K. Barnhart et al., Distribution of topical medication in the human vagina as imaged by magnetic resonance imaging, FERT STERIL, 76(1), 2001, pp. 189-195
Objective: To assess the use of magnetic resonance imaging (MRI) to determi
ne the varying distribution of a vaginally placed gel over time and with di
fferent levels of patient activity.
Design: Prospectives interventional trial.
Setting: University medical center.
Patient(s): One nulliparous volunteer with normal menstrual cycles and no g
ynecologic disease who underwent seven MRI scans of the pelvis. Interventio
n(s): Five mt of a commercially available topical spermicide was mixed with
gadolinium-chelate magnetic resonance contrast material and introduced wit
h a standard applicator. T1-weighted three-dimensional MRI was done to asse
ss the distribution of the gel.
Main Outcome Measure(s): Gel thickness and distribution.
Result(s): The initial bolus of gel was delivered into the upper portion of
the vagina, above the urogenital diaphragm. Thereafter, it spread into the
vaginal fornices and "flattened" to cover the lateral aspects of the vagin
a. Without ambulation, the majority of spread was confined to the upper vag
ina. With ambulation and longer elapsed time, the gel spread further in the
upper vagina and into the lower vagina, and significant vaginal surface co
verage increased significantly.
Conclusion(s): Magnetic resonance imaging can be used to monitor the spread
of vaginally placed products and to evaluate coverage of topical drugs use
d for prevention and treatment, including those used for HIV prophylaxis.