Estrogen vs. Conservative Therapy for Labial Agglutination in Prepubertal Girls

The increase in the number of prepubertal girls who require evaluation of possible sexual abuse creates a need for detailed information, not previously available from cross-sectional studies, on the influence of aging on the hymen's appearance. This study was undertaken to evaluate and document, using a longitudinal design, changes in the hymen's morphology in 62 girls without a history of sexual abuse between birth and their first birthday. Labial agglutination extensive enough to obscure the inferior half of the hymen was observed in 5 girls (8%) at 1 year of age. Thirty-three (58%) of the remaining 57 infants experienced a marked decrease in the amount of their hymenal tissue between birth and 1 year. Significantly more infants at 1 year of age had a crescentic configuration (0% vs 28%), and significantly fewer had an external ridge (82% vs 14%) as compared to the newborn period. An annular hymen with a central or ventrally displaced opening progressed to a crescentic hymen in 13 children by 1 year, 77% (10/13) of whom were observed to have a notch (cleft) at the 12 o'clock position on the earlier study. A superior notch appeared for the first time in 9 girls. Lateral notches resolved in 5 cases and persisted in 2. Inferior notches between the 4 and 8 o'clock positions were not observed at birth or 1 year. Hymenal tags resolved in 2 instances, persisted in the same location in 2, and appeared for the first time in 4 cases. Three girls had a hymenal mound (bump) at 1 year, all of which could be traced back to a similar finding at birth. No change in the number of infants with longitudinal intravaginal ridges was observed. Clinicians should be aware of the influence of age and changing estrogen levels on the hymen's morphology in order to differentiate normal anatomical from posttraumatic or infectious changes.

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Appearance of the Hymen in Prepubertal Girls

PEDIATRICS ◽

10.1542/peds.89.3.387 ◽

1992 ◽

Vol 89 (3) ◽

pp. 387-394

Author(s):

Abbey B. Berenson ◽

Jean M. Hayes ◽

Rahn K. Bailey ◽

Astrid H. Heger ◽

S. Jean Emans

Keyword(s):

Sexually Abused ◽

Common Type ◽

Medical Professionals ◽

Normal Finding ◽

Well Child Care ◽

Significant Difference ◽

History Of ◽

Study Population ◽

Labial Agglutination ◽

Prepubertal Girls

The recent increase in requests for genital examinations in girls who may have been sexually abused has necessitated detailed information not previously available on normal anatomy of the prepubertal girl. This study was undertaken to document the genital anatomy of 211 girls between the ages of 1 month and 7 years who presented for well child care or nongynecologic complaints and who had no history of sexual abuse. Each child's genitalia was examined and photographed, with findings reported reflecting those observed photographically. The study population consisted of 36% blacks, 33.6% white non-Hispanics, 29.9% Hispanics, and 0.5% Asians. Subjects had a mean age of 21 ± 20.6 (SD) months. Extensive labial agglutination sufficient to obscure the hymen was noted in 5% (10/211) and partial agglutination in an additional 17% (35/211). A significant difference was noted in hymenal configuration by age, with a fimbriated hymen the most common type (46%) in infants aged 12 months or younger and a crescentic hymen the most common (51%) in girls older than 24 months (P ≤ .001). No significant difference was noted in hymen configuration by race. Hymenal bumps (mounds) were observed in 7%, hymenal tags in 3%, vestibular bands in 98%, longitudinal intravaginal ridges in 25%, and external ridges in 15% of subjects in whom the anatomy under study could be visualized. Hymenal notches (clefts) occurred superiorly and laterally on the hymenal rim but none were found inferiorly on the lower half of the hymen. A narrow rounded hymenal ring with a transection was observed in only 1 (0.5%) of 201 subjects and was not considered a normal finding. Transverse hymenal openings measured only in annular and crescentic hymens had a mean which ranged from 2.5 ± 0.8 to 3.6 ± 1.2 mm and varied significantly with age (P = .003). Normal hymenal findings must be recognized by medical professionals so that posttraumatic findings can be diagnosed appropriately.

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Elevated anti-Müllerian hormone (AMH) and inhibin B levels in prepubertal girls with type 1 diabetes mellitus

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/j.yobg.2011.05.153 ◽

2011 ◽

Vol 2011 ◽

pp. 217-219

Author(s):

L.P. Shulman

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Inhibin B ◽

Prepubertal Girls

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Late recurrence of anal fissure after conservative therapy with botulinum toxin

Gastroenterology ◽

10.1016/s0016-5085(01)81975-2 ◽

2001 ◽

Vol 120 (5) ◽

pp. A398-A398

Author(s):

M MINGUEZ ◽

A ESPI ◽

V SANCHIZ ◽

I PASCUAL ◽

E GARCIAGRANERO ◽

...

Keyword(s):

Botulinum Toxin ◽

Anal Fissure ◽

Conservative Therapy ◽

Late Recurrence

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Ebstein Anomaly: Midterm Results of Surgical and Conservative Therapy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0033-1354468 ◽

2013 ◽

Vol 61 (S 02) ◽

Author(s):

P Murin ◽

S Sata ◽

C Haun ◽

M Schneider ◽

E Schindler ◽

...

Keyword(s):

Conservative Therapy ◽

Midterm Results ◽

Ebstein Anomaly

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Modern determinants of endometrium hyperplastic processes pathogenesis

HEALTH OF WOMAN ◽

10.15574/hw.2016.111.137 ◽

2016 ◽

pp. 137-142

Author(s):

V.O. Benyuk ◽

◽

V.M. Goncharenko ◽

T.R. Nykoniuk ◽

◽

...

Keyword(s):

Conservative Therapy ◽

Solid Phase ◽

Research Direction ◽

Immunohistochemical Method ◽

Results Of Treatment ◽

Treatment And Prevention ◽

Receptor Phenotype ◽

The Relationship ◽

Endometrial Proliferation

The objective: to еxplore the relationship between the activity of endometrial proliferation and the state of the local immune response in the uterus in the conditions berprestasi process. Patients and methods. Examined 228 women of reproductive and perimenopausal age with endometrial pathology using ultrasound and then performing hysteroresectoscopy. Determination of the concentrations of the cytokines IL-1, IL-2, IL-6 and TNF was performed by solid phase ELISA. Results. Found a trend that confirms the loss of sensitivity to hormones at the stage of malignancy of the endometrium and can be used as diagnostic determinants in determining the nature of intrauterine pathology and criterion of the effectiveness of conservative therapy. Conclusion. Improving etiopatogenetice approach to the therapy of hyperplastic proce.sses of endometrium with determination of receptor phenotype of the endometrium is a research direction in modern gynecology, which will help to improve the results of treatment and prevention of intrauterine pathology. Key words: endometrial hyperplasia,the receptors for progesterone and estrogen, immunohistochemical method.

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Conservative Therapy through Adequate Doctor Patient Interaction Improves outcomes in Patients Suffering from Mild and Moderate Knee Osteoarthritis

International Journal of Healthcare Education & Medical Informatics ◽

10.24321/2455.9199.201712 ◽

2018 ◽

Vol 04 (04) ◽

pp. 1-2

Author(s):

M Sharma ◽

Keyword(s):

Knee Osteoarthritis ◽

Conservative Therapy ◽

Patient Interaction

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Cesarean scar defects: diagnosis and treatment in non-pregnant women

GYNECOLOGY ◽

10.26442/20795696.2020.3.200189 ◽

2020 ◽

Vol 22 (3) ◽

pp. 6-10

Author(s):

Sergey A. Martynov

Keyword(s):

Magnetic Resonance Imaging ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Genital Tract ◽

Conservative Therapy ◽

Clinical Manifestations ◽

Subsequent Pregnancy ◽

Resonance Imaging ◽

Diagnostic Features ◽

Pregnancy And Childbirth

The aim of the review was to summarize information on clinical manifestations, diagnostic features, as well as methods for correction of scar defects after cesarean section (CS) outside pregnancy. Lack of the scar after CS, niche, isthmocele are a myometrium defect in the area of scar after CS, which is most often detected by ultrasound, sonohysterography or magnetic resonance imaging and is manifested by postmenstrual bleeding from the genital tract. In some cases, it can cause menorrhagia, dyspareunia, pelvic pain, infertility, uterine rupture during subsequent pregnancy and childbirth. Conservative therapy or surgical treatment with laparoscopy, laparotomy or vaginal approach is carried out depending on the symptoms, size of the defect, the thickness of the residual myometrium, as well as the womans reproductive plans.

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