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OBJECTIVE: Human Papilloma-Virus (HPV) vaccination has been introduced in recent years in clinical practice as the most effective primary prevention strategy for cervical cancer and HPV-induced lesions, either pre-malignant or benign. Since its introduction, HPV vaccination has been progressively demonstrated as extremely effective in preventing extra-genital and male diseases also; furthermore, non only adolescents but adult subjects have been investigated and reported as positively responding to vaccine immunostimulation. More recently, effectiveness of post-treatment vaccine administration has been preliminarily investigated with very promising results in terms of decreased recurrences. On this basis, we report an Italian-focused picture of the state of the art and take a position in favour of the extension of HPV vaccination to male adolescents, to older age groups and to already treated subjects. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the effectiveness of a topical vaginal preparation containing hyaluronic acid in controlling signs and symptoms correlated with postmenopausal vulvovaginal atrophy (VVA). PATIENTS AND METHODS: A prospective, observational study has been performed at the Obstetrics and Gynecology Department of the Vita Salute San Raffaele University of Milan, Italy. Forty-six (46) consecutive postmenopausal women complaining of genital discomfort due to postmenopausal estrogen lack have been enrolled. All patients have been investigated by the use of the Vaginal Health Index (VHI) and of a Visual Analogic Scale (VAS) of symptoms at baseline and one month after the end of the study. The treatment protocol consisted of the administration of a hyaluronic acid-based liquid preparation for vaginal use (Justgin®, Just Pharma, Rome, Italy) three times a week, for a total of 8 weeks. Statistical analysis of VHI and VAS scores has been performed by the use of the Wilcoxon signed-rank test for repeated values, assuming a p-value < 0.05 as significant. RESULTS: Both Vaginal Health Index (VHI) and Visual Analogic Scale (VAS) of genital symptoms showed statistically significant (p < 0.0001) improvements at the end of the study protocol. Patients' degree of satisfaction at the end of treatment was reported as high. CONCLUSIONS: Conventional treatment of the postmenopausal syndrome, either in terms of systemic and genital symptoms, is based on hormonal replacement therapy (HRT). The limitations to this approach are represented by the need to discontinue the treatment after some years and the contraindications that some women present about the estrogens. For these reasons, alternative approaches have been recently investigated and indicate promising perspectives. Hyaluronic acid topical approach with a liquid preparation for vaginal use (Justgin®, Just Pharma, Roma, Italy) to control signs and symptoms of vulvovaginal atrophy (VVA) in postmenopausal women demonstrated significant effectiveness both in terms of objective and subjective improvement. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of fractional microablative CO2 laser on sexual function and overall satisfaction with sexual life in postmenopausal women with vulvovaginal atrophy (WA). Method This prospective study included 77 postmenopausal women (mean age 60.6 ± 6.2 years) treated for WA symptoms with the fractional microablative CO2 laser system (SmartXide2 V2LR, Monalisa Touch, DEKA, Florence, Italy). Sexual function and quality of life were evaluated with the Female Sexual Function Index (FSFI) and the Short Form 12 (SF-12), respectively, both at baseline and at 12-week follow-up. A 10-mm visual analog scale was used to measure the overall satisfaction with sexual life and the intensity of WA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia and dysuria) before and after the study period. Results We observed a significant improvement in the total score and the scores in each specific domain of the FSFI at 12-week follow-up compared to baseline (p< 0.001). After concluding the laser treatment, the overall satisfaction with sexual life significantly improved (p< 0.001). Seventeen (85%) out of 20 (26%) women, not sexually active because of WA severity at baseline, regained a normal sexual life at the 12-week follow-up. Finally, we also found a significant improvement in each WA symptom (p < 0.001) and in quality- of-life evaluation, both for the scores in the physical (p = 0.013) and mental (p = 0.002) domains. Conclusions Fractional microablative CO2 laser treatment is associated with a significant improvement of sexual function and satisfaction with sexual life in postmenopausal women with WA symptoms. [ABSTRACT FROM AUTHOR]

Objective This pilot study aimed to assess the efficacy and feasibility of fractional CO2 laser in the treatment of vulvovaginal atrophy (VVA) in postmenopausal women. Methods VVA symptoms were assessed before and after three applications of laser over 12 weeks in 50 women (age 59.6 ± 5.8 years) dissatisfied with previous local estrogen therapies. Subjective (visual analog scale) and objective (Vaginal Health Index Score, VHIS) measures were used during the study period to assess VVA. Quality of life was measured by using the SF-12. A subjective scale to evaluate the degree of pain related to the laser application and the degree of difficulty to perform the laser procedure was used. Results Fractional CO2 laser treatment was effective to improve VVA symptoms (vaginal dryness, vaginal burning, vaginal itching, dyspareunia, dysuria; p < 0.001) at 12-week follow-up, as well as the VHIS (13.1 ± 2.5 at baseline vs. 23.1 ± 1.9; p < 0.001). Both physical and mental scores of quality of life were significantly improved in comparison with baseline ( p < 0.001). Satisfaction with the laser procedure was reported by 42 women (84%) and a minimal discomfort was experienced at the first laser application, mainly because of the insertion and the movements of the probe. Finally, the technique was very easy to perform in all women starting from the second application at week 4 and no adverse events were recorded during the study period. Conclusions A 12-week treatment with the fractional CO2 laser was feasible and induced a significant improvement of VVA symptoms by ameliorating vaginal health in postmenopausal women. Further controlled studies should be performed to confirm the present data and to assess the long-term effects of the laser procedure on vaginal tissues. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cervical cancer is the most commonly diagnosed malignancy in pregnancy and cervical screening should be accordingly performed in this particular situation. Occurrence of a preneoplastic cervical disease in pregnancy has for a long time represented a challenge for the clinician, both in terms of diagnostic accuracy, treatment options and risk of obstetrical complications. For these reasons, lack of uniformity in diagnosis and management is still commonly observed and the need for evidence-based clarifications is strongly required. Consistently with the literature evidences and accordingly with international guidelines, this review aim to overview the most significant aspects of the issue and trace simple and practical indications for an evidence-based correct workout and management of these conditions. MATERIALS AND METHODS: The most significative and focused-on results from literature as well as recent international guidelines have been considered and summarized in order to clarify the key-points of the topic; epidemiology, pathophysiology, natural history, treatment modalities and procedure-related risks have been approached and discussed. RESULTS: Risk factors, prevalence and progression rate of cervical intraepithelial neoplasia in pregnancy are comparable to those observed in non-pregnant patients; thus, pregnancy does not have to be considered a condition at higher risk. Cytology, histology and colposcopic patterns must be evaluated by experienced professionals because of pregnancy-induced modifications that can lead to misinterpretations. Each diagnostic step should be directed to exclusion of invasive cervical cancer. CONCLUSIONS: Once invasive cancer has been excluded through a comprehensive diagnostic workout, treatment of cervical intraepithelial neoplasia can be safely deferred after delivery. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Human papillomavirus (HPV) is the causal agent of cervical cancer. The great majority of abnormal Pap test results - almost 90% - is referrable to either atypical squamous intraepithelial lesion or CIN1. For these lesions, worldwide agreement exists concerning the high rate - ranging from 40% to 70% - of spontaneous regression over a period of 1-5 years. Host's immune response is a key point influencing the natural history of these conditions. Bovine colostrum is a natural agent positively promoting several immune activities against bacterial and viral agents. The aim of this report was to evaluate the potential positive effect of bovine colostrum-containing vaginal tablets administered to CIN1 diagnosed patients in a prospective trial in regards to spontaneous regression rate. PATIENTS AND METHODS: A series of 256 consecutive patients with histologically proven CIN1 recruited in a multicentre, observational, Italian study. Patients have been enrolled in a 24-weeks protocol of treatment and re-tested at the end of the study. Rates of regression have been recorded. RESULTS: Overall regression rate to a negative histology at the end of the 6 month follow up was 75.5%. CONCLUSIONS: Regression to normal histology was observed in a very high rate of cases in a very short period compared to the natural history of these lesions. CIN1 patients could benefit from bovine colostrum topical administration in terms of significantly shortening the regression time. [ABSTRACT FROM AUTHOR]

The large amount of literature published over the last two decades on human papillomavirus (HPV)-DNA testing has definitely demonstrated the association between high-risk viral genotypes (hrHPV) and cervical cancer. Moreover, hrHPV-DNA testing has shown excellent performance in several clinical applications, from screening settings to the follow-up of treated patients, compared to conventional cytology or colposcopy options. On the other hand, when a huge number of reports are published on the same subject in a relatively short period of time, with many variations in settings, study designs and applications, the result is often confusion and decreased comprehension by readers. In daily office practice, several different situations (in symptomatic or asymptomatic women) can be positively managed by the correct use of hrHPV-DNA testing. Validated hrHPV-DNA testing and, specifically, the HC2® assay, due to its excellent sensitivity and negative predictive value together with optimal reproducibility, currently represent a powerful tool in the clinician's hands to optimally manage several situations related to HPV infection and the potential development of cervical cancer. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the correlation between high-risk human papillomavirus (hrHPV)-DNA viral load with the different risks of underlying high grade cervical intraepithelial neoplasia (CIN2/CIN3) in atypical squamous cells of undetermined significance (ASC-US) cytology. It investigates whether low levels of hrHPV-DNA viral load might reduce the risk of high-grade CIN. Significant correlation between increasing hrHPV viral load and prevalence of CIN2/CIN3 were observed.

OBJECTIVE: Because the interaction between viral DNA products and cellular regulatory mechanisms is the first step leading to cancerous transformation, the detection of its presence in histologically negative lymph nodes may represent a very early biological step in cancer spread. The quantitative estimate may represent and an indirect sign of active cellular replication. MATERIALS AND METHODS: Cervical and lymph nodes tissues of 13 cases of invasive cervical cancer were analyzed for human papillomavirus (HPV)-DNA presence and viral load by HPV typing and quantification by real-time polymerase chain reaction. RESULTS: HPV-DNA was demonstrated in all tissue samples (primary tumor, positive lymph nodes, negative lymph nodes) with the most prevalence of HPV 16 (61.5%) and single-type infection (69.3%), whereas viral load (mean quantity of DNA copies) is statistically different in negative versus positive lymph nodes (p =.005). CONCLUSIONS: Concordance of viral type and lymph nodes viral load may represent as a useful tool in identifying early metastatic risk of tumor spread. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively., Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan-Meier survival analysis with Logrank test were performed., Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47-26.08, p = 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative ( p = 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases ( p = 0.005)., Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings.

Introduction: Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the therapeutic effectiveness and safety of BoNT usage in the treatment of vaginal, vulvar and pelvic pain disorders., Methods: We searched for all the original articles without date restriction until 31.12.2021. We included all the original articles which administered botulinum toxin in the vulva or vagina of women suffering from vaginismus, dyspareunia, and chronic pelvic pain. Only English language studies and those performed in humans were eligible. We excluded all case reports and pilot study from the qualitative analysis, although we accurately evaluated them. 22 original studies were finally included in the systematic review., Results: Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. No irreversible side effects were detected. Major side effects reported were transient urinary or fecal incontinence, constipation and rectal pain. The risk of bias assessment proved original articles to be of medium quality. No metanalysis could have been performed since lack of congruency in the definition of pathology and methods of botulinum toxin administration., Conclusion: Data extraction pointed out different endpoints and different methods of analysis. Studies focus on different types of participants and use various techniques and timing. According to the best evidence available, different techniques provide evidence about positive outcomes, with the need for a standardized protocol., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The World Health Organization (WHO) set the goal of 90% HPV vaccination coverage in the population to eliminate cervical cancer. Opportunistic vaccination is performed outside the free vaccination or catch-up programs. Both free and opportunistic HPV vaccination programs experienced slowdowns during the COVID-19 pandemic. In this retrospective study, we aimed to identify the benefits and the obstacles of opportunistic vaccination among male and female individuals who took advantage of the "on-demand" service offered by San Raffaele Hospital in Milan from April 2018 to May 2023. The impact that the COVID-19 pandemic had on vaccination adherence was also analyzed. Data on a total of 527 subjects were collected from an in-house database and through personal interviews. Women in the cohort of older patients (over 25) adhered to the vaccination schedule more than younger women. Opportunistic vaccination request is influenced by the need of a gynecologist, a general practitioner, or public health clinic availability. Women also showed good adherence to screening, demonstrating awareness of the importance of cervical cancer secondary prevention despite vaccination. Opportunistic vaccination offers the possibility of including individuals excluded from the free vaccination campaigns, often already affected by lesions caused by HPV, providing increased viral clearance and faster lesion regression. The main limit remains the economic burden.