<p>The aim of this study was to describe young women's experiences of midwives/ gynaecologists treatment in connection to gynaecological examination. A further aim was to achieve a better understanding of the factors that can form the basis of the experience of treatment. A qualitative study was performed in which the participants (N=10) was Swedish-speaking women aged 18-25 years, with experience of at least one gynaecological examination. Data were collected through semi-structured interviews, using an interview guide. The material was analyzed according to Graneheim and Lundman´s (2004) method for qualitative content analysis. The results were presented based on the two overarching themes that were found; <em>The importance of a confirmatory communication</em> and <em>A respectful and empathic approach</em>. The twelve underlying categories represented the factors that gave rise to the experience of treatment. Under the theme <em>The importance of a confirmatory communication</em>, the following categories were placed: Continuous dialogue, Information, Choice of words and comments, Tone of voice, Confirmation and Non-verbal communication. The theme <em>A respectful and empathic approach</em> contained the following categories: Respectful, No set of values, Empathic, Responsive/conformed, Inviting and Easy-going approach. Conclusion: Women's experiences of treatment in connection to gynaecological examination were in general described in positive terms, but with some negative elements. The results of this study indicate a need for an individualized treatment which most likely should be characterized by the attitudes mentioned above.</p> / <p>Studiens syfte var att beskriva unga kvinnors upplevelser av barnmorskors/gynekologers bemötande i samband med gynekologisk undersökning. Vidare var syftet att uppnå en ökad kunskap för de faktorer som kan ligga till grund för upplevelsen av bemötandet. Studien var av kvalitativ ansats där deltagarna (N=10) var svensktalande kvinnor i åldrarna 18-25 år, med erfarenhet av minst en gynekologisk undersökning. Den kvalitativa forskningsintervjun användes som datainsamlingsmetod, där semistrukturerade intervjuer genomfördes med hjälp av en intervjuguide. Materialet analyserades kvalitativt enligt Graneheim och Lundmans (2004) metod för innehållsanalys. Resultatet presenterades utifrån två funna övergripande teman; <em>Betydelsen av en bekräftande kommunikation </em>och <em>Ett respektfullt och empatiskt förhållningssätt. </em>De sammanlagt tolv underliggande kategorierna representerade de faktorer som låg till grund för upplevelsen av bemötandet. Under temat <em>Betydelsen av en bekräftande kommunikation </em>placerades följande kategorier: Kontinuerlig dialog, Information, Ordval och kommentarer, Tonfall, Bekräftelse samt Icke verbal kommunikation. Tema <em>Ett respektfullt och empatiskt förhållningssätt </em>utgjordes av kategorierna Respektfullt, Värderingsfritt, Empatiskt, Lyhört/anpassat, Inbjudande samt Lättsamt förhållningssätt. Slutsats: Kvinnornas upplevelser av bemötande i samband med gynekologisk undersökning beskrevs i övervägande positiva ordalag, dock med vissa negativa inslag. Studiens resultat indikerar ett behov av ett individanpassat bemötande vilket lämpligen karaktäriseras av ovan nämnda förhållningssätt.</p>

Bakgrund: Gynekologisk cancer drabbar ungefär 2800 kvinnor i Sverige varje år och är därmed bland kvinnor den näst största diagnosgruppen efter bröstcancer. Denna cancerform drabbar ett mycket privat område vilket innebär att den ofta omges av starka känslor och upplevs som svår att prata om.    Syfte: Syftet med denna studie var att beskriva kvinnors fysiska och psykosociala upplevelse av att ha överlevt gynekologisk cancer.  Metod: En litteraturstudie har gjorts utifrån granskning av åtta vetenskapliga artiklar. Via en manifest innehållsanalys har fyra huvudteman identifierats. Resultat: Att leva i en förändrad kropp: kvinnorna lever med en del kvarstående kroppsliga förändringar till följd av sjukdom och behandling. Det handlar om såväl konkreta fysiska symtom, men även om hur de här förändringarna påverkar kvinnorna, känslomässigt och psykosocialt. Ensamhet i mötet med sig själv och andra: kvinnornas upplevelse av överlevandet som en ensam process och avsaknad av stöd från närstående och sjukvård. Att skapa en ny plan för framtiden: att leva vidare efter sjukdom och behandling innebär att leva i spänningen mellan att försöka hantera det man gått igenom och söka något nytt samtidigt som man lever med en ständig oro inför framtiden. Positiv återgång till livet: sjukdomserfarenheten har inte enbart haft negativa följder utan många talar om erfarenheten som berikande och berättar om en större närvaro och uppskattning av livet.  Diskussion: Resultatet diskuteras i relation till Meleis transitionsteori samt relateras till tidigare forskning på området. Resultatet har visat att kvinnor som överlevt gynekologisk cancer är tvungna att hantera förändringar på olika nivåer och anpassa sig till livet på ett nytt sätt. Överlevandet kan beskrivas som en rörelse från ett tillstånd till ett annat, under vilken kvinnorna erfar såväl vinster som förluster. Att anpassa sig till livet efter cancer innebär att de måste lära sig att förhålla sig till och hantera de förändringar och omvandlingar de går igenom.

The aim of this study was to describe young women's experiences of midwives/ gynaecologists treatment in connection to gynaecological examination. A further aim was to achieve a better understanding of the factors that can form the basis of the experience of treatment. A qualitative study was performed in which the participants (N=10) was Swedish-speaking women aged 18-25 years, with experience of at least one gynaecological examination. Data were collected through semi-structured interviews, using an interview guide. The material was analyzed according to Graneheim and Lundman´s (2004) method for qualitative content analysis. The results were presented based on the two overarching themes that were found; The importance of a confirmatory communication and A respectful and empathic approach. The twelve underlying categories represented the factors that gave rise to the experience of treatment. Under the theme The importance of a confirmatory communication, the following categories were placed: Continuous dialogue, Information, Choice of words and comments, Tone of voice, Confirmation and Non-verbal communication. The theme A respectful and empathic approach contained the following categories: Respectful, No set of values, Empathic, Responsive/conformed, Inviting and Easy-going approach. Conclusion: Women's experiences of treatment in connection to gynaecological examination were in general described in positive terms, but with some negative elements. The results of this study indicate a need for an individualized treatment which most likely should be characterized by the attitudes mentioned above. / Studiens syfte var att beskriva unga kvinnors upplevelser av barnmorskors/gynekologers bemötande i samband med gynekologisk undersökning. Vidare var syftet att uppnå en ökad kunskap för de faktorer som kan ligga till grund för upplevelsen av bemötandet. Studien var av kvalitativ ansats där deltagarna (N=10) var svensktalande kvinnor i åldrarna 18-25 år, med erfarenhet av minst en gynekologisk undersökning. Den kvalitativa forskningsintervjun användes som datainsamlingsmetod, där semistrukturerade intervjuer genomfördes med hjälp av en intervjuguide. Materialet analyserades kvalitativt enligt Graneheim och Lundmans (2004) metod för innehållsanalys. Resultatet presenterades utifrån två funna övergripande teman; Betydelsen av en bekräftande kommunikation och Ett respektfullt och empatiskt förhållningssätt. De sammanlagt tolv underliggande kategorierna representerade de faktorer som låg till grund för upplevelsen av bemötandet. Under temat Betydelsen av en bekräftande kommunikation placerades följande kategorier: Kontinuerlig dialog, Information, Ordval och kommentarer, Tonfall, Bekräftelse samt Icke verbal kommunikation. Tema Ett respektfullt och empatiskt förhållningssätt utgjordes av kategorierna Respektfullt, Värderingsfritt, Empatiskt, Lyhört/anpassat, Inbjudande samt Lättsamt förhållningssätt. Slutsats: Kvinnornas upplevelser av bemötande i samband med gynekologisk undersökning beskrevs i övervägande positiva ordalag, dock med vissa negativa inslag. Studiens resultat indikerar ett behov av ett individanpassat bemötande vilket lämpligen karaktäriseras av ovan nämnda förhållningssätt.

Punitive gynaecology is a set of healthcare-related attitudes and practices that aim to take control of a woman's body, sexuality and reproductive system in order to produce a reformed body. This thesis scrutinizes thephenomenonofpunitivegynaecology in modernRussia.Narrativeinquirywas conducted to provide an understanding of the ways punitive gynaecology works on the female body, restructures it and inscribes meanings. Autobiographical narratives are analysed and located within a wider socio- political context to concretize the dimensions of punitive practices in gynaecology. The main foci of analysis are the medical gaze, the spatial organization of the gynaecological clinic, pastoral power and agency in the gynaecological examination, the sexuality of the examination, the contingencies of shame, pain and embarrassment. The research uses a Foucauldian framework to uncover power relations permeating the doctor-patient interaction in the gynaecological examination. This thesis thus offers a reflectiononthepreferredmodes ofembodiment anddocilitythat punitivegynaecology attempts toinstil in its' subject. Keywords: punitive gynaecology, discipline, power, gaze, agency, body, hegemonic femininity, clinic, doctor-patient interaction, docility

Symptoms after surgery and anaesthesia influence the patient´s ability to resume daily activities. If postoperative symptoms are controlled rehabilitation may be accelerated. The aims of this dissertation were to identify disturbing symptoms reported by patients after gynaecological surgery, to investigate what effect prohylactic treatment with antiemetics has on these symptoms and whether or not sensory simulation of the P6-acupressure has an effect on postoperative nausea and vomiting (PONV) and motion sickness. Methods: Total 1138 women participated in three clinical trials (Studies I, II, III) and one experimental study (Study IV). A questionnaire investigating postoperative symptoms was constructed and validated. The questionnaire was used in a prospective, consecutive, doubleblind, randomised, multicentre, and controlled study to identify incidence, and intensity of postoperative symptoms and the effect of common antiemetics (droperidol and granisetron) (Study III). The patients were followed for 24 h. In two studies (I, II) P6-acupressure was compared (prospective, double-blind, ransomised, controlled) with placebo acupressure and a reference group where the effect on PONV was followed over 24 h. The effect of P6-acupressure and placebo acupressure on motion sickness induced by a nauseogenic motion challenge was studied (Study III). Results: A high incidence and severity of postoperative symptoms were found after gynaecological surgery in a group with a high risk (&gt;30%) for PONV. Sixty-four per cent (107/165) of the patients experienced disturbing symptoms after surgery and 46 % (76/165) scored their symptoms as moderate to very severe. Fourty-eight per cent (79/165) had two or more symptoms. A higher incidence of symptoms were reported in the groups with prophylactic treatment, granisetron 74% (123/165) and droperidol 80% (133/165) compared to the control group 41% (69/165) (P &lt;0.05). The relative risk reduction for PONV with granisetron or droperidol prophylaxis is 27% respective 22%. The relative risk increase for headache is 63% after granisetron, and 44% for difficulty with accommodation after droperidol. Less PONV was seen after P6-acupressure, 33% (44/135) compared to reference group 46% (63/136) (p = 0.019), number needed to treat (NNT) was 7 [95% confidence interval (CI) 4- 6]. When comparing laparoscopic and vaginal surgery (subgroup analysis) the main effect was in the vaginal group (day-case surgery), 36% (27/75) in the reference group to 27% (23/86) in the placebo group and to 20% (17/84) in the P6-acupressure group, (P = 0.017), NNT for the vaginal group was 6 [95% CI 3-18]. P6-acupressure increased time to nausea after a laboratory motion challenge and reduced the total number of symptoms reported (p &lt;0.009). Conclusions: There is no clinical efficacy in the form of reduced postoperative symptoms after prophylactic antiemetics (droperidol and granisetron) in females with a high risk (&gt;30%) for PONV undergoing gynaecological surgery. P6-acupressure reduces the incidence of PONV after gynaecological surgery in females with a high (&gt;30%) risk for PONV. The effect seems to be most prominent after vaginal surgery. P6-acupressure increased tolerance to experimental nausogenic stimuli and reduced the total number of symptoms reported in females with a history of motion sickness. / On the day of the public defence the status of article IV was: Submitted.

Research Doctorate - Doctor of Philosophy (PhD) / Endometrial cancer is one of the most common female cancers in industrialized countries. Traditional risk factors associated with endometrial cancer are well understood and include excessive exposure to estrogen or estrogen unopposed by progesterone. However, variations in the genes that influence these hormones and their association with endometrial cancer have not been well investigated. By studying genetic variation in endometrial cancer, novel markers of risk may be discovered that can be used to identify women at high risk and for the implementation of specialised treatments. Polymorphisms in the genes involved in the following pathways; hormone biosynthesis, hormone receptors, estrogen metabolism, DNA repair and cell cycle control, have been suggested to be involved in the initiation and development of endometrial cancer. The focus of this study was to examine genetic variants in these pathways to assess the existence of an association with the risk of endometrial cancer. In the first part of this study, the COMT V158M polymorphism was examined in a hereditary non-polyposis colorectal cancer (HNPCC) cohort to determine its association with disease expression. The heterozygous genotype was over-represented in women with endometrial/ovarian cancer that did not harbour mismatch repair (MMR) gene mutations. This result suggested that the COMT V158M polymorphism may alter the risk of developing HNPCC related endometrial/ovarian cancer in MMR mutation negative women. Since COMT is involved in the metabolism of estrogen and that estrogen is the main risk factor for endometrial cancer development, closer examination was warranted to determine the association of genetic variation involved in hormone-related pathways and endometrial cancer risk, outside of the context of an inherited predisposition to disease. In the second part of this study, a cohort of 191 women with endometrial cancer and 291 healthy control women were genotyped for polymorphisms in genes involved in hormone biosynthesis, hormone receptors, estrogen metabolism, DNA repair and cell cycle control. The results revealed that variations in estrogen receptor alpha (ESR1) and beta (ESR2), and the androgen receptor (AR), were associated with an increase and decrease in endometrial cancer risk, respectively. Additionally, polymorphisms in CYP1A1, CYP1B1, GSTM1 and GSTP1 were related to a decrease in endometrial cancer risk. A trend was observed for the cyclin D1 870 G>A polymorphism and an increase in endometrial cancer risk, however, this result did not reach significance. Taken together, these results revealed that perturbations in the hormone receptors and estrogen metabolism genes, may aid in the identification of women at high risk of developing endometrial cancer. Interestingly, stratification of the women with endometrial cancer revealed that combinations of polymorphisms in TP53 and MDM2 were associated with higher grades of cancer. This finding may possibly have significant implications as women with reduced apoptotic ability, due to combinations of polymorphisms in these genes, have an increased risk of presenting with higher grades of endometrial cancer, that are associated with lower survival rates. In summary, the results of this thesis showed that variation in the estrogen and androgen receptors, and estrogen metabolism genes, may alter the risk of developing endometrial cancer. Moreover, polymorphisms in the cell cycle control genes, TP53 and MDM2, appear to be associated with higher grades of endometrial cancer. This study of polymorphisms may help explain genetic differences in individual susceptibility to endometrial cancer and are markers of risk that aid in the development of effective and personalised strategies to prevent disease development. This study has improved the understanding of genetic variation associated with endometrial cancer risk. It has the potential to enhance our ability to treat women with endometrial cancer through improved identification and treatment strategies, by virtue of the genetic variation identified, that appears to predispose to disease.

Background: Irritable bowel syndrome (IBS) is an extremely common condition affecting approximately 10-15% of the population. Lower abdominal pain is a common feature and, if the patient also has gynaecological symptoms such as heavy periods, they may be referred to a gynaecologist especially when the bowel symptoms are relatively mild. In this setting a laparoscopy is often undertaken and endometriosis commonly identified as this condition affects up to 10% of women. Consequently pain is frequently attributed to the endometriosis even when it is relatively mild. However it is a common observation amongst gynaecologists that women with mild endometriosis often have severe symptoms which do not seem to respond well to treatment. This raises the possibility that their pain may not actually be due to endometriosis or is being amplified by the visceral hypersensitivity which is a characteristic feature of irritable bowel syndrome.Methods: 20 patients with minimal-mild endometriosis, 20 with moderate-severe endometriosis, 20 healthy volunteers (HV) who have had laparoscopy for sterilisation, 20 IBS patients and 20 patients with pain who were found to have a normal pelvis (on laparoscopy) were studied. Gastrointestinal, gynaecological, and noncolonic symptoms were recorded as well as demography, quality of life and psychological status. Visceral sensitivity was assessed in all patients and abdominal distension was studied in a sub group of 26 endometriosis patients and 20 IBS patients.Results: 20 (100%) of IBS patients, 13 (65%) of minimal-mild endometriosis patients, 11 (55%) of moderate-severe endometriosis patients, 17 (85%) of laparoscopic negative pain patients and no healthy volunteers fulfilled ROME III criteria for IBS. Patients with endometriosis and IBS had similar levels of visceral sensitivity which were significantly lower than that observed in controls (p=0·002, p<0·001).In particular, both minimal-mild and moderate-severe endometriosis patients had significantly lower (mean-95% CI) pain thresholds in mmHg 28.1(24.5, 31.6) and 28.8(24.9, 32.6) respectively compared with controls 39·5 (36·0, 43·0) p=0.001and p=0.002. However, with few exceptions, there were no distinguishing features between patients in terms of demography, symptomatology and distension.Conclusion: Clinically, it is very difficult to distinguish between endometriosis and IBS. However, visceral hypersensitivity appears to be a major component of endometriosis and may explain the problem of excessive pain especially in patients with mild disease offering a potential new target for treatment

Introduction: Effusion cytology can be performed for the purpose of diagnosis, treatment, and prognosis of malignant disease. A common analysis of effusion cytology samples is the May Grunwald Giemsa stain.    Aim: The aim of the study was to compare May Grunwald Giemsa stain and May Grunwald Giemsa Quick Stain in order to determine the best quality stain and suggest ways to improve the current staining protocol.     Materials and Methods: The methods used in this study are the routine laboratory’s standard procedures for  May-Grunwald Giemsa stain and May-Grunwald Giemsa Quick Stain but with adapted washing steps that investigates the effect of tap water, distilled water, and phosphate buffer on stain quality. Two pleural effusion samples were stained in the initial experiment and two pleural effusions and one ascites sample in the second experiment.    Results and Conclusion: All samples gave a greater score when stained with May-Grunwald Giemsa Quick Stain compared to traditional May-Grunwald Giemsa stain. For the traditional May-Grunwald Giemsa, the use of any of the three phosphate buffers scores higher than the routine washing where tap water is used. In conclusion, it would be of benefit to further investigate and implement phosphate buffer in traditional staining or proceed with the May-Grunwald Quick Stain for all pleural and ascites effusions.

Analisamos uma coorte de mulheres no sul do Brasil, com objetivo de identificar associações epidemiológicas para persistência e cura da infecção pelo HPV e realizamos uma metanálise para determinar a acurácia da telomerase nas lesões precursoras do câncer cervical. Métodos: O estudo de coorte foi iniciado em fevereiro de 2003. Foram coletados espécimes cervicais para citologia oncótica e para detecção do DNA HPV na entrada do estudo e no seguimento. O desfecho foi dividido em quatro categorias: (1) persistência, (2) conversão (3) cura. A quarta categoria (referência) eram mulheres negativas no início que permaneceram negativas. Foram usados o teste χ2 de Pearson, regressão logística multinomial e Kaplan- Meier para análise estatística. Para a metanálise foram incluídos estudos que comparavam o teste de telomerase (TRAP) e anatomopatológicos, obtidos por biópsias cervicais para diagnóstico de lesões cervicais. Resultados: A Incidência de HPV foi 12,3%. O HPV16 foi o tipo mais encontrado (18,6%), entre as 501 mulheres do estudo.Trinta e quatro mulheres (6,78%) ficaram persistentemente infectadas pelo HPV, estando essa categoria associada à idade da sexarca inferior a 21 anos (OR = 3,14, IC 95%, 1,43-6,87) e a quatro ou mais parceiros durante a vida (OR = 2,48 IC 95%, 1,14-5,41). No período mediano de 19 meses, 80,7 % das mulheres tinham curado o HPV, a cura foi significativamente associado à cor preta (OR= 3,44 IC 95%, 1,55-7,65), co-infecção com C. trachomatis no arrolamento (OR= 3,26, IC 95%, 1,85-5,76) e história de já ter realizado exame de Papanicolaou (OR= 3,48, IC 95%, 1,51- 8,00). Na metanálise dez estudos foram analisados, os quais incluíram 1069 mulheres. Para lesões intraepiteliais de baixo grau (LIEBG) vs. normal ou lesões benignas, encontrou-se uma positividade do teste da telomerase, sendo que o resultado da odds ratio para diagnóstico (DOR) foi de (DOR = 3,2, IC 95%,1,9-5,6). Nas lesões intraepiteliais de alto grau (LIEAG) vs LIEBG, normal ou benigna: (DOR = 5,8, IC 95%, 3.1-10). )]. Encontrou-se uma DORelevada de 8,1 (IC 95%: 3,2-20) nas lesões de câncer cervical vs LIEAG. Da mesma forma, nas lesões de câncer cervical vs. LIEBG, a razão de chance foi elevada, com uma DOR de 40,9 (IC 95%: 18,2-91). Conclusões: A persistência da infecção pelo HPV foi associada com a sexarca precoce e ao número de parceiros sexuais na vida, sugerindo que estratégias de orientação sexual podem modificar as taxas de persistência do HPV. A associação da cura do HPV com história prévia de realização de Papanicolaou salienta a importância de aprimorar os programas de rastreamento de câncer cervical. Futuros estudos da associação de infecções ginecológicas com cura da infecção pelo HPV são necessários. Na metanálise nossos dados suportam a corrente hipótese da atividade da telomerase como um evento precoce na carcinogênese e que poderia estar associado ao início e à progressão de lesões cervicais. / We analysed a cohort of women in Southern Brazil with the aim to identify epidemiological correlates for persistence and clearance of cervical HPV infection. A quantitative systematic review was performed to estimate the accuracy of telomerase assay in cervical lesions. Methods: A cohort study was started on February 2003. Cervical smears were collected to perform Pap cytology and HPV DNA detection at baseline and during the follow up. The outcome was constructed in four categories (1) persistence of HPV DNA; (2) conversion; (3) clearance of HPV. Pearson’s χ2 test, multinomial logistic regression and univariate analysis using the log-rank test were performed. Meta-analysis studies that evaluated the telomerase test (telomerase repeated amplification protocol) for the diagnosis of cervix lesions and compared it to paraffin-embedded sections as the diagnostic standard were included. Results: Incidence of HPV DNA: 12.3%. HPV16 was the most frequent type (18.6%) among 501 women in the study. Thirty-four women were persistently infected with HPV, which was associated with age below 21 years at first intercourse (OR 3.14, 95% CI, 1.43-6.87) and ≥ 4 sexual partners during lifetime (OR 2.48, 95% CI, 1.14-5.41). In a median period of 19 months, 80.7% of women had clearance of HPV, which was associated with black race (OR 3.44, 95% CI, 1.55-7.65), co-infection with C. trachomatis at baseline (OR 3.26, 95% CI, 1.85-5.76) and history of previous Pap smear (OR 3.48, 95% CI, 1.51-8.00). In meta-analysis ten studies were analyzed, which included 1,069 women. The diagnostic odds ratio (DOR) for a positive telomerase test for Lo-SIL vs. normal or benign lesions was 3.2 (95% CI, 1.9-5.6). The DOR for a positive telomerase test for Hi-SIL vs. Lo-SIL, normal or benign lesions was 5.8 (95% CI, 3.1-10). For cervix cancer vs. Hi-SIL, the DOR for a positive telomerase test was 8.1 (95% CI, 3.2-20.3) and for cervix cancer vs. Lo-SIL, normal or benign lesions, it was 40.9 (95% CI, 18.2-91). Conclusions: Persistence of HPV infection wasassociated with early age at first intercourse and number of sexual partners during lifetime, suggesting that strategies for sexual orientation may modify the rates of HPV persistence. The association of HPV clearance with a history of previous Pap smear screening highlights the importance of improving cervical screening programs. Further studies on the association of gynaecological infections with HPV clearance are needed. In meta-analysis our data support the current hypothesis that telomerase may activate an early event in cervical carcinogenesis, that could be associated with the initiation and progression of cervical lesions.

Analisamos uma coorte de mulheres no sul do Brasil, com objetivo de identificar associações epidemiológicas para persistência e cura da infecção pelo HPV e realizamos uma metanálise para determinar a acurácia da telomerase nas lesões precursoras do câncer cervical. Métodos: O estudo de coorte foi iniciado em fevereiro de 2003. Foram coletados espécimes cervicais para citologia oncótica e para detecção do DNA HPV na entrada do estudo e no seguimento. O desfecho foi dividido em quatro categorias: (1) persistência, (2) conversão (3) cura. A quarta categoria (referência) eram mulheres negativas no início que permaneceram negativas. Foram usados o teste χ2 de Pearson, regressão logística multinomial e Kaplan- Meier para análise estatística. Para a metanálise foram incluídos estudos que comparavam o teste de telomerase (TRAP) e anatomopatológicos, obtidos por biópsias cervicais para diagnóstico de lesões cervicais. Resultados: A Incidência de HPV foi 12,3%. O HPV16 foi o tipo mais encontrado (18,6%), entre as 501 mulheres do estudo.Trinta e quatro mulheres (6,78%) ficaram persistentemente infectadas pelo HPV, estando essa categoria associada à idade da sexarca inferior a 21 anos (OR = 3,14, IC 95%, 1,43-6,87) e a quatro ou mais parceiros durante a vida (OR = 2,48 IC 95%, 1,14-5,41). No período mediano de 19 meses, 80,7 % das mulheres tinham curado o HPV, a cura foi significativamente associado à cor preta (OR= 3,44 IC 95%, 1,55-7,65), co-infecção com C. trachomatis no arrolamento (OR= 3,26, IC 95%, 1,85-5,76) e história de já ter realizado exame de Papanicolaou (OR= 3,48, IC 95%, 1,51- 8,00). Na metanálise dez estudos foram analisados, os quais incluíram 1069 mulheres. Para lesões intraepiteliais de baixo grau (LIEBG) vs. normal ou lesões benignas, encontrou-se uma positividade do teste da telomerase, sendo que o resultado da odds ratio para diagnóstico (DOR) foi de (DOR = 3,2, IC 95%,1,9-5,6). Nas lesões intraepiteliais de alto grau (LIEAG) vs LIEBG, normal ou benigna: (DOR = 5,8, IC 95%, 3.1-10). )]. Encontrou-se uma DORelevada de 8,1 (IC 95%: 3,2-20) nas lesões de câncer cervical vs LIEAG. Da mesma forma, nas lesões de câncer cervical vs. LIEBG, a razão de chance foi elevada, com uma DOR de 40,9 (IC 95%: 18,2-91). Conclusões: A persistência da infecção pelo HPV foi associada com a sexarca precoce e ao número de parceiros sexuais na vida, sugerindo que estratégias de orientação sexual podem modificar as taxas de persistência do HPV. A associação da cura do HPV com história prévia de realização de Papanicolaou salienta a importância de aprimorar os programas de rastreamento de câncer cervical. Futuros estudos da associação de infecções ginecológicas com cura da infecção pelo HPV são necessários. Na metanálise nossos dados suportam a corrente hipótese da atividade da telomerase como um evento precoce na carcinogênese e que poderia estar associado ao início e à progressão de lesões cervicais. / We analysed a cohort of women in Southern Brazil with the aim to identify epidemiological correlates for persistence and clearance of cervical HPV infection. A quantitative systematic review was performed to estimate the accuracy of telomerase assay in cervical lesions. Methods: A cohort study was started on February 2003. Cervical smears were collected to perform Pap cytology and HPV DNA detection at baseline and during the follow up. The outcome was constructed in four categories (1) persistence of HPV DNA; (2) conversion; (3) clearance of HPV. Pearson’s χ2 test, multinomial logistic regression and univariate analysis using the log-rank test were performed. Meta-analysis studies that evaluated the telomerase test (telomerase repeated amplification protocol) for the diagnosis of cervix lesions and compared it to paraffin-embedded sections as the diagnostic standard were included. Results: Incidence of HPV DNA: 12.3%. HPV16 was the most frequent type (18.6%) among 501 women in the study. Thirty-four women were persistently infected with HPV, which was associated with age below 21 years at first intercourse (OR 3.14, 95% CI, 1.43-6.87) and ≥ 4 sexual partners during lifetime (OR 2.48, 95% CI, 1.14-5.41). In a median period of 19 months, 80.7% of women had clearance of HPV, which was associated with black race (OR 3.44, 95% CI, 1.55-7.65), co-infection with C. trachomatis at baseline (OR 3.26, 95% CI, 1.85-5.76) and history of previous Pap smear (OR 3.48, 95% CI, 1.51-8.00). In meta-analysis ten studies were analyzed, which included 1,069 women. The diagnostic odds ratio (DOR) for a positive telomerase test for Lo-SIL vs. normal or benign lesions was 3.2 (95% CI, 1.9-5.6). The DOR for a positive telomerase test for Hi-SIL vs. Lo-SIL, normal or benign lesions was 5.8 (95% CI, 3.1-10). For cervix cancer vs. Hi-SIL, the DOR for a positive telomerase test was 8.1 (95% CI, 3.2-20.3) and for cervix cancer vs. Lo-SIL, normal or benign lesions, it was 40.9 (95% CI, 18.2-91). Conclusions: Persistence of HPV infection wasassociated with early age at first intercourse and number of sexual partners during lifetime, suggesting that strategies for sexual orientation may modify the rates of HPV persistence. The association of HPV clearance with a history of previous Pap smear screening highlights the importance of improving cervical screening programs. Further studies on the association of gynaecological infections with HPV clearance are needed. In meta-analysis our data support the current hypothesis that telomerase may activate an early event in cervical carcinogenesis, that could be associated with the initiation and progression of cervical lesions.