Background: Stress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor. Methods: Women with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score. Results: Thirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22–24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22–24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044). Conclusions: Female pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.

Genitourinary syndrome of menopause (GSM) affects a significant percentage of postmenopausal women and manifests as vaginal dryness, irritation, and urinary discomfort, typically treated with vaginal estrogens. Hydrogels are preferred over creams due to their superior comfort and mucoadhesive properties. This study introduces a novel vaginal gel formulation containing hydroxyethyl cellulose (HEC) and estriol-hydroxypropyl-β-cyclodextrin complex (E3-HPBCD) for the treatment of GSM. The estriol (E3) release profile of the gel was evaluated using a Franz diffusion cell system, and its permeability was tested on reconstructed human vaginal epithelium. Biocompatibility was assessed using (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) (MTT), lactate dehydrogenase (LDH) assays, and real-time cell analysis (RTCA) on human skin keratinocyte (HaCaT) cells, which showed increased cell viability and no obvious cytotoxicity. The results indicated that efficient E3 release and satisfactory epithelial permeability with HPBCD provide the bioavailability of E3. These results suggest the potential of the gel as a biocompatible and effective alternative for the treatment of GSM. Further studies are required to assess the long-term safety and clinical efficacy.

Objective: Our study aimed to improve the understanding of the biomechanical changes occurring in the pelvic floor due to pelvic floor muscle training (PFMT), which is responsible for improving stress urinary incontinence (SUI) symptoms. Study design: In this prospective cohort study, we examined the impact of a six-week PFMT program in women with stress or stress-predominant urinary incontinence on the biomechanical parameters of the pelvic floor. Fifty-two biomechanical parameters were measured by Vaginal Tactile Imager (VTI) at baseline and at a six-week follow-up. In addition, we have assessed the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient's Global Impression of Severity (PGI-S) scores at enrolment and at six-week follow-up. We have divided our cohort into two groups, Improved Group (IG) and Not-improved Group (NIG), based on the change in UDI-6 score after six weeks and compared the biomechanical changes within and between the two groups. Results: The overall cohort included twenty women with stress or stress-predominant SUI based on MESA questionnaire [MESA SUI index (mean +/- SD) 63.3 % +/- 24.0 %, MESA UUI index (mean +/- SD) 13.3 % +/- 15.3 %, p < 0.01]. Nine of the 52 VTI parameters have changed significantly after six weeks of PFMT in the entire cohort. Eleven women (IG) achieved the minimum 11-point change in the UDI-6 scaled score. In IG, we found that three VTI parameters differed significantly: Parameter 1: the maximum value of force measured during the VTI probe insertion [(N, mean +/- SD) 0.55 +/- 0.18 vs. 0.78 +/- 0.31, p < 0.049], parameter 18: the maximum gradient at the upper third of the vagina (posterior) [(kPa/mm, mean +/- SD) 0.16 +/- 0.05 vs. 0.36 +/- 0.28, p < 0.048], and parameter 47: integral force change in the anterior compartment at reflex pelvic muscle contraction (cough) [(N, mean +/- SD) 1.61 +/- 0.85 vs. 1.97 +/- 0.71, p < 0.045]. Conclusion: Our study revealed a significant association between the improvement of strength in targeted muscle groups and a reduction in urinary incontinence symptoms. Identifying specific muscles changing PFMT provides valuable insights for specific interventions. Our findings may help to create personalized and targeted interventions to improve the quality of life of women affected by SUI.

Background/Objective: Infertility affects an estimated 40–50% of women with polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility, but only a small proportion of the patients require in vitro fertilization (IVF) therapy. Both PCOS and IVF are associated with an increased risk of obstetric complications. To compare preconception endocrine profiles and symptoms, as well as obstetric outcomes of PCOS patients who achieved successful pregnancies with and without IVF treatment. Methods: A single-center retrospective cohort study was conducted. Data spanning from 2012 to 2019 were compiled from patients with PCOS who visited the Gynecologic Endocrinology Unit and the Infertility Unit at the Department of Obstetrics and Gynecology, University of Debrecen. Patients diagnosed with PCOS who had had at least one successful delivery beyond the 23rd gestational week at the department were eligible for inclusion in the study. Results: Fifteen percent of the 206 pregnancies leading to successful deliveries of 232 newborns in our cohort conceived with IVF. A one year increase in the maternal age increased the odds of being in the IVF group by 22% (OR: 1.222, 95% confidence interval, CI: 1.11–1.35, p < 0.001). Baseline DHEAS and androstenedione levels were significantly lower in the IVF group as compared to the non-IVF group: 1 μmol/L increase in the DHEAS level decreased the odds of being in the IVF group by 18% (OR: 0.82, 95% CI: 0.66–1.01, p = 0.06), and 1 μg/L increase in the serum androstenedione concentration decreased the same odds by 42% (OR: 0.58, 95% CI: 0.33–1.02, p = 0.056). DHEAS levels <6.5 μmol/L had an OR 3.86 (95% CI 1.10–13.50, p = 0.04) and LH/FSH ratio <1.3 had an OR 3.58 (95% CI 1.18–10.81, p = 0.03) for being in the IVF group. The birth weight (3069 ± 683 g vs. 3362 ± 638 g, p = 0.02) and the gestational age (37.23 ± 2.55 vs. 38.54 ± 2.28 weeks, p = 0.004) were significantly lower in the IVF group, but in the singleton subgroups, no significant differences could be found. Birth weight percentiles showed no significant difference in either subgroup. In the IVF group, both preterm delivery (29% vs. 8.3%, OR 4.53, 95% CI 1.75–11.70, p = 0.002; singleton subgroup: 17.4% vs. 6.3%, OR 3.12, 95% CI 0.89–10.92, p = 0.07) and cesarean section (71% vs. 43.2%, OR 3.22, 95% CI 1.40–7.40, p = 0.006; singleton subgroup: 65.2% vs. 42.4%, OR 2.55, 95% CI 1.02–6.35, p = 0.04) were more frequent than in the non-IVF group. Gestational diabetes and preeclampsia were not significantly different in the IVF and non-IVF groups. Conclusions: In PCOS patients with successful pregnancies, those who conceive with IVF seem to be different in their baseline hormone levels and symptoms from the non-IVF group. Adverse obstetric outcomes are more common in the IVF group, and some of these differences persist when adjusting for singleton pregnancies and maternal age, too.

Vulvovaginal symptoms affect up to 39% of women. These symptoms have a significant impact on quality of life and are often linked to imbalances in the vaginal microbiota. This study evaluates the therapeutic efficacy of a zinc-containing hydroxyethyl cellulose-based hydrogel in 37 women with different vulvovaginal symptoms (itching, burning, irritation, pain, dryness, discharge, and odor). Over 12 weeks, participants applied the gel intravaginally with both assessments conducted at baseline and follow-ups. Results revealed substantial improvements in symptoms, including reductions in vaginal discharge, itching, and burning, as measured by the Vulvovaginal Symptom Questionnaire (VSQ-21), with scores decreasing from 10.78 ± 3.66 at baseline to 3.17 ± 4.16 at week 12 (p < 0.01). Vaginal Health Index (VHI) scores improved significantly, from 20.78 ± 1.74 at baseline to 23.64 ± 2.59 (p < 0.01). Cervicovaginal lavage (CVL) zinc levels decreased from 110 ± 102 µg/L at baseline to 62 ± 48 µg/L at week 4 (p < 0.01), increased to 80 ± 55 µg/L at week 8 (p = 0.04), and reached 99 ± 92 µg/L by week 12 (NS). A correlation analysis showed an inverse relationship between baseline CVL zinc levels and VSQ-21 scores (r = −0.3586, p = 0.034), while no significant correlation was observed with VHI scores (r = −0.0187, p = 0.9545). Vaginal pH levels decreased significantly, dropping from 4.03 ± 0.42 to 3.71 ± 0.48 (p < 0.01). These findings support the gel’s role as an effective, nonhormonal, drug-free, and local adjunct treatment for a variety of vulvovaginal symptoms.

Background: The management of ovarian cysts in postmenopausal women is still a diagnostic dilemma. Although ultrasound is the diagnostic cornerstone of the initial assessment, it is limited by its interpretation in cases without clear morphological features of malignancy. Objectives: The aim of this study was to assess whether the addition of grayscale ultrasound features with inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can improve diagnostic accuracy in the identification of malignant ovarian lesions as compared to benign cysts in postmenopausal women. Methods: A total of 103 surgically removed adnexal masses were examined retrospectively. Ultrasound morphology was categorized to either simple or complex while NLR and PLR were calculated from preoperative full blood counts. The reference standard was histopathology. Results: Of the 103 cysts taken out, 74 cysts (71.8%) were benign while 29 cysts (28.2%) were malignant. Complex morphology was shown by all malignant lesions. NLR values in malignancy vs. benignancy showed a mean NLR of 4.96 ± 2.3 in the malignant cases, while it was 2.56 ± 1.2 in the benign cases (p < 0.001). In a similar fashion, the PLR was 198.4 ± 45.1 in malignant compared to 134.2 ± 32.7 in benign cases (p < 0.001). In the group of complex cysts (n = 52), NLR and PLR were compared to differentiate between malignant and benign lesions. In logistic regression, complex morphology was an independent predictor of malignancy, while NLR showed a positive, non-significant trend; PLR was not independently associated. Conclusions: Use of NLR and PLR in combination with grayscale ultrasonographic morphology improves the diagnostic characterization of postmenopausal women with adnexal masses. This easy, cost-effective method might aid in better triage and surgery planning.