Longitudinal vaginal septum is an uncommon Müllerian developmental anomaly caused by incomplete fusion or resorption of the Müllerian ducts. It is frequently associated with uterine malformations, whereas isolated forms are rare. Clinical presentation ranges from asymptomatic findings to dyspareunia, dysmenorrhea, infertility, or obstetric complications. Diagnosis is usually made during adolescence or reproductive evaluation and is unusual after prior vaginal delivery. A 36-year-old woman with one previous spontaneous vaginal delivery presented with dyspareunia. Pelvic examination revealed a thick longitudinal vaginal septum protruding externally beyond the vulvar introitus. The septum extended from the cervix to the lower third of the vagina and measured more than 2 cm in thickness. A single cervix was identified. Imaging studies excluded associated uterine or urinary tract anomalies, confirming an isolated longitudinal vaginal septum. The patient underwent office-based vaginoscopic resection using a 5-mm bipolar energy device. The septum was coagulated and excised under direct visualization without intraoperative complications. At 6-month follow-up, vaginal anatomy was normal, with no stenosis or residual tissue. The patient reported complete resolution of dyspareunia and satisfactory sexual function. This case highlights the possibility of late diagnosis of isolated longitudinal vaginal septum even after vaginal childbirth and supports minimally invasive office vaginoscopic management as a safe and effective therapeutic approach.

High-tone pelvic floor dysfunction (HTPFD) affects a substantial proportion of women with chronic pelvic pain and is characterized by hypertonic musculature, myofascial tenderness, dyspareunia, and urinary and defecatory symptoms. Although pelvic floor physical therapy (PFPT) is the first-line treatment, access is severely limited: only 2.47% of U.S. zip codes have even one trained pelvic floor physical therapist, and completion rates at some referral centers are as low as 20%. Existing telehealth and home biofeedback tools support muscle-strengthening exercises but cannot guide patients to therapist-defined myofascial trigger points or objectively verify that therapeutic depth, rotational orientation, and force are reproduced during home-based treatment-capabilities essential for HTPFD management. We developed the SmartWand, a Bluetooth-enabled intravaginal device that quantifies insertion depth (cm), rotational orientation (degrees), and applied force (kg/cm²) and pairs with a smartphone application to deliver real-time, multimodal guidance. Using a two-phase workflow, a pelvic floor physical therapist first programs patient-specific trigger-point coordinates during an in-clinic session; the patient then independently reproduces those coordinates at home with on-screen directional feedback, auditory confirmation, and haptic cues. In this prospective validation study, 20 adult women-10 with HTPFD and 10 healthy controls-underwent therapist-guided pelvic floor mapping at eight anatomical sites followed by blinded, independent coordinate reproduction. Inter-rater reliability between therapist-programmed and participant-reproduced measurements was assessed using intraclass correlation coefficients (ICC) from two-way mixed-effects models with subject-specific random intercepts to account for repeated within-subject measures. The SmartWand demonstrated excellent agreement for insertion depth (ICC 0.98; 95% CI 0.971-0.986) and rotational orientation (ICC 0.999; 95% CI 0.998-0.999), and good agreement for applied force (ICC 0.877; 95% CI 0.82-0.916). All ICC values surpassed the prespecified success threshold of 0.65. Critically, reliability was consistent across both participant groups, indicating that the hypertonic musculature and myofascial tenderness characteristic of HTPFD did not impair measurement reproducibility. These findings establish proof-of-concept that patients can independently perform technique-specific internal myofascial release-previously considered feasible only under direct therapist supervision-with objective, quantitative verification of accuracy. The SmartWand system represents a meaningful technological advance over existing home biofeedback platforms by enabling therapist-programmed spatial targeting and calibrated force delivery at patient-specific trigger points. By digitizing treatment parameters and generating objective adherence data, this technology has the potential to expand guideline-concordant PFPT to the millions of women with HTPFD who currently cannot access or complete in-person care, and to support standardized dosing and longitudinal monitoring in future hybrid telehealth care models. Randomized controlled trials comparing SmartWand-augmented hybrid PFPT to standard in-person therapy are warranted to establish clinical efficacy.

Vaginal atrophy is a common condition in postmenopausal women, frequently associated with vaginal symptoms and alterations of the vaginal microbiota. This randomized study evaluated the clinical and microbiological effects of vaginal CO2 laser therapy administered alone or in combination with an oral probiotic containing L. crispatus M247 in postmenopausal women with vulvovaginal atrophy. Women were randomized (2:1) to receive vaginal laser therapy alone (laser-only group) or laser therapy plus oral probiotic for 90 days (probiotic plus laser group). Clinical efficacy was assessed through a prespecified panel of outcomes, including vaginal pH and symptom severity assessed by Visual Analogue Scale (VAS), at baseline and during follow-up up to 90 days, with Day 90 representing the main efficacy timepoint. Vaginal microbiota composition was analyzed in a subset of participants. Both groups showed improvement over time in vaginal pH and VAS scores for vaginal dryness, dyspareunia, burning, itching, and introital pain. Compared with laser alone, the probiotic plus laser group showed lower symptom scores at Day 90 in selected clinical domains, with effect estimates generally favoring the probiotic plus laser group, although confidence intervals were relatively wide for some endpoints. P-values for individual outcomes should be interpreted as nominal in the absence of prespecified multiplicity adjustment across clinical domains. For vaginal pH, both groups showed a decrease over time, but the group × time interaction was not statistically significant, indicating no clear differential temporal response. Microbiota analysis showed an increase in the relative abundance of L. crispatus and a concomitant decrease in L. iners only in the probiotic plus laser group, suggesting a shift toward a more favorable vaginal microbial profile. Overall, vaginal CO2 laser therapy was associated with clinical improvement, and adjunctive treatment with L. crispatus M247 was associated with additional benefits across selected clinical and microbiological outcomes; however, confidence intervals for several clinical estimates were relatively wide, supporting cautious interpretation and confirmation in larger blinded studies.

This review explores the use of local vaginal estrogen therapy for managing genitourinary syndrome of menopause by survivors of hormone-sensitive breast and gynaecological cancer, emphasizing its role in improving quality of life and alleviating symptoms such as vaginal dryness, dyspareunia and recurrent urinary tract infections. Treatments for hormone-sensitive cancers often cause sudden menopause, and prolonged use of endocrine therapies can worsen the symptoms of genitourinary syndrome of menopause. The syndrome is frequently under-recognized and inadequately managed, and women should be screened and educated about symptoms and treatment options, especially survivors of breast and gynaecological cancer. Shared decision-making is central to managing genitourinary syndrome of menopause in hormone-sensitive cancers, as options balance the side-effects of cancer treatments and endocrine therapies against quality of life. While nonhormonal therapies are recommended as first-line treatment, if ineffective, low-dose vaginal estrogen provides significant symptom relief and efficacy in easing genitourinary symptoms and reducing urinary tract infections with minimal systemic absorption. While caution has traditionally been suggested in estrogen-sensitive cancers, the use of vaginal estrogen therapy by women with breast cancer receiving endocrine therapy with tamoxifen or aromatase inhibitors and by women with hormone-sensitive gynaecological cancers is discussed. Interpreting safety data-especially for hormone-sensitive cancers-requires careful, individualized decision-making in collaboration with oncology teams. Individualized care is essential to balance symptom relief, patient safety and compliance with treatments, optimizing outcomes and quality of life for these patients. The paper highlights the need for additional research on long-term safety and efficacy across cancer subtypes to improve personalised care.

Episiotomy was traditionally performed routinely during vaginal delivery to prevent severe obstetric anal sphincter injuries and to shorten the second stage of labor, with the aim of improving neonatal outcomes. However, accumulating evidence has challenged these benefits. Its adverse consequences, including hemorrhagic, urinary, and infectious complications, as well as dyspareunia and psychological disorders, have prompted scientific societies to recommend a restrictive policy. Despite this consensus, clinical practices remain heterogeneous, and the potential role of episiotomy in specific situations is still being debated. This review examines the current place of episiotomy in light of recent evidence and international guidelines.