Reproductive tract infections (RTI) are associated with adverse outcomes in pregnant African women. However, many diagnostic strategies are unaffordable or perform poorly. Here, we assess RTI prevalence and predictors of chlamydia/gonorrhea (CT/NG) in pregnant women reporting vaginal discharge and the performance of our previously published CT/NG risk algorithm in this population versus Rwandan National Guidelines (RNG). From 2017-2020, free sexually transmitted infections (STI) services were provided to residents in Kigali, Rwanda. Medical history and gynecologic examination were done. Laboratory assessments included HIV; syphilis; microscopy for trichomoniasis, bacterial vaginosis (BV), and candida; and PCR for CT/NG. Eighty-seven pregnant women received STI services. Prevalence was 28% for CT/NG, 15% for trichomoniasis, 24% for BV, 39% for candida, and 79% for any RTI. Predictors of CT/NG were age <=25 (adjusted prevalence odds ratio [aPOR]=4.92; 95% confidence interval [CI]: 1.52-15.90; p=0.008), inconsistent condom use (aPOR=4.86; 95%CI: 0.98-24.10; p=0.053), absence of candida (aPOR=4.23; 95%CI: 1.13-15.82; p=0.032), and endocervical inflammation/discharge (aPOR=4.91; 95%CI: 1.40-17.20; p=0.013). Our algorithm outperformed the 2019 and 2024 RNG (sensitivity: 92% versus 46% and 35% respectively). Pregnant women seeking STI services had high RTI prevalence. Our algorithm performed well. Algorithms tailored for pregnant women and including male partner risk factors should be explored.

Gynaecological disorders, including abnormal vaginal discharge, vulvovaginal infections and chronic vulvovaginal inflammation, are common clinical problems for which locally acting therapies are particularly relevant. Triphala, a classical polyherbal formulation composed of Terminalia chebula, Terminalia bellirica and Phyllanthus emblica, has been traditionally used for mucosal and gynaecological conditions and is supported by experimental evidence suggesting antimicrobial, anti-inflammatory, antioxidant and wound-healing activities. This structured narrative review aimed at synthesising and critically evaluating the available evidence on the topical use of Triphala in gynaecological disorders, with an emphasis on pharmacological mechanisms, formulation strategies and reported clinical applications. Literature searches were conducted in PubMed, Scopus, Google Scholar and selected traditional medicine databases to identify English-language publications published between 2011 and December 2025. Experimental studies, clinical trials, and observational or clinical reports describing topical or locally applied Triphala formulations in gynaecological conditions or mechanistically relevant models were considered for qualitative synthesis. The reviewed literature suggests that Triphala-based topical formulations, including vaginal washes, intravaginal pessaries, tampon-based applications, medicated ghee preparations and semi-solid gels, may exhibit antimicrobial, anti-inflammatory, antioxidant and wound-healing properties at the vulvovaginal and cervical epithelium through modulation of inflammatory pathways, reduction of microbial burden, protection against oxidative stress and support of epithelial repair processes. However, the currently available evidence remains limited and heterogeneous, and further well-designed clinical investigations are required to clarify the therapeutic potential, safety and clinical applicability of Triphala as a topical botanical intervention in gynaecological practice.

Genital prolapse is very rare in neonates. In neonates affected by spina bifida, genital prolapse can occur due to improper nerve supply to the pelvic diaphragm. When genital prolapse occurs in neonates, it can be associated with severe morbidity as time goes on, since inflammation and infection can develop. This study reports a 3-day-old female neonate who presented with genital prolapse associated with meningomyelocele, which was successfully treated with bottle nipple support left for 5 days after digital reduction and surgical repair of the meningomyelocele. Type one genital prolapse in neonates can be successfully treated with surgical meningomyelocele repair, digital reduction of the prolapse, and leaving a bottle nipple in the vaginal canal. However, given that the meningomyelocele repair was performed shortly before reduction and that spontaneous resolution after spinal repair has been reported, the success of bottle nipple device use can be associative rather than causal. After leaving a bottle nipple in the vaginal canal, the following precautions should be taken to decrease the risk of vaginitis. A new bottle nipple, which has never been previously used for feeding, should be used, and the bottle nipple insertion should be done using sterile gloves. The perineal area should be cleaned with sterile saline during routine diaper changes. Last but not least, the genital area should be closely inspected for any change of color, swelling, discharge, or expulsion of the bottle nipple.

Vesicovaginal fistula (VVF) after radiotherapy is a serious complication that occurs after radiotherapy for pelvic malignant tumors. Traditional nephrostomy greatly affects patients' quality of life, restricting their daily activities. It may also cause side injuries and bleeding due to large surgical trauma, which made the widespread adoption of this surgery method difficult. This article aims to explore the application of bulbospongiosus muscle flap packing combined with vaginal closure in complex VVF after radiotherapy. We presented a case where a patient with stage IIIB cervical squamous cell carcinoma developed abnormal vaginal discharge two years after full-dose chemoradiotherapy. The patient was diagnosed with VVF and conservative treatment was ineffective. After the assessment of no tumor recurrence, repair using bulbospongiosus muscle flap tamponade combined with vaginal closure was performed. The surgeries were successfully completed. The operation time was 96 min and the bleeding volume was 69 mL. The catheter was retained for two weeks after operation. The patient was followed up for 18 months after the operation. There was no vaginal discharge; the bladder mucosa was well repaired; the bladder capacity was about 300 mL; there were no symptoms of frequent urination and urgent urination; and there was no hydronephrosis of the renal pelvis. Vaginal packing with bulbospongiosus muscle flap combined with vaginal sealing can be used as a repair technique for complex fistulas in the perineal region. This is a surgical method that is convenient for obtaining materials, simple to operate, minimally invasive, and delivers clear therapeutic results.

Current practice guidelines for postpartum pain management lack specific recommendations for opioid prescribing after vaginal births or vaginal births with associated procedures such as operative vaginal birth (ie, forceps, vacuum-assisted birth) and repair of third- or fourth-degree lacerations. This study used adjusted logistic regression models to assess between-hospital variation in opioid prescribing rates and prescription amounts in oral morphine equivalents (OMEs) for vaginal births with associated procedures. We performed a retrospective cohort study across 67 hospitals of 14,690 opioid-naive, nulliparous patients with term births, of whom 7.2% (n=1,053) had operative vaginal births and 4.9% (n=724) had third- or fourth-degree lacerations. In total, 1.8% of patients (n=269) received an opioid prescription, with a median amount of 60 OMEs (IQR 37.5-75). Prescription rate was higher for third- or fourth-degree laceration (11.6%), and prescription amount was highest for operative birth (75 OMEs, IQR 45-90 OMEs). At a hospital level, the largest range of proportion of patients receiving discharge opioid prescriptions was for third- or fourth-degree lacerations (0-66.7%) and the largest amount was for operative birth (25-135 OMEs). Opioid prescribing after vaginal births with associated procedures is higher than for routine vaginal birth and marked by variation among hospitals, highlighting an opportunity for standardization.

Uterine fibroids are among the most common benign tumors affecting women, with a prevalence reaching up to 50-60% in those over 40 years of age, although often underestimated due to asymptomatic cases. Radiofrequency ablation (RFA) represents a minimally invasive alternative to surgery for selected patients. We report the case of a 41-year-old woman with symptomatic uterine fibroids (FIGO type 4, size of 5 cm) treated with transvaginal RFA. One month post- treatment, the fibroid showed partial volume reduction. Two months after the procedure, the patient presented with foul-smelling discharge and heavy bleeding. Ultrasound confirmed complete fibroid migration into the cervical canal. Vaginal removal was performed without complications. Fibroid expulsion after RFA is a rare event that may represent either a complication or a therapeutic outcome. A balanced interpretation and appropriate clinical management are required. Further studies are needed to clarify its clinical significance.