Perineal Hygienic Practices in Patients of Himalayan Foothills - A Descriptive Study

BACKGROUND It has been said that health is wealth and when it comes to reproductive health of a women it has a significant value indeed. There is lot of loops and holes in perineal hygiene practices due to incomplete knowledge and various myth that is transferred from generation to generation in a family. The aim of the study was to study the perineal hygiene practices in women of Himalayan foothills. METHODS This is an observational study performed between March 2019 to February 2020 at AIIMS Rishikesh. Data was extracted from OPD records of patients which included details on perineal hygiene, routinely asked in one of the three units in department of obstetrics and gynaecology at AIIMS Rishikesh. RESULTS Total of 2400 women participated in the study. The mean age of subjects was 32± 6.9(Range 12 - 80 years). Maximum patients were married (92 %), mostly Hindus (48 %) belonging to upper lower class (37.5 %) according to modified Kuppuswamy socioeconomic scale. In this study we studied the routine perineal cleaning practices, Attention is being drawn to the fact that only 15 % of the subjects cleaned the genital area with water after urination, 5 % while changing pads during menstruation, only 1.5 % washed the genitalia immediately after sexual intercourse In present study the commonest method removal of perineal hair was shaving (38.4 %). While analysing menstrual hygiene, in present study, 42.5 % of study population was using sanitary pads from market and 35 % used homemade cloth pads. Ninety eight point seven percent of women avoided sexual intercourse during menstruation in present study. CONCLUSIONS Female genital hygiene is a vital topic. Awareness should be increased regarding maintenance of hygienic practices through health education programmes. More studies need to be performed in order to provide directions for proper female genital hygiene, as well as guidelines. KEY WORDS Perineal Hygiene, Pubic Hair Grooming, Menstrual Hygiene, Perineal Itching, Perineal Rashes, Long Mirror for Self Examination.

Delayed pubarche

In healthy adolescents, delayed pubarche is generally a benign condition that is caused by a physiological discrepancy between gonadarche and adrenarche. In presence of other clinical signs and symptoms, delayed pubarche can be caused by single or multiple hormones deficiency (such as adrenal insufficiency, panhypopituitarism and hypothyroidism) and/or genetic conditions (Turner syndrome, androgen insensitivity syndrome). Exposition to endocrine disruptors has also been described as a possible cause of delay of pubic hair development. Basic blood tests, karyotype and first level imaging studies are helpful in the differential diagnosis.

Pornography and Body Image

There is a concern that the bodies that are shown to us in sexually explicit media are changing what we think is beautiful, are making us anxious and depressed, and even are pushing us to engage in self-harmful behavior. This chapter provides theoretical explanations for why pornography images could impair health and reviews studies that have investigated this question. The chapter covers findings related to pubic hair removal, labiaplasty, vulva acceptance, men’s genital dissatisfaction, satisfaction with body shape and size, self-esteem and self-confidence, and expectations of partners’ bodies. The chapter concludes that pornography likely harms some people’s self-image, and for a minority of those who are harmed, it drives them to extreme behaviors and has mental health consequences. For the majority, pornography either has no effect, improves how they feel about their bodies, or underscores the body-related attitudes that they have already acquired from non-sexually-explicit media.

Comparing adolescent self staging of pubertal development with hormone biomarkers

Objectives Physical examinations to characterize pubertal maturation may be unacceptable for children enrolled in research studies. Studies confirm the utility of pubertal self staging for research, but there has been limited comparison of self examination with hormone biomarkers. Our objective was to assess concordance of pubertal self staging with hormone biomarkers of puberty. Methods Participants were enrolled in the Health Outcomes and Measures of the Environment Study, a longitudinal pregnancy and birth cohort study. At age 12 years, 139 females and 112 males completed pubertal self staging including breast and pubic hair development in females and pubic hair development in males. No clinical physical examination was performed. Hormone concentrations were measured in 102 females and 96 males including serum dehydroepiandrosterone sulfate, luteinizing hormone, and follicle-stimulating hormone in all; estradiol in females; and testosterone in males. Results Estradiol was significantly associated with female breast stage, even when adjusted for BMI, with geometric least squares means (95%CI) of 13.2 (8.7, 20.2), 38.3 (29.9, 49.1), 59.4 (39.8, 88.6), and 81.2 (45.6, 144) pg/mL for breast stage 1–2, 3, 4, and 5, respectively. Testosterone was significantly associated with male pubic hair stage, with adjusted geometric least squares means (95%CI) of 37.6 (19.9, 71.1), 43.4 (27.7, 68.3), 126 (78.4, 203), 275 (146, 521), and 559 (237, 1319) ng/dL for pubic hair stage 1, 2, 3, 4, and 5, respectively. Conclusions Self assessed pubertal development was positively associated with hormonal biomarkers of puberty.

Functional Adrenocortical Adenoma in a Child with Beckwith–Wiedemann Syndrome

Beckwith–Wiedemann syndrome (BWS) is a rare congenital condition characterized by complex overgrowth of different body parts. Children with Beckwith–Wiedemann syndrome, particularly those with hemihypertrophy, experience an increased risk of developing benign and malignant tumors. This case report presents an 18-month-old girl with features suggestive of Beckwith–Wiedemann syndrome who developed pubic hair, high levels of testosterone, and DHEAS with normal cortisol and progesterone levels. Computed tomography revealed a left adrenal mass. Histopathological examination of the resected mass showed an adrenocortical tumor. Her postoperative evaluation showed normal testosterone and DHEAS levels. Early diagnosis and detection of intra-abdominal neoplasms in infants with Beckwith–Wiedemann syndrome are essential to avoid serious clinical complications.

Immune-mediated Coombs negative intravascular haemolysis in systemic lupus erythematosus (SLE)

A 27-year-old woman presented with a history of excessive hair loss, loss of appetite, loss of weight, amenorrhoea and loss of axillary and pubic hair for 6 months followed by fever and vomiting for 5 months and abdominal pain for 1 month. During the course of her illness, the patient developed intravascular haemolysis as evidenced by a drop in haemoglobin, indirect hyperbilirubinaemia, raised lactate dehydrogenase (LDH) and haemoglobinuria. Examination revealed severe pallor, mild icterus, elevated jugular venous pressure, generalised lymphadenopathy and hyperpigmentation. Investigations revealed severe anaemia, indirect hyperbilirubinaemia, raised LDH and negative Coombs test. Antinuclear antibody and anti-dsDNA, anti-Sm and anti-SS-A/Ro antibodies were positive and complement C3 was low. The patient was diagnosed to have systemic lupus erythematosus and immune-mediated intravascular haemolysis and was treated with prednisolone and hydroxychloroquine. Haemolysis resolved following steroid therapy, and during follow-up, there were no further episodes of haemolysis.

Dynamics of anthropometric indicators in girls within the pubertal period of ontogenesis

The harmony of the organism development in different periods of ontogenesis, and especially puberty, determines the future fate of women in both medical and social aspects. The aim of the research was to study the total and partial body sizes in girls of pubertal period of ontogenesis. We surveyed 128 schoolgirls of 5-8 grades. We evaluated the stages of development of secondary sexual characteristics by hair growth in the axilla and pubis, the development of the mammary glands and age of onset of the first menstruation. According to G.G. Avtandilov’s classification, all girls were divided into three groups – prepubertal (preceding the appearance of pubic hair), pubertal (puberty before menarche) and postpubertal period (fixed and completed pubertal maturation). The group of pubertal girls consisted of 106 schoolgirls, who were divided into groups according to calendar age: 13-year-old (n=29), 12-year-old (n=30), 11-year-old (n=24) and 10-year-old (n=23). Anthropometric survey was conducted according to the scheme of V.V. Bunak and contained the definition of total (length and body weight) and partial (longitudinal, transverse and anterior-posterior) dimensions. The analysis of the obtained results was performed in the license package Statistica 5.5 using non-parametric methods of evaluation of indicators. In our study, it was found that anthropometric indicators characterize the physical development, the level of its harmony and morphofunctional maturity of girls within the pubertal period of ontogenesis. We found a progressive age dynamics of total and partial body size in girls of this age period. The periods of the most intensive growth within the pubertal period of ontogenesis of total and partial sizes of a body are established. At the end of puberty there is the most intense age increase in body length: a rapid increase in body weight begins at the age of 12, the most intense processes of longitudinal growth of the torso and lower extremities in girls are observed from 11 years. Most of the transverse dimensions within the pubertal period of ontogenesis have a pronounced progressive age dynamic. Lower thoracic size, interspinous distance, and external conjugate did not differ statistically significantly between girls of different ages during puberty.

Familial Hyperinsulinism due to HNF4A Deficiency and Benign Premature Adrenarche: A Case Report

Background: Familial Hyperinsulinism due to HNF4A deficiency (FHI-HNF4A) is a form of diazoxide-sensitive, diffuse hyperinsulinism, characterized by transient or persistent hyperinsulinemic hypoglycemia, and a propensity to develop Maturity-Onset Diabetes of the Young type 1 (MODY1). The association between FHI-HNF4A deficiency and benign premature adrenarche (BPA) is unknown. The Case: We report the case of a 5-year-old girl with FHI-HNF4A, controlled on diazoxide, who presented with BPA and Tanner stage III pubic hair associated with body odor and acne. Work-up revealed elevated dehydroepiandrosterone sulfate (DHEAS), elevated free testosterone, and advanced bone age. Insulin levels were elevated in the setting of normal fasting blood glucose. We discuss the possible hormonal underpinnings of hyperandrogenism. Conclusion: Though the underlying pathophysiology of this phenotype is unclear, a possible synergistic mechanism exists between insulin-induced hyperandrogenism and HNF4A deficiency leading to a transient decrease of SHBG and thus increased free testosterone levels. Further investigation is required to determine the association between HNF4A dysfunction and BPA.

Primary Amenorrhea with Mayer-Rokitansky-Kuster-Hauser Syndrome

BACKGROUND: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare disorder described as aplasia or hypoplasia of uterus and vagina due to an early arrest in the development of Mullerian ducts. The etiology of MRKH syndrome remains uncertain: Although at the beginning, it was mentioned that this syndrome was the result of sporadic abnormalities. It has recently been assumed the genetic background is the cause of the increasing number of familial cases. CASE REPORT: A 29-year-old female patient presented with amenorrhea. She also has normal pubic and axillary hair and breast development. Routine investigations were normal. Genitalia inspection shows that pubic hair was well developed, labia majora and vagina were seen. Inspeculo show that vaginal wall was smooth, but portio was not seen. Vaginal examination result: The uterus was unpalpable, both adnexa were normal, parametrium was laxed, and Douglas pouch was not protruded. Rectal examination shows that uterus and both adnexa were difficult to identify. Transvaginal sonography revealed absence of uterus, both ovaries within normal. Transvaginal sonography diagnosed a uterine aplasia. With this, the provisional diagnosis made as primary amenorrhea due to suspected MRKH syndrome, the patient was referred for follicle-stimulating hormone, estradiol, testosterone, and prolactin levels by enzyme-linked immunosorbent assay examination and the result was within normal limit followed by genetic karyotyping and the result was normal 46, XX. CONCLUSIONS: We report a 29-year-old woman with primary amenorrhea. From our examination, the patient was diagnosed with MRKH syndrome. Uterus transplant is an alternative for that woman to treat amenorrhea and possibility to get pregnant.