Few decisive articles in gynecology from 2015

Medication approved for low sexual desire in women.

Flibanserin is the first and currently only drug approved by the US Food and Drug Administration (FDA) for female sexual dysfunction. The U.S. Food and Drug Administration today approved Addyi (flibanserin) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. It is hailed by many as “Female Viagra”, but the daily dosing, severe adverse reaction when combined with alcohol, somnolence and dizziness limits its use. Also the daily dosing will only result in   modest increase in sexually satisfying event and sexual desire.

New guidelines from Bethesda for cervical screening cytology reporting.

The past decade has witnessed several changes in the realm of cervical cancer screening, prevention, and management. A new category was created as ‘ASC-H ‘which includes those Low-grade squamous intraepithelial lesion (LSIL) specimens that contain a few cells that are suspicious for but not diagnostic of high-grade squamous intraepithelial lesions (HSIL). More testing is recommended in the form of colposcopy and biopsy.
The Bethesda System 2001 for reporting cervical cytology recommends reporting benign-appearing, exfoliated endometrial cells (BEC) in women aged 40 years or older. The 2014 guidelines advocate it’s reporting only in women ≥45 years as finding of BEC was not found to be effective for predicting endometrial hyperplasia or carcinoma in women aged 40-45 yrs. 

CDC updates the guidelines on the management of sexually transmitted infections in June 2015. 

 

These updated guidelines discuss:

• Screening recommendations for gonorrhea and chlamydia;
• Nucleic acid amplification tests for diagnosing trichomoniasis;
• Updated treatment for chlamydia during pregnancy;
• Updated human papillomavirus (HPV) vaccine recommendations;
• Alternative treatment options for genital warts;
• The role of Mycoplasma genitalium in urethritis and cervicitis;
• Information on the clinical care of transgender men and women.
• Annual testing for hepatitis C in persons with HIV-infected men who have sex with men and T. vaginalis testing for HIV-infected women annually and when pregnant;
• Updated recommendations for diagnostic evaluation of urethritis;
• T. vaginalis retesting in women to detect repeat infection after 7 days of treatment.

Timing is important in Menopausal Hormone Therapy (MHT).

The use of MHT has been a subject of debate two decades.  However studies in 2015 and an updated version of Cochrane review that was published in 2013 lend support to the ‘timing hypothesis’, which posits that cardiovascular benefit may be derived when ET or HT is used close to the onset of menopause. It is seen in recent studies that menopausal hormone therapy (MHT) in the early menopausal years (<10 years from menopause) may not be associated with excess cardiovascular risk when compared with use in the later menopausal years.

This hypothesis was further supported by a meta-analysis of 19 trials of oral HT (which included the women’s health initiative) leading to a combined total of 40,410 post-menopausal women. These women had a lower risk of coronary heart disease (CHD) compared with placebo and a lower mortality rate. The relationship of duration of therapy to cardiovascular outcomes awaits further study. Furthermore, additional studies on progesterone versus synthetic progestins are needed.

Topical steroids confer protection against Vulvar carcinoma in women with Vulvar Lichen Sclerosus(VLS).

A prospective longitudinal cohort study conducted by a private dermatologist and gynecologist included 507 women with histologically proven VLS. The study objective was long-term preventive topical corticosteroid (TCS) treatment of VLS, with a target outcome of induction and maintenance of normal skin texture and color, reduces the risk of vulvar carcinoma, relieves symptoms, improves function, and preserves vulvar architecture, and to evaluate the adverse effects of treatment.

It was seen that women who was compliant with the treatment had a better chance of near normal cosmetic appearance, decreased risk of vulvar carcinoma. The adverse effects of corticosteroids were minimal.

References:

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm458734.htm

https://www.karger.com/Article/Pdf/381326

http://www.cancer.gov/types/cervical/understanding-cervical-changes

http://www.cdc.gov/std/tg2015/

http://www.ncbi.nlm.nih.gov/pubmed?term=25754617