Study Question: What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system?Summary Answer: The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented.What Is Known Already: Accurate diagnosis of congenital anomalies still remains a clinical challenge because of the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes.Study Design, Size, Duration: The ESHRE/ESGE CONgenital UTerine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project.Participants/materials, Setting, Methods: The consensus is developed based on: (i) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy by performing a systematic review of evidence and (ii) consensus for the definition of where and how to measure uterine wall thickness and the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method.Main Results and the Role Of Chance: Uterine wall thickness is defined as the distance between the interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional (3D) US is recommended for the diagnosis of female genital anomalies in 'symptomatic' patients belonging to high risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the subgroup of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopically.Limitations, Reasons For Caution: The various diagnostic methods should always be used in the proper way and evaluated by experts to avoid mis-, over- and underdiagnosis.Wider Implications Of the Findings: The role of a combined US examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity.Study Funding/competing Interests: None. [ABSTRACT FROM AUTHOR]

Control of genital infections remains challenging in most regions. Despite advocacy by the World Health Organization for syndromic case management, there are limited data on the syndromic approach, especially in HIV care settings. This study compared the syndromic approach with laboratory diagnosis among women in HIV care in Kenya. A mobile team visited 39 large HIV care programmes in Kenya and enrolled participants using population-proportionate sampling. Participants provided behavioural and clinical data with genital and blood specimens for lab testing. Among 1063 women, 68.4% had been on antiretroviral therapy >1 year; 58.9% were using cotrimoxazole prophylaxis; 51 % had CD4+T-lymphocytes < 350 cells/µL. Most women (63.1%) reported at least one genital symptom. Clinical signs were found in 63% of women; and 30.8% had an aetiological diagnosis. Bacterial vaginosis (17.4%), vaginal candidiasis (10.6%) and trichomoniasis (10.5%) were the most common diagnoses. Using laboratory diagnoses as gold standard, sensitivity and positive predictive value of the syndromic diagnosis for vaginal discharge were 47.6% and 52.7%, respectively, indicating a substantial amount of overtreatment. A systematic physical examination increased by 9.3% the positive predictive value for genital ulcer disease. Women attending HIV care programmes in Kenya have high rates of vaginal infections. Syndromic diagnosis was a poor predictor of those infections. [ABSTRACT FROM AUTHOR]

With the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) recently released, there has been important debate as to what constitutes low sexual desire/low sexual interest in women and how best to operationalise this construct. A new set of diagnostic criteria has been included for women who present with concerns relating to their level of desire. However, inherent to the diagnosis of “abnormal” or low level of sexual desire or interest, is the notion that there is a “normal” or average level of desire. Given that low desire is present in as many as 55% of women, it is possible that variations in desire levels may be a normative response to life circumstances. Increasing desire level has traditionally been the focus of therapy when individuals and couples experiencing desire problems present for treatment. However, this goal has proven difficult to achieve. Recent research investigating the distress associated with low desire, rather than low desire itself, may encourage a new line of potential treatment targets to address distress, as well as improve relationship quality. This paper will highlight the gaps in our understanding of this construct, outlining the seminal research conducted within the field, and offering support for new directions of enquiry. [ABSTRACT FROM AUTHOR]

Background: Most breast cancer survivors (BCSs) experience sexual dysfunction from treatment-induced hormonal changes, making sexual assessment an important component of survivorship care. However, because many oncology healthcare providers do not perform such assessment, a number of BCSs endure unidentified sexual dysfunction. Barriers to assessment faced by providers must be identified, and further research should examine the perspectives of BCSs and their partners regarding preferences for sexual assessment and interventions. Objectives: The purpose OF this literature review was to explore tools used to assess sexual functioning and evidence-based interventions used to treat sexual dysfunction in BCSs. Methods: Articles published from 2003-2013 that reported on the effects of breast cancer and its treatment on sexual functioning in BCSs and located through online database searches (PubMed, the Cochrane Library, MEDLINE®, CINAHL®) were reviewed. Findings: Sexual dysfunction is a common problem among BCSs. Using various assessment tools, providers should regularly assess sexual functioning in BCSs during and after treatment to improve quality of life for BCSs and their partners. [ABSTRACT FROM AUTHOR]

Sex is a motive force bringing a man and a woman into intimate contact. Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. Though generally, women are sexually active during adolescence, they reach their peak orgasmic frequency in their 30 s, and have a constant level of sexual capacity up to the age of 55 with little evidence that aging affects it in later life. Desire, arousal, and orgasm are the three principle stages of the sexual response cycle. Each stage is associated with unique physiological changes. Females are commonly affected by various disorders in relation to this sexual response cycle. The prevalence is generally as high as 35-40%. There are a wide range of etiological factors like age, relationship with a partner, psychiatric and medical disorders, psychotropic and other medication. Counseling to overcome stigma and enhance awareness on sexuality is an essential step in management. There are several effective psychological and pharmacological therapeutic approaches to treat female sexual disorders. This article is a review of female sexuality. [ABSTRACT FROM AUTHOR]

Background: Sexual functioning and variables that influence sexual functioning have not been studied in Indian women with epilepsy. Materials and Methods: In a pilot study, female (age, 18-45 years) outpatients with epilepsy who were in a stable sexual relationship for at least 1-year were screened using the mini international neuropsychiatric interview. Those without anxiety or depressive disorders (n = 60) were studied using the female sexual function index (FSFI; higher scores indicate better functioning). Findings were compared with age- and sex- matched sample of healthy control women drawn from the same sociodemographic population. Results: Women with epilepsy had significantly poorer sexual functioning on all FSFI subscales (desire, arousal, lubrication, orgasm, satisfaction, pain), as well as on the total scale scores, and >70% of these women were rated as dysfunctional on individual FSFI subscales and on the total scale. In multivariate analysis, use of clobazam and phenobarbitone, and longer time after the last seizure were each associated with significantly higher FSFI scores; and longer duration of epilepsy was associated with significantly lower FSFI scores. Conclusion: There is a substantial impairment of sexual functioning in women with epilepsy. This study demonstrates the need for increased awareness of the problem, better case identification, and improved seizure control. [ABSTRACT FROM AUTHOR]

Sexual function of women can be affected by many factors resulting in female sexual dysfunction (FSD). Sexual dysfunction is a common problem among women of all ages and has negative effects not only on their quality of lives but also on the sexual function and quality of life of their partners. It can also affect mental health of the entire family and society. Regarding the multidimensional nature of female sexual dysfunction and considering its consequences, this condition needs to be recognised in its early stages in order to prevent future consequences and impacts. This article discusses biopsychosocial aspect of female sexual function, classifications and risk factors of female sexual dysfunction and investigates current approaches to identify and treat this problem. [ABSTRACT FROM AUTHOR]

The traditionally recognized role of vitamin D consists in the regulation of bone metabolism and calcium-phosphorus homeostasis but recently a lot of in vitro and in vivo studies recognized several “noncalcemic” effects of vitamin D metabolites. Accumulating evidence suggests that the metabolic pathways of this vitamin may play a key role in the developing of gynaecological/obstetric diseases. VDR-mediated signalling pathways and vitamin D levels seem to (deeply) affect the risk of several gynaecological diseases, such as polycystic ovary syndrome (PCOS), endometriosis, and ovarian and even breast cancer. On the other hand, since also the maternal-fetal unit is under the influence of vitamin D, a breakdown in its homeostasis may underlie infertility, preeclampsia, and gestational diabetes mellitus (GDM). According to our literature review, the relationship between vitamin D and gynaecological/obstetric diseases must be replicated in future studies which could clarify the molecular machineries behind their development. We suggest that further investigation should take into account the different serum levels of this vitamin, the several actions which arise from the binding between it and its receptor (taking into account its possible polymorphism), and finally the interplay between vitamin D metabolism and other hormonal and metabolic pathways. [ABSTRACT FROM AUTHOR]

Background: A bladder cancer diagnosis and the effects of treatment can have a significant impact on a patient’s physical, emotional, and psychological well-being. Because healthcare providers tend to focus on these aspects of care, a patient’s concerns with changes regarding sexual health are often overlooked. Objectives: The purpose of this article is to provide oncology nurses with an overview of causes of and treatment for sexual dysfunction as it relates to patients with bladder cancer. Methods: Data were extracted using key words and phrases such as bladder cancer, cystoscopy, cystectomy, pelvic exenteration, and sexual dysfunction. Findings: Oncology nurses are ideal healthcare providers to assess the sexual health concerns of patients with bladder cancer. Oncology nurses can be valuable resources for patients by giving them permission to discuss sexual health, educating them and their partners about potential implications of treatment on sexuality, reviewing treatment options, and facilitating referrals to other providers who specialize in treating sexual dysfunction. [ABSTRACT FROM AUTHOR]

Context.--Immunohistochemistry has assumed an increasing role in the identification and characterization of gynecologic disorders including lesions with deceptively bland morphology, uncommon and underdiagnosed neoplasms, and neoplasms with specific genetic alterations associated with overexpression or loss of expression of specific proteins. The diagnostic accuracy has been significantly improved owing to the discovery and increasing experience with the tumor-associated biomarkers, and the increasing demand for precise tumor classification to assess suitability for the expanding therapeutic modalities including clinical trials. Objective.--To differentiate lesions of the gynecologic tract through the use of effective immunohistochemical panels. Data Sources.--Literature review and authors’ personal practice experience. Conclusions.--The application of diagnostic and prognostic immunohistochemical panels has enabled pathologists to better guide therapeutic decisions and to better predict the clinical outcome. It is now well established that the use of ancillary testing, including immunohistochemistry, has a significant power in the identification, differentiation, and classification of reactive, premalignant, and malignant gynecologic disorders. This article discusses the utilities and pitfalls of the commonly used immunohistochemical markers in the context of overlapping morphologic features encountered in the uterus, ovaries, and fallopian tubes. [ABSTRACT FROM AUTHOR]

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Deep infiltrating endometriosis is an important gynecologic disease that may develop during the reproductive years and is responsible for severe pelvic pain. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligament, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. Surgery remains the best therapeutic treatment for affected patients and an accurate preoperative evaluation of the extension of endometriotic lesions is essential for a successful outcome. However, many atypical locations for deep pelvic endometriosis exist although still lesser known to both gynecologists and radiologists such as endometriosis of the round ligaments of the uterus (RLUs). In this article, we review embryology and anatomy of the RLUs as well clinical characteristics associated with these endometriotic locations. In addition, we describe magnetic resonance (MR) imaging protocol, normal MR imaging appearances of the RLUs and the most common abnormal findings of endometriotic involvement of these ligaments at MR imaging. Radiologists should always keep in mind the RLUs as a possible site of deep pelvic endometriosis localization and should not forget to carefully look for them on MR images. [ABSTRACT FROM AUTHOR]

Background: Til date, none of the diagnostic techniques available for the detection of female genital tuberculosis (FGTB) are 100% accurate. We therefore, proposed to use the endometrial tissue biopsies (ETBs), ovarian tissue biopsies (OTBs) and pelvic aspirated fluids (PAFs) for the diagnosis of FGTB among infertile women by conventional versus molecular methods. Methodology/Principal Findings: A total of 302 specimens were collected both from 202 infertile women highly suspected of having FGTB on laparoscopy examination and 100 control women of reproductive age. Out of 302 specimens, 150 (49.67%) were ETBs, 95 (31.46%) were OTBs and 57 (18.87%) were PAFs. All specimens were tested by conventional techniques, later compared with multi-gene PCR for the detection of Mycobacterium tuberculosis (MTB) and correlated with laparoscopic findings. The presence of MTB DNA was observed in 49.5% of ETBs, 33.17% of OTBs and 5.44% of PAF specimens collected from highly suspected FGTB patients. All women of control group were confirmed as negative for tuberculosis. The conventional methods showed 99% to 100% specificity with a low sensitivity, ranging from 21.78% to 42.08% while hematoxylin and eosin staining showed a sensitivity of 51.48%. Multi-gene PCR was found to have much higher sensitivity of 70.29% with MTB64 gene, 86.63% with 19 kDa antigen gene at species and TRC4 element at regional MTB complex and 88.12% with 32 kDa protein gene at genus level. The specificity of multi-gene PCR was 100%. Compared with culturing and Ziehl-Neelsen's staining, multi-gene PCR demonstrated improvement in the detection of FGTB (χ2 = 214.612, 1 df, McNemar's test value <0.0001). Conclusions Significance: We suggest site specific sampling, irrespective of sample type and amplification of the 19 kDa antigen gene in combination with TRC4 element as a successful multi-gene PCR for the diagnosis of FGTB and differentiation of mycobacterial infection among endo-ovarian tissue biopsies and PAFs taken from infertile women. [ABSTRACT FROM AUTHOR]

Context.--Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant mimics, the latter setting often being represented by secondary involvement by endometrioid endometrial carcinoma especially in small samplings. Objectives.--To highlight key histologic features and immunohistochemical markers that may be helpful in the distinction of in situ endocervical carcinoma from benign glandular proliferations, and those that separate different subtypes of invasive endocervical carcinoma, as well as invasive carcinoma from other carcinomas secondarily involving the cervix and nonneoplastic proliferations of the cervix. Conclusions.--Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis. [ABSTRACT FROM AUTHOR]

Abstract: Adolescent gynaecology is increasingly recognized as an area in which specific knowledge and expertise is required to ensure that patients achieve the best outcome. Gynaecological problems in adolescents are common, and although serious pathology is rare, distress and discomfort can be significant. Adolescent girls are under greater pressure than ever before, particularly in terms of examination performance; they find menstrual dysfunction particularly difficult to manage. Careful and sympathetic assessment is crucial, and simple treatment remedies may be all that is required. However, complex and rare medical conditions can also occur and must not be missed. Some congenital disorders present for the first time in adolescence. Early detection and appropriate treatment will ensure the best possible outcomes in terms of sexual function and potential fertility. [Copyright &y& Elsevier]

Background Human papillomavirus (HPV) DNA testing combined with cytology has been recommended as a primary cervical cancer screening strategy. Methods PubMed/MEDLINE, Embase, the Cochrane Library and the NIH trial registry were searched for randomized controlled trials comparing co-testing with cytology alone for the detection of high-grade CIN lesions and cancers. Of 1156 articles identified, four met inclusion criteria. The performance of co-testing and cytology alone was compared at baseline screening, second round screening and overall. Cumulative meta-analysis, Begg's test, Egger's test and sensitivity analysis were performed. Results At baseline, co-testing was associated with a significantly higher detection rate of CIN 2+ [risk ratio (RR) = 1.41, 95% confidence interval (CI): 1.12, 1.76] and a non-significantly higher CIN 3+ detection rate (RR = 1.15, 95% CI: 0.99, 1.33). At second round screening, co-testing was associated with significantly lower detection rates of both CIN 2+ and CIN 3+ (RR = 0.77, 95% CI: 0.63, 0.93; RR = 0·68, 95% CI: 0.55, 0.85). The overall detection rate did not differ between co-testing and cytology alone for CIN 2+ (RR: 1·19, 95% CI: 0.99, 1.46) or CIN3+ (RR: 0.99, 95% CI: 0.87, 1.14). Conclusion Co-testing increases the detection of CIN2+ lesions at baseline and significantly decreases the detection rates of CIN2+ or CIN3+ lesions at subsequent screening compared with cytology alone. [ABSTRACT FROM PUBLISHER]

Background: Tuberculosis (TB) is still a major worldwide concern. There is no pathognomonic clinical feature or imaging findings for definite diagnosis of extra pulmonary TB. Therefore, TB involvement of Gastrointestinal or Genitourinary tract can be easily confused with peritoneal carcinomatosis and advanced ovarian carcinoma. Our aim is to emphasize the importance of considering the disease based upon the epidemiologic clues of the patients, while interpreting the positive results for a suspicious ovarian malignancy. Cases: This paper illustrates 8 cases of ovarian or peritoneal tuberculosis, whose initial diagnoses were malignant processes of the GU tract. Conclusion: Tuberculosis (TB) should be always being considered in the differential diagnosis of advanced ovarian cancer, especially in the regions that are endemic for the disease. [ABSTRACT FROM AUTHOR]

Female sexual dysfunction (FSD) is a common health issue that can have significant negative effects on overall well-being and quality of life. The primary purpose of this article is to review commonly noted pharmacologic therapies for FSD. The pathophysiology, clinical evaluation, and selected nonpharmacologic therapies are also briefly addressed as well as recommendations for practice. [ABSTRACT FROM AUTHOR]

Sexual dysfunction is highly prevalent in gynaecological cancer patients. Most of the time, sexual dysfunction in gynaecological cancer is underdiagnosed as there is overlapping of symptoms with other psychological morbidities, interplaying of multiple risks, patients' reluctance to complain or incompetence of health care provider to assess. Determining the risk factors of sexual dysfunction in cancer patients enables us to pay more attention to those who are vulnerable and to device strategies for early detection, prevention and treatment of sexual dysfunction in them. The main aim of the study was to determine the prevalence of sexual dysfunction and its risk factors in gynaecological cancer patients in Hospital Sultanah Bahiyah, Alor Star, Malaysia. Sexual function of eighty-three gynaecological cancer patients who were married were assessed with self-rated MVFSFI (Malay version Female Sexual Function Index). Self-rated WHOQOL-BREF (World Health Organization- Quality of Life- 26) which assessed the domains of quality of life was used while MINI (Mini International Neuropsychiatry Interview) was used for diagnosis of major depressive disorder. The prevalence of sexual dysfunction among the married gynaecological cancer patients was 65% (54/83). Sexual dysfunction was significantly associated with low education level (OR 3.055, CI 1.009-9.250), shorter duration of cancer (OR 0.966, CI 0.966- 0.998), ongoing chemotherapy (OR 3.045, CI 1.149-8.067), pain perception (OR 3.230, CI 1.257-8.303), absence of sexual intercourse for more than one month (OR 1.862) and three domains of quality of life such as physical health, psychological health and social relationship (OR 0.942, CI 0.908-0.978; OR 0.955, CI 0.916-0.995; OR 0.933, CI 0.894-0.973, respectively). However, sexual dysfunction was not associated with major depressive disorder (χ² = 1.224, p = 0.268). The prevalence of sexual dysfunction in gynaecological cancer patients was comparable to other studies of similar population. Since, the risk factors of sexual dysfunction in gynaecological cancer patients are multidimensional, the process of assessment and management need to be holistic and patient-oriented. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease. Background Sexual dysfunction is one of the most common problems in women with chronic disease. There is limited understanding of the related factors of sexual dysfunction in women with chronic disease, with research currently limited to other problems and problems related to chronic diseases. Design This research was conducted as a descriptive survey. Methods This study involved 100 female inpatients at clinics of internal medicine of a university hospital. Data were collected with a patients identification form and a female sexual function index (KCFI). Kruskal- Wallis test, test of significance of difference between two means and test of significance of difference between two pairs were used in the data analysis. Results Sixty-five percentage of women in the sample were defined to have sexual dysfunction. The majority of women expressed pain during sexual intercourse, problems in orgasm and satisfaction, and reluctance to have sex. Older age, being unemployed, being in menopause, fatigue, sleep disorder, and pain and weakness in extremities were the factors that were found to significantly affect the prevalence of sexual dysfunction ( p < 0·05). Conclusions This study concluded that sexual function of women with chronic disease is affected negatively. Chronic disease-related symptoms, experienced changes in the body and psychosocial problems are changing the lives of women. Ultimately, these changes also affect sexual activity. Relevance to clinical practice Determination of the factors affecting sexual activity in women with chronic disease is important for women' ability to cope with sexual dysfunction and keep it under control. To be able to accomplish this, it is necessary for healthcare personnel, the partners and family to work together. [ABSTRACT FROM AUTHOR]

Abstract: The detection of high-risk (HR) HPV in cervical cancer screening is important for early diagnosis of cervical cancer or pre-cancerous lesions. We evaluated the analytical and clinical performances of 3 HR HPV assays in Gynecology patients. A total of 991 specimens were included in this study: 787 specimens for use with a Hybrid Capture 2 (HC2) and 204 specimens for a HPV DNA microarray (DNA Chip). All specimens were tested using an Abbott RealTime High Risk HPV assay (Real-time HR), PGMY PCR, and sequence analysis. Clinical sensitivities for severe abnormal cytology (severe than high-grade squamous intraepithelial lesion) were 81.8% for Real-time HR, 77.3% for HC2, and 66.7% for DNA Chip, and clinical sensitivities for severe abnormal histology (cervical intraepithelial neoplasia grade 2+) were 91.7% for HC2, 87.5% for Real-time HR, and 73.3% for DNA Chip. As compared to results of the sequence analysis, HC2, Real-time HR, and DNA Chip showed concordance rates of 94.3% (115/122), 90.0% (117/130), and 61.5% (16/26), respectively. The HC2 assay and Real-time HR assay showed comparable results to each other in both clinical and analytical performances, while the DNA Chip assay showed poor clinical and analytical performances. The Real-time HR assay can be a good alternative option for HR HPV testing with advantages of allowing full automation and simultaneous genotyping of HR types 16 and 18. [Copyright &y& Elsevier]

Background: The Bethesda System (TBS) aims to simplify cervical smear report and make it more reproducible and facilitates the communication between pathologist and clinician. Objectives: To evaluate 2001 Bethesda System of cervicovaginal smear classification in the diagnosis of different pathologies seen in women having different gynecological complaints. Methods: A prospective study of cervicovaginal smears that obtained from 360 female patients (aged 15-75 years) attending Gynecological Consultation Clinic in Al-Imamian Al-Kadhimiyian Medical City - Baghdad- Iraq for the period from November 2011 to April 2012. Smears were stained by Pap stain to evaluate according to Bethesda system 2001. Results A total of 360 cases were evaluated, 317 cases (88%) had satisfactory smears for evaluation. 246 cases (68.3%) had negative cervical smears for intraepithelial neoplasia (TBS 2001). Seventy one cases (19.72%) had abnormal cervical smears (AS). Minimal cervical smear abnormalities (ASC-US, ASC-H, AGC, LSIL), includes (53) cases (74.64% of AS). HSIL (CIN- II, CIN-III, & carcinoma in situ), includes (18) cases (25.36% of AS). Conclusion: Pap smear is a screening test, it is not a diagnostic test; positive result indicates that there may be a problem and that further diagnostic procedures must be done. The Bethesda system is of validity in providing a uniform format for cervical cytology report. [ABSTRACT FROM AUTHOR]

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Context.-Cytopathology experts, interested stakeholders, and representatives from the College of American Pathologists, the Centers for Disease Control and Prevention, the American Society of Cytopathology, the Papanicolaou Society of Cytopathology, the American Society for Clinical Pathology, and the American Society of Cytotechnology convened the Gynecologic Cytopathology Quality Consensus Conference to present preliminary consensus statements developed by working groups, including the Cytologic-Histologic Correlations Working Group 4, using results from surveys and literature review. Conference participants voted on statements, suggested changes where consensus was not achieved, and voted on proposed changes. Objectives.--To document existing practices in gynecologic cytologic-histologic correlation, to develop consensus statements on appropriate practices, to explore standardization, and to suggest improvement in these practices. Data Sources.--The material is based on survey results from 546 US laboratories, review of the literature from 1988 to 2011, and the College of American Pathologists Web site for consensus comments and additional survey questions. Conclusions.--Cytologic-histologic correlations can be performed retrospectively, during initial case review, or both. At minimum, all available slides should be reviewed for a high-grade squamous intraepithelial lesion Papanicolaou test with negative biopsies. The preferred monitor for correlations is the positive predictive value of a Papanicolaou test. Laboratories should design cytologic-histologic correlation programs to explore existing or perceived quality deficiencies. [ABSTRACT FROM AUTHOR]

Context.--Implementation of proficiency testing for gynecologic cytology was delayed 20 years because of challenges addressing the subjective nature of cytologic interpretation and replicating normal working conditions. Concern remains regarding test scoring, slide validation, test environment, and other issues. How these test results are, or should be, used in quality management has never been explored. Objective.--To provide information on good laboratory practices for gynecologic cytology proficiency testing based on findings from the College of American Pathologists' survey-based project funded by the Centers for Disease Control and Prevention. Data Sources.--An expert working group evaluated results from a Web-based, national laboratory survey plus responses from follow-up questions and findings from the literature. The group created statements on good laboratory practices pertinent to proficiency testing and its role in quality management, which were discussed and voted on at a consensus conference. Conclusions.--Two-thirds of laboratories report having an individual with an unsuccessful proficiency testing score. More than 90% did not initiate any remedial action for 1 or 2 unsuccessful tests; 84% of laboratories reported they actively monitored results from proficiency testing, but most laboratories did not initiate any remedial action for cytotechnologists (81.4%; 376 of 462) or pathologists (87.7%; 405 of 462) who passed a proficiency test but who did not score 100%. Proficiency testing pass-fail rates should be monitored globally for the laboratory and for each individual. Proficiency testing slides should be prescreened by cytotechnologists for pathologists who are not primary screeners. Remedial action should not be required for a passed, but imperfect, test. No remedial action is required for an unsuccessful, first proficiency test result before retesting. [ABSTRACT FROM AUTHOR]

Objective: To undertake a review of the literature on the epidemiology, etiology, diagnosis and management of uterine vessel ruptures in pregnancy.Materials and methods: A case of a 32 yearold woman with spontaneous hemoperitoneum in the immediate post-partum period secondary to a rupture of superficial uterine vessels at Hospital Universitario Fundación Santa Fe, a high complexity institution that provides care to patients with private contributive health insurance coverage. Emergency laparotomy and hysterectomy were performed with a finding of endometrial tissue in the posterior aspect of the uterus and the posterior cul-de-sac, and active venous bleeding. A search of the literature was done in Medline/Pubmed, Ebsco, Ovid and ProQuest, using the terms "hemoperitoneum", "pregnancy", "uterine vessel rupture" and "endometriosis" with no language limitation and epidemiologic design, published since 1966 to this date. Results: Out of 34 articles of interest, 13 were selected: 1 clinical practice guideline, 2 review articles and 10 case reports. Conclusion: Hemoperitoneum in pregnancy, secondary to uterine vessel rupture is a rare complication of unclear etiology and non-specific clinical presentation. Management requires a multidisciplinary approach with early surgical intervention and correct intravascular volume replacement. [ABSTRACT FROM AUTHOR]

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We present 2 cases of Cokeromyces recurvatus in routine, liquid-based Papanicolaou tests (ThinPrep). Patient 1 is a healthy, asymptomatic, 26-year-old woman with no pertinent past medical history. Patient 2 is a healthy, asymptomatic, 47-year-old woman with no pertinent past medical history. The Papanicolaou tests from both patients showed many fungal-like elements as globose, yeastlike forms measuring 10 to 30 µm in diameter with multiple, narrowly attached apparent ''daughter'' buds. This morphology was consistent with Paracoccidioides brasiliensis. However, broad-range fungal polymerase chain reaction and deoxyribonucleic acid sequence analysis performed with GenBank Basic Local Alignment Search Tool showed an exact match for C recurvatus. Our cases highlight the importance of molecular techniques to prevent misdiagnosis of C recurvatus as P brasiliensis, based on morphology alone. There have been 8 previously published cases of C recurvatus infection in humans, 3 of which were reported in the female genital tract. [ABSTRACT FROM AUTHOR]

Copyright of Suelo Pélvico is the property of Ediciones Mayo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Urogenital diseases, especially infection and cancer, are major causes of death and morbidity in females. Yet, millions of women in the developing world have no access to basic urogynecological care, and the diagnosis and treatment of widespread aberrant bacterial conditions (bacterial vaginosis [BV] and aerobic vaginitis [AV]) remain suboptimal the world over. Samples from women living in resource-disadvantaged and developed countries have been analyzed by high-throughput sequencing to reveal the diversity of bacteria in the vagina, how rapidly the bacterial population fluctuates over time, and how rapidly the switch occurs between healthy and aberrant conditions. Unfortunately, clinical diagnostic methods are inefficient and too often outdated therapies are administered. The net result is suboptimal care and recurrent disease that adversely affects the quality of life. This viewpoint outlines a scientific and translational road map designed to improve the cervicovaginal health and treatment of disease. This comprises (1) improving education of women and physicians on the vaginal microbiota; (2) having agencies target funding for research to improve diagnosis and test new therapies; and (3) making sure that new approaches are accessible in developing countries, empowering to women, and are acceptable and appropriate for different populations. [ABSTRACT FROM AUTHOR]

Abstract.-The terminology for human papillomavirus (HPV)-associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care. [ABSTRACT FROM AUTHOR]