The Protection Afforded by the Cervical Mucus in Human Reproduction
Thomas W Hilgers
Author affiliations
Pope Paul VI Institute for the Study of Human Reproduction, Omaha, Nebraska.ROR
Abstract
From January 1, 1968 to May 31, 1973, 100 patients received first kidney transplants from sibling donors. All recipients have been followed for at least two years and several as long as 7.5 years. One hundred per cent follow-up information is available. The absolute two-year patient survival is 85% and the absolute two-year kidney function survival is 76%. Patients with diabetes (especially males) have less success following transplantation than do patients without diabetes. When diabetic patients are excluded, older patients appear to do slightly less well than younger patients. Patients with phenotypically identical HL-A matches with the donor do better than patients without such matches. In the nondiabetic technically perfect transplant recepient, better than 90% long-term transplant function can be expectedwith no kidney losses after the first few months. In contrast, the less well-matched transplant demonstrated both an increased early rejection rate and a high rate of loss after the third to fifth year. Increasing doses of anti-lymphoblast globulin (ALG) had beneficial results in HL-A mismatched sibling transplants, but were slightly detrimental in phenotypically identical HL-A donor-recipient pairs because of an increased rate of infection. The results are compared with the results of transplants from other related donors and from cadavers performed during the same period.
De Ponte A et al., 2026·The journal of sexual medicine
[INTRODUCTION] Platelet-rich plasma (PRP) is an innovative tool in regenerative medicine. It is defined as an autologous product obtained by density gradient centrifugation of blood, resulting in a platelet concentrate rich in growth factors. In gynecology, PRP has been used to treat vaginal atrophy, sexual dysfunction, and inflammatory conditions such as vulvar lichen sclerosus. PRP injection into the vulvo-vaginal area is a potential treatment for several conditions; however, treatment methods and applications vary widely across the published literature. [OBJECTIVE] To provide an updated synthesis of current evidence on the administration of PRP to the vulva and vagina as a stand-alone technique in a non-surgical outpatient setting, and to identify its main clinical indications. [METHODS] A systematic search of PubMed and Embase was conducted for studies published up to October 2024 using the terms "platelet rich plasma" AND "vaginal" and "platelet rich plasma" AND "vulvar." Eligible studies included human case reports, prospective, and retrospective cohort studies, as well as randomized and non-randomized controlled trials, assessing PRP injections as a stand-alone technique in the vulvo-vaginal area. Extracted data included study design, patient characteristics, indications, PRP preparation and administration protocols, number of sessions, outcomes, and adverse events. [RESULTS] Eighteen studies met the inclusion criteria: two randomized controlled trials, 10 single-arm clinical trials, one retrospective cross-sectional study, and five case reports, comprising 480 patients (401 treated with PRP). The most frequent indication was vulvar lichen sclerosus (n = 179), followed by sexual dysfunction (n = 133) and vulvovaginal atrophy (n = 87). Protocols varied in preparation methods, injection techniques, and treatment schedules. Across studies, PRP injections were associated with improvements in symptoms, sexual function, and vaginal health, with few and mild adverse events. [CONCLUSION] Current evidence suggests that PRP injections in the vulvo-vaginal area may offer clinical benefits across several indications, with a favorable safety profile. However, the high variability in protocols, small sample sizes, and methodological limitations preclude definitive conclusions. Further high-quality randomized controlled trials are required to establish standardized protocols and confirm efficacy.
infections-and-microbiome/vaginal-and-cervical-flora/vaginal-microbiomesexual-health/vulvovaginal-health/vaginal-atrophyinfertility/evaluation/epidemiology-and-risk-factors
Open Access
Vitale SG et al., 2021·International Journal of Molecular Sciences
The human microbiome plays a crucial role in determining the health status of every human being, and the microbiome of the genital tract can affect the fertility potential before and during assisted reproductive treatments (ARTs). This review aims to identify and appraise studies investigating the correlation of genital microbiome to infertility. Publications up to February 2021 were identified by searching the electronic databases PubMed/MEDLINE, Scopus and Embase and bibliographies. Only full-text original research articles written in English were considered eligible for analysis, whereas reviews, editorials, opinions or letters, case studies, conference papers, and abstracts were excluded. Twenty-six articles were identified. The oldest studies adopted the exclusive culture-based technique, while in recent years PCR and RNA sequencing based on 16S rRNA were the most used technique. Regardless of the anatomical site under investigation, the Lactobacillus-dominated flora seems to play a pivotal role in determining fertility, and in particular Lactobacillus crispatus showed a central role. Nonetheless, the presence of pathogens in the genital tract, such as Chlamydia trachomatis, Gardnerella vaginalis, Ureaplasma species, and Gram-negative stains microorganism, affected fertility also in case of asymptomatic bacterial vaginosis (BV). We failed to identify descriptive or comparative studies regarding tubal microbiome. The microbiome of the genital tract plays a pivotal role in fertility, also in case of ARTs. The standardization of the sampling methods and investigations approaches is warranted to stratify the fertility potential and its subsequent treatment. Prospective tubal microbiome studies are warranted.
gynecology/infections/vaginal-and-cervical-infectionscontraception/long-acting-methods/intrauterine-devicessexual-health/vulvovaginal-health/vaginal-atrophy
Open Access
Peebles K et al., 2021·Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Limited evidence suggests that the nonhormonal contraceptive copper intrauterine device (Cu-IUD) may increase bacterial vaginosis (BV) risk, possibly due to increased volume and duration of menses, a common side effect of Cu-IUD use. Although increases in bleeding typically resolve within 6-12 months following initiation, evaluations of the association between Cu-IUD and BV have not included more than 6 months of follow-up. This secondary analysis of a human immunodeficiency virus type 1 prevention trial included 2585 African women ages 18-45 followed for up to 33 months. Women reported contraceptive use each month. BV was evaluated by Nugent score in 6-monthly intervals and, if clinically indicated, by Amsel criteria. Andersen-Gill proportional hazards models were used to (1) evaluate BV risk among Cu-IUD users relative to women using no/another nonhormonal contraceptive and (2) test changes in BV frequency before, while using, and following Cu-IUD discontinuation. BV frequency was highest among Cu-IUD users at 153.6 episodes per 100 person-years (95% confidence interval [CI]: 145.2, 162.4). In adjusted models, Cu-IUD users experienced 1.28-fold (95% CI: 1.12, 1.46) higher BV risk relative to women using no/another nonhormonal contraception. Compared to the 6 months prior to initiation, BV risk was 1.52-fold (95% CI: 1.16, 2.00) higher in the first 6 months of Cu-IUD use and remained elevated over 18 months of use (P < .05). Among women who discontinued Cu-IUD, BV frequency was similar to pre-initiation rates within 1 year. Cu-IUD users experienced elevated BV risk that persisted throughout use. Women and their providers may wish to consider BV risk when discussing contraceptive options.
We report the results of a first exploratory study testing the use of vaginal microbiome transplantation (VMT) from healthy donors as a therapeutic alternative for patients suffering from symptomatic, intractable and recurrent bacterial vaginosis (ClinicalTrials.gov NCT02236429 ). In our case series, five patients were treated, and in four of them VMT was associated with full long-term remission until the end of follow-up at 5-21 months after VMT, defined as marked improvement of symptoms, Amsel criteria, microscopic vaginal fluid appearance and reconstitution of a Lactobacillus-dominated vaginal microbiome. One patient presented with incomplete remission in clinical and laboratory features. No adverse effects were observed in any of the five women. Notably, remission in three patients necessitated repeated VMT, including a donor change in one patient, to elicit a long-standing clinical response. The therapeutic efficacy of VMT in women with intractable and recurrent bacterial vaginosis should be further determined in randomized, placebo-controlled clinical trials.