OBJECTIVE: Presentation of complex information about the vaginal microbiota from historical view to current concepts with focus on latest findings on the structure and functioning of the vaginal microbiome. DESIGN: Review article. SETTING: Department of Clinical Microbiology, University Hospital and Faculty of Medicine in Hradci Králové, Charles University in Prague. METHODS: Literature review using the databases (PubMed, Web of Science, Ovid, etc.) with keywords (vaginal microbiota/ microbiom; vaginal discharge; bacterial vaginosis; vulvovaginitis; vaginal Lactobacillus). RESULTS: The vaginal microbiome is a specific compartment of the human microbiome. Unique conditions of the vagina are characterized by a few microbial species, usually lactobacilli, which are able to utilize glycogen, which is under control of estrogens. Lactobacilli and other fermentative bacteria together with vaginal epithelial cells produce lactic acid and are responsible for acidifying vaginal milieu. Lactic acid occurs in two isomeric forms, and their relative ratio is likely to give the vaginal microbiota a certain degree of stability and ability to withstand some infections. This microbiota is manifested by a low degree of diversity and by the high dynamics of changes of its composition under the influence of various exogenous and endogenous factors. Increase in diversity can be paradoxically associated with a dysbiosis such as bacterial vaginosis. Individual species of lactobacilli mainly Lactobacillus crispatus characterize the main community state types in the vagina. Apart from lactobacilli, healthy women may be colonized with a non-lactobacillary microbiota whose rate is dependent on ethnicity. CONCLUSION: The definition of vaginal microbiota cannot be only related to the presence or absence of individual microorganisms, although the incidence of some of them can be correlated with dysbiosis or eubiosis. The composition of microbiota is important, but it is only one of the basic attributes of normal vaginal microbiota, but not sufficient; that is the functional definition of vaginal microbiota in relation to its structure and dynamics, including the influence of ethnicity, physiological status of the vagina, and genetic disposition of woman.

• Keywords
• (vaginal microbiota/ microbiom; vaginal discharge; bacterial vaginosis; vulvovaginitis; vaginal Lactobacillus). Results: The vaginal microbiome is a specific compartment of the human microbiome. Unique conditions of the vagina are characterized by a few microbial species, H2O2, Lactobacillus, although the incidence of some of them can be correlated with dysbiosis or eubiosis. The composition of microbiota is important, and genetic disposition of woman. Keywords: vaginal microbiome, and their relative ratio is likely to give the vaginal microbiota a certain degree of stability and ability to withstand some infections. This microbiota is manifested by a low degree of diversity and by the high dynamics of changes of its composition under the influence of various exogenous and endogenous factors. Increase in diversity can be paradoxically associated with a dysbiosis such as bacterial vaginosis. Individual species of lactobacilli mainly Lactobacillus crispatus characterize the main community state types in the vagina. Apart from lactobacilli, but it is only one of the basic attributes of normal vaginal microbiota, but not sufficient; that is the functional definition of vaginal microbiota in relation to its structure and dynamics, community state types, dysbiosis, healthy women may be colonized with a non-lactobacillary microbiota whose rate is dependent on ethnicity. Conclusion: The definition of vaginal microbiota cannot be only related to the presence or absence of individual microorganisms, historical and recent concept, including the influence of ethnicity, lactic acid, pH, physiological status of the vagina, sexual hormones, sexual hormones historical and recent concept., usually lactobacilli, vaginal microbiome, which are able to utilize glycogen, which is under control of estrogens. Lactobacilli and other fermentative bacteria together with vaginal epithelial cells produce lactic acid and are responsible for acidifying vaginal milieu. Lactic acid occurs in two isomeric forms,
• MeSH
• Vaginosis, Bacterial microbiology   MeSH
• Lactic Acid metabolism   MeSH
• Lactobacillus * MeSH
• Humans MeSH
• Microbiota * MeSH
• Vagina microbiology   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Lactic Acid MeSH

• MeSH
• Administration, Intravaginal MeSH
• Pregnancy Complications, Infectious prevention & control   MeSH
• Humans MeSH
• Pregnancy MeSH
• Vaginitis prevention & control   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The aim of this study is to detect the rate of cytolytic vaginosis (CV) cases in patients with symptoms resembling those ones of candida vaginitis and to distinguish them from candidiasis cases by examining of 2947 Papanicolaou-stained vaginal smears. Fifty four of 2947 patients (1.83%) were diagnosed as having CV based on cytologic criteria such as naked nuclei of intermediate cells (IC), the overgrowth of lactobacilli, cytoplasmic fragmentations due to lysis of the cells. None of these smears contained candidal blastospores and hyphae and polymorphonuclear leucocytes. The pH was 3.5 to 5.5 and the clinical symptoms were profuse vaginal discharge (VD) especially whitish-cheesy vaginal discharge and other symptoms of vaginal candidiasis. The study indicated that special attention has to be paid during evaluation the vaginal smears of the patients with presumed vaginal candidiasis in order to prevent an erroneous diagnosis of CV.

• MeSH
• Cytodiagnosis MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Candidiasis, Vulvovaginal diagnosis   MeSH
• Lactobacillus isolation & purification   pathogenicity   MeSH
• Humans MeSH
• Adolescent MeSH
• Papanicolaou Test * MeSH
• Vaginal Smears * MeSH
• Vaginitis diagnosis   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH
• Geographicals
• Turkey MeSH

OBJECTIVE: To compare the efficacy of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in patients with levator ani avulsion. METHODS: This was a single-center, randomized interventional trial, of two standard surgical procedures for post-hysterectomy vaginal vault prolapse: Prolift Total vs unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair (sacrospinous fixation, SSF), during the period from 2008 to 2011. Entry criteria included at least two-compartment prolapse, as well as complete unilateral or bilateral levator ani avulsion injury. The primary outcome was anatomical failure based on clinical and ultrasound assessment. Failure was defined clinically, according to the Pelvic Organ Prolapse Quantification system, as Ba, C or Bp at the hymen or below, and on translabial ultrasound as bladder descent to 10 mm or more below the lower margin of the symphysis pubis on maximum Valsalva maneuver. Secondary outcomes were evaluation of continence, sexual function and prolapse symptoms based on validated questionnaires. RESULTS: During the study period, 142 patients who were post-hysterectomy underwent surgery for prolapse in our unit; 72 of these were diagnosed with an avulsion injury and were offered participation in the study. Seventy patients were randomized into two groups: 36 in the Prolift group and 34 in the SSF group. On clinical examination at 1-year follow-up, we observed one (3%) case of anatomical failure in the Prolift group and 22 (65%) in the SSF group (P < 0.001). Using ultrasound criteria, there was one (2.8%) failure in the Prolift group compared with 21 (61.8%) in the SSF group (P < 0.001). The postoperative POPDI (Pelvic Organ Prolapse Distress Inventory) score for subjective outcome was 15.3 in the Prolift group vs 21.7 in the SSF group (P = 0.16). CONCLUSION: In patients with prolapse after hysterectomy and levator ani avulsion injury, SSF has a higher anatomical failure rate than does the Prolift Total procedure at 1-year follow-up.

• Keywords
• 4D ultrasound, Prolift Total, SSF, levator avulsion, mesh, sacrospinous vaginal colpopexy, ultrasound assessment, vaginal prolapse surgery, vaginal sacrospinous fixation,
• MeSH
• Pain complications   diagnostic imaging   surgery   MeSH
• Surgical Mesh * MeSH
• Gynecologic Surgical Procedures methods   MeSH
• Hysterectomy, Vaginal adverse effects   MeSH
• Coitus MeSH
• Middle Aged MeSH
• Humans MeSH
• Anus Diseases complications   diagnostic imaging   surgery   MeSH
• Pelvic Floor surgery   MeSH
• Postoperative Complications diagnostic imaging   surgery   MeSH
• Pelvic Organ Prolapse diagnostic imaging   etiology   surgery   MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• Urinary Incontinence, Stress etiology   MeSH
• Ultrasonography MeSH
• Vagina diagnostic imaging   physiopathology   surgery   MeSH
• Valsalva Maneuver MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH
• Comparative Study MeSH

Lactobacilli use in treatment and prevention of the vaginal microflora disorders, such as bacterial vaginosis and vulvovaginal candidiasis, is highly promising. The objective of this study was is to develop formulation and technology of the extemporal Lactobacillus casei (L. casei) ІМВ В-7280-containing medicinal product in the form of vaginal pessaries. The quality control parameters were defined in accordance with the State Pharmacopeia of Ukraine (2nd edition) and included appearance, uniformity of texture, uniformity of mass and disintegration test. Lactobacilli assay was determined after preparation and within the storage period. Thus, feasible formulation and technology were selected for vaginal pessaries with an expected 6-month shelf life. The results of the hereby described research will be used for technological instruction development for extemporaneous vaginal pessaries with defined probiotic activity.

• Keywords
• Lactobacilli, vaginal dysbiosis, vaginal pessaries,
• MeSH
• Vaginosis, Bacterial therapy   MeSH
• Humans MeSH
• Pessaries * MeSH
• Drug Compounding * MeSH
• Probiotics pharmacology   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Human papillomavirus (HPV) has been directly related to acuminate warts and cervical cancer, the second most common neoplasia among women. Given the lack of treatment against the virus itself, many medications have been utilised, mainly aiming in modifying the host's immunological response. We present the case of a 54 years old postmenopausal patient with a history of vaginal cuff wart and HPV persistence that we managed in our clinic for 6 months with a mix of curcumin, aloe vera, amla and other natural ingredients. As the patient was found to be intolerant to imiquimod (one of the most common conservative methods of treatment) we attempted the use of curcumin, which was applied to the area of the wart three times per week for 6 months. Both clinical and colposcopical improvement was noted in regular clinic visits with regression of the lesion. The outcome of this case encourages our view that curcumin should be considered as a significant treatment modality against HPV infection and acuminate warts.

• Keywords
• CM-β glucans, Docosanol, HPV, Indian Grapefruit (AMLA), SiloffGyn, aloe vera, curcumin, lactic acid, vaginal cuff wart,
• MeSH
• Adjuvants, Immunologic adverse effects   MeSH
• Antineoplastic Agents therapeutic use   MeSH
• beta-Glucans therapeutic use   MeSH
• Squamous Intraepithelial Lesions of the Cervix drug therapy   pathology   MeSH
• Drug Combinations MeSH
• Phytotherapy MeSH
• Imiquimod adverse effects   MeSH
• Papillomavirus Infections drug therapy   pathology   MeSH
• Colposcopy MeSH
• Condylomata Acuminata drug therapy   pathology   MeSH
• Curcumin therapeutic use   MeSH
• Lactic Acid therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Fatty Alcohols therapeutic use   MeSH
• Papanicolaou Test MeSH
• Phyllanthus emblica MeSH
• Plant Preparations therapeutic use   MeSH
• Vaginal Creams, Foams, and Jellies MeSH
• Vaginal Diseases drug therapy   pathology   MeSH
• Vaginal Smears MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• Adjuvants, Immunologic MeSH
• Antineoplastic Agents MeSH
• beta-Glucans MeSH
• docosanol MeSH Browser
• Drug Combinations MeSH
• Imiquimod MeSH
• Curcumin MeSH
• Lactic Acid MeSH
• Fatty Alcohols MeSH
• Plant Preparations MeSH
• Vaginal Creams, Foams, and Jellies MeSH

• Keywords
• ORBITAL NEOPLASMS *, VAGINAL NEOPLASMS *,
• MeSH
• Carcinoma in Situ * MeSH
• Humans MeSH
• Orbital Neoplasms * MeSH
• Vaginal Neoplasms * MeSH
• Neoplasms * MeSH
• Neoplasms, Second Primary * MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The aim of this study is to determine whether there is a relationship between the presence of Lactobacilli and the growth of Candida. For this purpose, 1110 cervico-vaginal smears were examined cytologically and 450 patients who were normally menstruating were subsequently selected among them. Fifty nine of 450 were diagnosed as having Candida and they were accepted as study group. Three hundred and ninety-one patients who were diagnosed as having no infectious agents were accepted as control group. Lactobacilli were present in 50 of 59 in various degree and were absent in 9 of 59. The prevalence rates of the presence of Lactobacilli (84.74%) as well as intermediate cells (98.30%) were higher in study group than in control group. There was also a significant correlation between the presence of Lactobacilli and the growth of Candida (p < 0.05). Statistical analysis was performed with chi 2 test using SPSS package programme. We can suggest that Lactobacilli do not have a protective role when there is Candida growth in the vaginal mucosa.

• MeSH
• Candida albicans isolation & purification   MeSH
• Adult MeSH
• Candidiasis, Vulvovaginal diagnosis   MeSH
• Lactobacillus isolation & purification   MeSH
• Middle Aged MeSH
• Humans MeSH
• Chi-Square Distribution MeSH
• Vagina microbiology   MeSH
• Vaginal Smears MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: Description of rare complication of long-term uterine prolaps. Desing: Case report. SETTING: Department of Obstetric and Gynecology, University Hospital Ostrava. CASE REPORT: A seventy-years-old pacient with longterm complete uterine prolaps underwent vaginal hysterectomy with colpoclesis at department of Obstetric and Gynecology of university hospital Ostrava in August 2017. The surgery was planned more than year ago, when patient had no symptoms. But due to patient's injury, it was postponed and the condition was already complicated by urine incontinency. The surgery was complicated by bladder lesion, because it was suggested as a pelvis tumor. Correction of cystolithiasis was planned at a second time, when suprapubic cystoli-thotomy was performed after 16 days. Temporary urinary derivation was ensured by bilateral nephrostomy, epicystostomy and urinal catetrization for low residual bladder capacity after surgery. CONCLUSION: Bladder stones are a rare complication of otherwise relatively frequent complete urogenital prolaps in women. Major causes include micturition disorder and chronic urinary tract infection which is caused by vaginal and uterus descensus.

• Keywords
• bladder lesion rare complication., long-term vaginal prolapse,
• MeSH
• Urinary Bladder Calculi etiology   MeSH
• Humans MeSH
• Uterine Prolapse complications   MeSH
• Aged MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

• Keywords
• VAGINAL SMEARS *, VAGINITIS/diagnosis *,
• MeSH
• Cytodiagnosis * MeSH
• Humans MeSH
• Vaginal Smears * MeSH
• Vaginitis diagnosis   MeSH
• Vulvovaginitis * MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH