Effects of female genital mutilation on birth outcomes in Switzerland

OBJECTIVE: The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland. Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes. DESIGN: A retrospective case-control study. SETTING: A teaching hospital. POPULATION: One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls. METHODS: Data for patients' wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age. MAIN OUTCOME MEASURES: Patients' satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures. RESULTS: Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears. CONCLUSION: An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.

Genital chlamydia prevalence in Europe and in non-European high income countries: systematic review and meta-analysis

Background: Accurate information about the prevalence of Chlamydia trachomatis is needed to assess national prevention and control measures. Methods: We systematically reviewed population-based cross-sectional studies that estimated chlamydia prevalence in European Union/European Economic Area (EU/EEA) Member States and non-European high income countries from January 1990 to August 2012. We examined results in forest plots, explored heterogeneity using the I2 statistic, and conducted random effects meta-analysis if appropriate. Metaregression was used to examine the relationship between study characteristics and chlamydia prevalence estimates. Results: We included 25 population-based studies from 11 EU/EEA countries and 14 studies from five other high income countries. Four EU/EEA Member States reported on nationally representative surveys of sexually experienced adults aged 18-26 years (response rates 52-71%). In women, chlamydia point prevalence estimates ranged from 3.0-5.3%; the pooled average of these estimates was 3.6% (95% CI 2.4, 4.8, I2 0%). In men, estimates ranged from 2.4-7.3% (pooled average 3.5%; 95% CI 1.9, 5.2, I2 27%). Estimates in EU/EEA Member States were statistically consistent with those in other high income countries (I2 0% for women, 6% for men). There was statistical evidence of an association between survey response rate and estimated chlamydia prevalence; estimates were higher in surveys with lower response rates, (p=0.003 in women, 0.018 in men). Conclusions: Population-based surveys that estimate chlamydia prevalence are at risk of participation bias owing to low response rates. Estimates obtained in nationally representative samples of the general population of EU/EEA Member States are similar to estimates from other high income countries.

Waddlia chondrophila induces systemic infection, organ pathology, and elicits Th1-associated humoral immunity in a murine model of genital infection

Waddlia chondrophila is a known bovine abortigenic Chlamydia-related bacterium that has been associated with adverse pregnancy outcomes in human. However, there is a lack of knowledge regarding how W. chondrophila infection spreads, its ability to elicit an immune response and induce pathology. A murine model of genital infection was developed to investigate the pathogenicity and immune response associated with a W. chondrophila infection. Genital inoculation of the bacterial agent resulted in a dose-dependent infection that spread to lumbar lymph nodes and successively to spleen and liver. Bacterial-induced pathology peaked on day 14, characterized by leukocyte infiltration (uterine horn, liver, and spleen), necrosis (liver) and extramedullary hematopoiesis (spleen). Immunohistochemistry demonstrated the presence of a large number of W. chondrophila in the spleen on day 14. Robust IgG titers were detected by day 14 and remained high until day 52. IgG isotypes consisted of high IgG2a, moderate IgG3 and no detectable IgG1, indicating a Th1-associated immune response. This study provides the first evidence that W. chondrophila genital infection is capable of inducing a systemic infection that spreads to major organs, induces uterus, spleen, and liver pathology and elicits a Th1-skewed humoral response. This new animal model will help our understanding of the mechanisms related to intracellular bacteria-induced miscarriages, the most frequent complication of pregnancy that affects one in four women.

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system.

STUDY QUESTION How comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies? SUMMARY ANSWER The ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system. WHAT IS KNOWN ALREADY Until now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment. STUDY DESIGN, SIZE AND DURATION The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. PARTICIPANTS/MATERIALS, SETTING, METHODS Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. MAIN RESULTS AND THE ROLE OF CHANCE The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system. LIMITATIONS, REASONS FOR CAUTION The review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare. WIDER IMPLICATIONS OF THE FINDINGS The comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care and research. STUDY FUNDING/COMPETING INTERESTS None.

Antibiotic Susceptibility and Sequence Type Distribution of Ureaplasma Species Isolated from Genital Samples in Switzerland.

Antibiotic resistance in Ureaplasma urealyticum/Ureaplasma parvum and Mycoplasma hominis is an issue of increasing importance. However, data regarding the susceptibility and, more importantly, the clonality of these organisms are limited. We analyzed 140 genital samples obtained in Bern, Switzerland, in 2014. Identification and antimicrobial susceptibility tests were performed by using the Mycoplasma IST 2 kit and sequencing of 16S rRNA genes. MICs for ciprofloxacin and azithromycin were obtained in broth microdilution assays. Clonality was analyzed with PCR-based subtyping and multilocus sequence typing (MLST), whereas quinolone resistance and macrolide resistance were studied by sequencing gyrA, gyrB, parC, and parE genes, as well as 23S rRNA genes and genes encoding L4/L22 ribosomal proteins. A total of 103 samples were confirmed as positive for U. urealyticum/U. parvum, whereas 21 were positive for both U. urealyticum/U. parvum and M. hominis. According to the IST 2 kit, the rates of nonsusceptibility were highest for ciprofloxacin (19.4%) and ofloxacin (9.7%), whereas low rates were observed for clarithromycin (4.9%), erythromycin (1.9%), and azithromycin (1%). However, inconsistent results between microdilution and IST 2 kit assays were recorded. Various sequence types (STs) observed previously in China (ST1, ST2, ST4, ST9, ST22, and ST47), as well as eight novel lineages, were detected. Only some quinolone-resistant isolates had amino acid substitutions in ParC (Ser83Leu in U. parvum of serovar 6) and ParE (Val417Thr in U. parvum of serovar 1 and the novel Thr417Val substitution in U. urealyticum). Isolates with mutations in 23S rRNA or substitutions in L4/L22 were not detected. This is the first study analyzing the susceptibility of U. urealyticum/U. parvum isolates in Switzerland and the clonality outside China. Resistance rates were low compared to those in other countries. We hypothesize that some hyperepidemic STs spread worldwide via sexual intercourse. Large combined microbiological and clinical studies should address this important issue.

Optimal frequency of Imiquimod (Aldara(RTM)) 5% cream treatment of external genital warts in immunocompetent adults. Systematic review and meta-analysis

Genital warts are a sexually transmitted disease with high prevalence in the U.S. Imiquimod 5% cream is a self-applied treatment, prescribed three-times weekly, at bedtime, for 16 weeks. The post-marketing research addressed questions of imiquimod dosing frequency. MEDLINE, Embase, and the Cochrane Library were searched for randomized trials on efficacy and safety of imiquimod 5% cream with either three-times weekly or once-daily regimens to systemically review treatment options. Efficacy was evaluated by completely cleared warts at the end of treatment, and safety - by frequency of adverse events and at least one rest period taken from treatment. Six studies were selected for the analysis, including circumcised men, uncircumcised men, and women. The once-daily compared to three-times weekly regimen did not improve the efficacy, but resulted in increased incidence of local skin reactions and events, when at least one rest period was taken from treatment. The optimal regimen is three-times weekly.^

The influence of HIV/AIDS on the association between genital human papillomavirus and cervical cancer in HIV/AIDS infected women: A literature review

Background: With over 440 million cases of infections worldwide, genital HPV is the most frequent sexually transmitted infection. There are several types including high risk types 16, 18, 58 and 70 among others, which are known to cause cervical cell abnormality and if persistent, can lead to cervical cancer which globally, claims 288,000 lives annually. 33.4 million people worldwide are currently living with HIV/AIDS, with 22.4 million in sub-Saharan Africa where 70% of the female population living with HIV/AIDS is also found. Similar risk factors for HPV, cervical cancer and HIV/AIDS include early age at sexual debut, multiple sexual partners, infrequent condom use, history of STI and immune-suppression. ^ Objectives: To describe the role of HPV in cervical cancer development, to describe the influence of HIV/AIDS on HPV and in the development of cervical cancer and to describe the importance of preventive measures such as screening. ^ Methods: This is a literature review where data were analyzed qualitatively and a descriptive narrative style used to evaluate and present the information. The data came from searches using Pub Med, Cochrane Library, EBSCO Medline databases as well as websites such as the CDC and WHO. Articles selected were published in English over the last 10 years. Keywords used included: 'HPV, cervical cancer and HIV', 'HIV and HPV', 'HPV and cervical cancer', 'HPV infection', 'HPV vaccine', 'genital HPV', 'HIV and cervical cancer', 'prevalence of HIV and cervical cancer' and 'prevalence of cervical cancer'. ^ Results: Women with HIV/AIDS have multiple HPV types, persistent infection, are more likely to present with cervical neoplasia and are at higher risk for cervical cancer. Research also shows that HIV could affect the transmissibility of HPV and that HPV itself could also increase the susceptibility to HIV acquisition. ^ Conclusion: HIV, genital HPV and cervical cancer are all preventable. Need to emphasize programs that aim to increase HIV/AIDS, HPV and cervical cancer awareness. Stress importance of behavior modification such as frequent use of condoms, decreased sexual partners and delayed first intercourse. Facilitate programs for screening and treating HPV, male circumcision, effective management of HAART and HPV vaccination.^

El sistema genital masculino y el control androtrófico en un ampulárido

Fil: Gamarra Luques, Carlos . Universidad Nacional de Cuyo. Facultad de Ciencias Médicas

El aparato estatal educativo : La perspectiva sociológica y política en su construcción como objeto de estudio desde la Administración de la Educación

Este trabajo se propone precisar algunas consideraciones conceptuales respecto del análisis del sistema educativo, en relación con una perspectiva de la Administración de la Educación construida desde preocupaciones propias de la sociología y la política. Esta última es particularmente clave para la comprensión del sistema educativo dada su naturaleza estatal. Las consideraciones conceptuales refieren centralmente a dos perspectivas sociológicas, donde lo político se presenta como una dimensión constitutiva de lo social, aunque desde diferentes caminos o enfoques: la noción de sujeto y campo, de Bourdieu, por un lado, y las de actor y sistema, de Crozier y Friedberg, por otro. En este sentido, el trabajo intenta destacar las divergencias relativas de ambas perspectivas (especialmente, en relación con lo que podríamos denominar una teoría de la acción), para capitalizar sus convergencias en el examen del aparato estatal educativo: un examen centrado en las relaciones o articulaciones, considerado en diferentes ?escalas? o niveles de abstracción. Esta trama relacional es considerada como el nudo mismo de esa dimensión política, es decir, apreciada en términos de regulación o integración, configurando posiciones relativas aventajadas/desaventajadas. Finalmente, se señalan algunas implicancias, más específicas, respecto de la construcción del sistema educativo como objeto de estudio - desde la Administración de la Educación- lo que se presenta en términos de su articulación político-administrativa

La sexualidad psicoanalítica y los avatares de su interpretación por los colectivos de diversidad y género

El presente trabajo se presenta como un avance del Proyecto de investigación acreditado en el Programa de incentivos denominado 'La responsabilidad del sujeto en el campo del Psicoanálisis. Sexuación femenina y sexuación masculina'. En el mismo me propongo realizar un conjunto de reflexiones acerca del tema siempre complejo de losavatares del sujeto a partir de su determinismo estructural sexuado, el paradojal sentido de los no saberes que determinan el posicionamiento como hombre y mujer, así como la variedad de posibles relaciones entre los mismos, además deponer en situación dicha constitución subjetiva con los actuales planteos de las orientaciones de los colectivos de género, entre otros. A partir de ello se intenta poner en situación la responsabilidad subjetiva, que interpelamos habitualmente en los consultorios, es decir la responsabilidad ética de ese sujeto en relación a su deseo inconsciente que lo pone y quizás 'dispone' para el acto analítico. Resulta de plena actualidad analizar el discurso de los colectivos de género, a la luz del conjunto de reivindicaciones políticas que realizan sus grupos de vanguardia. El discurso de los mismos había quedado engrampado durante muchos años en la trampa del esencialismo dualista, que lo enfrentaba a categorías de hombre, mujer, masculino o femenino, patriarcado o matriarcado, etc. que pulía radicalmente las complejas aristas de la constitución de subjetividad. Los estudios sobre la sexualidad del psicoanálisis fue un continuoreferente para dichos colectivos, pero se piensa que no selogró captar desde un principio la potencialidad de argumentación casi revolucionaria que presentaban los mismos, quedando reducidos a una crítica reduccionista del planteo al que denominaron falocentrismo, una concepción biologizada de la teoría de la falta en ser constitutiva de lo humano. La dificultad de aprehensión de una realidad como la psíquica de naturaleza sexual, orientada por una falta en ser constitutiva y estructural, rompe con el modelo de las categorías de fuerte raigambre en los colectivos tales como el de identidad, hombre, mujer, poder, etc.De las apreciaciones y desarrollos se desprende que buena parte de los estudios sobre feminismo, género, etc. existe una matriz disciplinar común que pule las enriquecedoras aristas de la singularidad propia de los desarrollos del psicoanálisis que ellos mismos referencian, demarcando direccionalidades y determinaciones sociales en la orientación sexual, que ponen a distancia la falta en ser constitutiva de la subjetividad. A partir de lo anterior dichos enfoques se convierten en simples revisiones críticas de viejos modelos sociales, lingüísticos, discursivos, políticos, etc. La circulación discursiva con el Psicoanálisis se piensa que posibilitará que estos colectivos reactualicen su doctrina que quedó coaligada con la lectura genital del falo, desprendiéndose de allí una lectura sesgada por una ideología de dominancias que no son tales. Así el realizar un conjunto de reflexiones respecto al derrotero histórico que han seguido estos movimientos en la imposibilidad de adecuar a sus reivindicaciones y luchas sociales, aportes importantes del aparato teórico del Psicoanálisis de base freudiana y lacaniana, se piensa que colaborará al debate que se reactualiza, a partir que alguna de esas luchas han logrado fuerte impacto y éxito en el campo socio legal. Ultimamente algunos autores tales como Judith Butler realizan una aplicación de la teoría psicoanalítica sobre todo de base lacaniana, encontrando sobrados argumentos de base para el análisis, dando sustento teórico al discurso de los colectivos

El ombligo del aparato anímico freudiano : Un recorrido sobre lo no conocido [unnerkant]

El presente trabajo se propone explorar el uso que hace Freud de la categoría de lo 'no conocido' (unnerkant) a partir de la expresión 'el ombligo del sueño' utilizada en 'La Interpretación de los Sueños'. Intentando recorrer el lugar que tiene esta categoría en el pensamiento Freudiano y en la noción de Aparto Anímico, se recorrerán dos textos articulados a 'La Interpretación de los Sueños': 'Algunas notas adicionales a la interpretación de los sueños en su conjunto' y el 'Complemento Metapsicológico a la doctrina de los sueños'. El ombligo del sueño aparece mencionado en una breve y oscura referencia que realiza Freud en 'La Interpretación de los Sueños' en la cual se localiza lo "no conocido" en el Aparato Anímico. Años más tarde, esta categoría vuelve a ser mencionado en las 'Notas adicionales'. Se trata de tres breves escritos pensados por su autor como anotaciones al final de la Interpretación de los sueños. Algo en ellos, escandalizó a la comunidad analítica de su época y nunca tendrán ese destino. Freud se ocupa allí de temáticas complejas, polémicas: 'Los límites de la interpretabilidad', 'La responsabilidad moral por el contenido de los sueños', y 'El significado ocultista del sueño'. Allí nuevamente Freud no retrocede ante lo 'no conocido'. Nos detendremos en el tercero en donde Freud aborda el enigma de los fenómenos de adivinación, intentando explicarse cómo puede explicarse el mensaje que se recibe 'supuestamente' desde afuera, desde el adivino. Articulará estos fenómenos a un mecanismo que denomina 'transferencia inmediata': alguna moción reprimida pasó del consultante al adivino mientras éste distraía su atención. ¿Cuál es la mediación que no se produjo? ¿Qué lugar tiene allí la atención? Estas preguntas nos llevarán a pensar un modo de operación del Aparato Anímico descripto en 'La Interpretación de los Sueños' como 'Procesos Incorrectos': El segundo sistema solo inviste una representación si está en condiciones de inhibir el desarrollo de displacer que parte del primer sistema. Lo que se sustraiga de esta inhibición queda inasequible al segundo sistema. Por otro lado, dado que el proceso secundario adviene tardíamente, las mociones y deseos del inconsciente, 'núcleo de nuestro ser', permanecen no inhibibles, inasequibles a la investidura del preconsciente. Pero si lo reprimido se inviste con la moción inconsciente y es abandonado por la investidura prcc, queda a merced del proceso psíquico primario y apunta a la descarga motriz o a la reanimación alucinatoria de la identidad perceptiva. Los llama 'Procesos incorrectos', modos de trabajo primario del aparato, cuando ha sido librado de la inhibición. Se muestran allí desplazamientos y contaminaciones idénticos a la 'falta de atención' El lugar entonces de la atención y la conciencia (o Segundo Sistema) nos llevará a una última articulación con el 'Complemento Metapsicológico a la doctrina de los sueños'. Allí Freud estudia la creencia en la realidad del cumplimiento de deseo en el sueño, que pone en serie con algunos fenómenos alucinatorios. Este fenómeno lo llevara a proponer un dispositivo: el examen de realidad. Dirá que se trata del dispositivo que establece la diferencia entre realidad y deseo. El caso de la Psicosis Alucinatoria de Deseo, pondrá en evidencia que puede un deseo cumplido figurarse con creencia plena, como si fuese una realidad exterior. Así, podemos pensar que no ya en el sistema Inconsciente (Primer Sistema), sino en este caso en el Segundo Sistema hay un punto, un punto en el que el aparato se abre y no al mundo exterior. De modo que podemos pensar que para Freud, a la hora de formalizar su experiencia en lo que se conocerá como 'Aparato Anímico' las categorías adentro y afuera no permitirían dar cuenta de su espacialidad. Del mismo modo que los tres tiempos y su clásico ordenamiento, tampoco permiten inscribir la temporalidad con la que tal aparato revela su funcionamiento La exploración de lo no conocido (unnerkant) recorre fenómenos que plantean esta dificultad: algo es abierto y cerrado al mismo tiempo. Como un ombligo. Nos interesa subrayar que, si tenemos en cuenta las 'Notas' y el 'Complemento' esto atraviesa también el funcionamiento del segundo sistema. De modo que parece extenderse al funcionamiento del aparato y no sólo del Inconsciente. Es decir, permite pensar un aparato abierto-cerrado al mismo tiempo