Vaginal staging

Two new female condoms, ie, vaginal pouches, are in early stages of development. These devices still require thorough preclinical and clinical studies to demonstrate safety and effectiveness before they reach the market (102). 

Recent studies using vaginal-cervical cells suggest yet another mechanism for the early stage of tight junctional disassembly, namely, the breakdown of occludin 65-kDa isoform to the lesser functional 50-kDa isoform. Occludin appears to constitutively undergo calpain-mediated proteolysis, increasing the amount of non-functional 50-kDa isoform [35, 43], As described above,... 

Vaginal cancers are so similar to cervical cancers with respect to epidemiology, behavior, and treatment response that many clinicians have chosen to treat vaginal cancers of stage II or greater with chemoradiation on the basis of results from cervical cancer trials. Unfortunately, only scattered published reports of chemoradiation are available for this rare tumor. 

Fluconazole is very effective in the treatment of infections with most Candida spp. Thrush in the end-stage AIDS patient, often refractory to nystatin, clotrimazole, and ketoconazole, can usually be suppressed with oral fluconazole. AIDS patients with esophageal candidiasis also usually respond to fluconazole. A single 150-mg dose has been shown to be effective treatment for vaginal candidiasis. A 3-day course of oral fluconazole is effective treatment for Candida urinary tract infection and is more convenient than amphotericin B bladder irrigation. Preliminary findings suggest that Candida endophthalmitis can be successfully treated with fluconazole. Stable nonneutropenic patients with candidemia can be adequately treated with fluconazole, but unstable, immunosuppressed patients should initially receive... 

A more permeable epithelium obviously facilitates greater absorption. Some epithelia are relatively more permeable than others. For example, the skin is an extremely impermeable barrier, whereas the permeability of the lung membranes towards many compounds is much higher than the skin and is also higher than that of the small intestine and other mucosal routes. The vaginal epithelium is relatively permeable, particularly at certain stages of the menstrual cycle. 

Phase I studies suggest that DS vaginal gel used at doses of up to 100 pg/ml does not exert an adverse effect on vaginal epithelium, or on vaginal bacterial ecology. However, no conclusions can be drawn at this stage about the likely tolerability, safety and efficacy of the gel in the context of sexual intercourse. 

During the 2-week dosing premating phase, daily vaginal smears assessed for stage of estrus... 

The first stage in practicing EBM is to define the precise question to which an evidence-based answer is required. A carefully focused question will inform the search for relevant evidence, and should (hopefully) avoid excessive retrieval of irrelevant publications and other information sources. For example, a clinician who wishes to know whether it is best to use oral or topical antifungals for the treatment of vaginal candidiasis could articulate the question as What is the relative effectiveness of oral versus intra-vaginal antifungals for the treatment of uncomplicated vulvovaginal candidiasis ... 

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