Persistent infection with high-risk human papillomavirus (HR-HPV) is the primary etiological factor for cervical intraepithelial neoplasia grade 2 (CIN 2). The accuracy of CIN 2 diagnosis is affected by the limitations of colposcopic biopsy and the variability in pathological interpretation. Underdiagnosis or overdiagnosis may lead to missed detection of more severe lesions or overtreatment. Particularly for young women and those with fertility requirement, overtreatment can increase the risk of adverse pregnancy outcomes in the future. Based on evidence-based medicine and China's national conditions, this consensus proposes refined management strategies for the CIN 2 women. Comprehensive consideration of multiple factors (including age, fertility needs, and lesion characteristics, etc) is required, for low-risk individuals eligible for conservative observation, close monitoring and dynamic assessment should be implemented. For high-risk individuals ineligible for conservative observation, it is recommended to undergo excisional treatment to reduce the risk of missed diagnosis and disease progression. For special populations of CIN 2: follow-up is the mainstay for pregnant women, with reassessment post-delivery; excisional treatment is preferred for postmenopausal women; and immunocompromised women require individualized assessment, enhanced monitoring, or active treatment.

随着子宫颈癌筛查策略的优化，子宫颈鳞状上皮内病变，尤其是高级别鳞状上皮内病变（HSIL）的检出率显著上升，其临床管理面临治疗与保护生育功能的双重挑战。子宫颈切除性治疗和消融治疗虽能有效清除病灶，但不同程度的会增加术后流产、早产、子宫颈管狭窄等风险，影响生育结局。光动力治疗（PDT）作为一种非切除性、无创的治疗手段，通过选择性破坏病变细胞并清除高危型人乳头瘤病毒，实现清除病灶的同时，能最大限度地保留子宫颈正常结构和功能，为有生育需求的女性提供新的治疗选择。本共识基于现有循证医学证据，系统阐述了PDT的作用机制、不同光敏剂的应用特点、操作规范及适应证，旨在为不同级别子宫颈鳞状上皮内病变的临床规范化治疗提供指导。

高危型人乳头瘤病毒（HR-HPV）持续感染是导致子宫颈癌的主要病因，近年来，HPV核酸检测已逐渐成为子宫颈癌筛查的重要手段。随着对HPV基因型分布的深入研究和检测技术的不断进步，HR-HPV DNA载量(HR-HPV载量）作为一种反映疾病风险的重要指标，逐渐受到关注。当前研究显示，HR-HPV载量与病变的严重程度存在一定的相关性，同时，不同的检测技术也为其临床应用提供了多样化的选择。如何有效地基于HR-HPV载量进行风险分层和管理仍然面临诸多挑战,本专家共识阐述了HR-HPV载量与子宫颈上皮内病变和子宫颈癌的关系、HR-HPV载量的检测方法以及HR-HPV载量检测的临床应用，根据HR-HPV载量情况在子宫颈癌筛查和分流等方面提出推荐意见。

Objective By comparing the latency and amplitude differences of sacral nerve magnetic stimulation evoked potentials between patients with pelvic organ prolapse (POP) and those without POP, this study aims to investigate whether pelvic floor nerve conduction dysfunction exists in patients with POP. Methods Fifty-five patients with POP who visited Peking University People's Hospital from October 2024 to January 2025 (POP group) and 52 patients with non-POP who visited due to benign diseases during the same period (control group) were selected. Both groups of patients underwent sacral nerve magnetic stimulation motor evoked potential examination. The differences in latency and amplitude of motor evoked potentials between the two groups were compared, and the influencing factors of motor evoked potentials in patients with pelvic floor organ prolapse were analyzed. Results Compared with the control group, the latency of the sacral nerve magnetic stimulation motor evoked potential in the POP group was significantly prolonged [(7.50±3.49) ms, (5.11±3.49) ms; P<0.001], and there was no significant difference in wave amplitude between the two groups [(69.55±33.21) uV, (76.70±33.21) uV, P=0.339]; The weakening of pelvic floor muscle strength was significantly correlated with the prolonged latency of magnetic stimulation motor evoked potentials (P=0.014). Conclusions Patients with POP have significantly slower latency of motor evoked potentials induced by sacral nerve magnetic stimulation compared to POP patients, suggesting that POP patients may have pelvic nerve damage. This examination is expected to become a non-invasive electrophysiological indicator for evaluating pelvic nerve function of POP patients.

Objective To investigate the clinical therapeutic effects of progressive step training combined with neuromuscular electrical stimulation (NMES) on postpartum patients with diastasis recti abdominis (DRA). Methods A total of 100 patients with DRA were prospectively enrolled and randomly assigned into two groups using a randomly divided into the control group (NMES only) and the observation group (NMES combined with progressive stepwise training), with 50 patients in each group. The treatment period lasted 5 weeks. Changes in inter-rectus distance (IRD), abdominal muscle strength, and lower back pain (assessed by VAS score) were compared before and after treatment. Results The total effective rate in the observation group was 97.9%, significantly higher than that in the control group (89.8%, P<0.01). Both groups showed significant post-treatment improvements in inter-rectus distance, muscle strength scores, and VAS scores compared with baseline (P<0.05), with the observation group demonstrating greater improvement than the control group (P<0.05). No serious adverse events occurred during the treatment period. A few of patients experienced mild skin tingling or transient muscle soreness, which were well tolerated. Conclusions Progressive stepwise training combined with NMES can effectively reduce inter-rectus distance, enhance abdominal muscle strength, and relieve lower back pain, and has clinical application value.

Objective To evaluate whether pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) can be improved by extraperitoneal high uterosacral ligament suspension (EHUS). Methods The clinical data of patients who visited Peking University People's Hospital due to POP and underwent EHUS from January to September 2021 were retrospectively collected. The patients were followed up before surgery, 1 month after surgery, 6 months after surgery, and 12 months after surgery. The POP-Q score was used to evaluate the postoperative anatomical repositioning effect of the patients, the overactive bladder symptom score questionnaire (OABSS) was used to evaluate the improvement of LUTS after surgery, and the pelvic floor dysfunction inventory-20 (PFDI-20) was used to evaluate the improvement of quality of life after surgery. Results Twelve months after EHUS, the location of POP-Q points was significantly higher than preoperative location (P<0.001). Twelve months after EHUS, the median OABSS score was 1 (0, 2) and the median PFDI-20 score was 0.00 (0.00, 0.83), both significantly lower than the preoperative scores (P<0.05). Conclusions EHUS can improve LUTS and quality of life in patients with POP while achieving anatomical restoration.

Objective To analyze the clinical characteristics and surgical management of postmenopausal ovarian endometriosis, exploring its pathogenesis and malignant potential. Methods Retrospective analysis of 130 postmenopausal patients with ovarian endometriosis who underwent surgery at Peking University People's Hospital (Jan 2014 - Aug 2023) were retrospectively analyzed, with surgical outcomes and clinical features evaluated. Results Among the 130 patients, the mean age of (58.36±5.66) years, with a mean menopausal age of (49.6±5.18) years. Postoperative pathology confirmed ovarian endometriomas in 69.23% (90/130) of cases, while 16.92% (22/130) exhibited malignant transformation. The malignancy rates were 35.71% (20/56) for cysts>4 cm and 73.68% (14/19) for those >10cm. Patients with elevated CA125 (>35 U/mL) showed a 44.44% (12/27) malignancy rate. Conclusions Asymptomatic postmenopausal ovarian endometriomas ≤4 cm may be monitored. Persistent cysts>4 cm warrant surgery. Cysts>10 cm or with elevated tumor markers require MRI evaluation for malignancy risk, with cautious selection of approach and scope.

Objective To explore the curative efficacy of transcervical resection of polyp (TCRP) combined with levonorgestrel-releasing intrauterine system (LNG-IUS), and its influences on serum sex hormones and recurrence. Methods A retrospective analysis was performed on the clinical data of 280 patients with endometrial polyps (EP) who underwent TCRP from March 2022 to September 2023. According to presence or absence of LNG-IUS, patients were divided into LNG-IUS group (n=141) and control group (n=139). All were followed up for 12 months after surgery. The endometrial thickness, menstrual volume pictorial blood loss assessment chart (PBAC), uterine hemodynamics pulsatility index (PI), and resistance index (RI), levels of serum vascular endothelial growth factor (VEGF), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were compared between the two groups, and recurrence rate was observed by follow-up. Results At 3, 6 and 12 months after surgery, endometrial thickness in LNG-IUS group was lower than that in control group (P<0.05), PBAC scores were lower than those in control group (P<0.05), and levels of serum VEGF, LH and FSH were lower than those in control group (P<0.05). At 12 months after surgery, PI and RI in LNG-IUS group were lower than those in control group (P<0.05). At 12 months after surgery, there were 2 recurrence cases (1.42%) in LNG-IUS group and 11 recurrence cases (7.91%) in control group, respectively. The recurrence rate in LNG-IUS group was lower than that in control group (χ2=6.670, P<0.05). Conclusions Hysteroscopic surgery combined with postoperative progesterone therapy is beneficial to reduce endometrial thickness, menstrual blood loss and risk of postoperative recurrence in patients with endometrial polyps, which has high safety.

Objective To compare the clinical efficacy of single pelvic floor rehabilitation versus synchronous recti abdominis combined with pelvic floor rehabilitation in postpartum patients with diastasis recti abdominis (DRA) and pelvic floor muscle strength less than grade 3. Methods A total of 96 primiparous women diagnosed with DRA and weakened pelvic floor muscle strength during 42-day postpartum examination at Changzhou Maternal and Child Health Care Hospital from January 2023 to January 2024 were selected, computer-generated random number table method was used to randomly divided into single pelvic floor rehabilitation group (single pelvic floor rehabilitation group) and combined group(synchronous recti abdominis rehabilitation combined with pelvic floor rehabilitation group). Both groups underwent one treatment course (10 sessions), and statistical analysis was performed to compare the differences in therapeutic effects between the two groups. Results Both groups showed improvements in pelvic floor muscle strength (deep and superficial muscles) and Pelvic Organ Prolapse Quantification (POP-Q) (Aa, Ba, C, D) indicators before and after treatment, with statistically significant differences (P＜0.05). However, no statistically significant between-group differences were observed in terms of pelvic floor muscle strength grade (deep and superficial muscles) or POP-Q (Aa, Ba, C, D, Ap, Bp, TVL) before and after treatment (P＞0.05). Conclusions Synchronous rehabilitation for postpartum DRA combined with pelvic floor muscle strength less than grade 3 is effective, safe, and is conducive to promoting early postpartum recovery.

经阴道骶棘韧带固定术（sacrospinous ligament fixation, SSLF）是妇科盆底重建手术中一种重要的术式，主要用于治疗中盆腔缺陷为主的盆腔器官脱垂（pelvic organ prolapse, POP）。SSLF因其疗效显著、恢复快等优点，在临床应用日益广泛。《经阴道骶棘韧带固定术专家共识（2025年版）》由中国妇幼保健协会妇科阴式手术专业委员会组织国内盆底专家共同制定，该共识从SSLF的适应证与禁忌证、术前评估、手术步骤及要点、并发症的处理与预防等方面进行了推荐，旨在规范该手术的临床应用，为临床医生提供实践指导。本文将对共识中的关键内容进行解读，以帮助临床医生更好地理解和应用这一术式。

目的 通过三联半定量排卵检测试纸和阴道超声监测排卵指导生育困难女性，并对成本效益进行分析。方法 前瞻性选取2021年11月至2022年4月在北京大学人民医院妇科门诊有生育需求、试孕半年以上未妊娠的女性56例，采用试纸法和超声法监测排卵，通过配对卡方检验和Kappa一致性检验比较两种方法的一致性，观察尿黄体生成素（luteinizing hormone, LH）试纸阳性与临床超声监测到排卵发生的时差，比较两种方法的时间、经济成本。结果 56例女性共监测排卵周期83个，其中59个周期（71.09%）监测到排卵，24个周期（28.92%）未监测到排卵，其中12个周期监测至第35天无优势卵泡生长给予孕激素治疗终止本周期，12个周期因节假日推迟超声检查无法确定排卵日。成功妊娠24例（42.9%）。超声监测排卵的阳性率（65%，54/83）高于试纸监测排卵的阳性率（43%, 36/83; P<0.001），但两种方法具有一致性（kappa=0.44, P<0.001）。超声监测排卵的时间、经济成本较高。此外，三联半定量排卵检测试纸出现LH 25 IU/L阳性比超声监测到排卵时间早23.5 h（12~49 h），出现LH 45 IU/L或65 IU/L阳性比超声监测排卵早12 h（8~25 h）。结论 三联半定量排卵检测试纸在监测排卵中与超声监测排卵具有一致性，且时间、经济成本显著低于超声监测排卵；试纸在LH 45 IU/L或65 IU/L阳性比超声监测排卵提前12 h，为临床应用试纸结合超声监测排卵提供了证据支持。

Objective To explore the efficacy of fertility-preserving therapy (FST) in patients with POLE ultra-mutant (POLEmut) endometrial carcinoma (EC)/endometrial atypical hyperplasia (EAH), and to compare the therapeutic effects between theprogestogen/gonadotropin-releasing hormone agonist (GnRH-a) and immune checkpoint inhibitors (ICIs) regimens. Methods Clinical data of POLEmut EC/EAH patients who received FST were collected retrospectively at Obstetrics and Gynecology Hospital of Fudan University and Shanghai Tenth People's Hospital of Tongji University from April 2019 to November 2025. They were divided into progestogen/GnRH-a group (n=8) and ICIs group (n=5). Therapeutic, follow-up and pregnancy outcomes were compared between groups. Results Among the 13 patients, 7 cases underwent off-indication FST, and 5 cases in the ICIs group were off-indication. There was no significant difference in the complete response (CR) rate between the two groups (P=1.000). The median CR time in the ICIs group (28.2 weeks) was shorter than that in the progestogen/GnRH-a group (35.9 weeks, P=0.450). There were 4 refractory cases, including 3 in the progestogen/GnRH-a group and 1 case in the ICIs group, with no statistical difference (P=1.000). The median total follow-up time and post-CR follow-up time in the ICIs group were significantly shorter than those in the progestogen/GnRH-a group (median 21.1 months vs 44.6 months, 14.0 months vs 33.8 months, both P<0.05). No recurrence was observed in the ICIs group, while 2 cases of recurred were in the progestogen/GnRH-a group (P=0.467). Among the 8 CR patients, 7 achieved successful pregnancy, including 5 cases in the progesterone/GnRH-a group, all of which resulted in successful pregnancies with 4 live births; 2 cases in the ICIs group achieved successful pregnancy, both of which were in the third trimester. Conclusion Both progestogen/GnRH-a and ICIs regimens are effective for FST in POLEmut EC/EAH patients. With all ICIs patients undergoing off-indication FST, the ICIs regimen shows a trend of faster onset, better short-term disease control and favorable pregnancy outcomes, which may be a preferred FST option.

Objective To analyze the clinical characteristics and treatment methods of patients with secondary pelvic metastases from gynecological malignancies, and to investigate prognostic factors. Methods Clinical data were collected from 29 patients with pelvic metastases from gynecologic malignancies admitted to Peking University People's Hospital between June 2010 and January 2025. Follow-up assessments included NRS pain grading, KPS functional status scores, postoperative MSTS-93 scores and survival status. Results All cases were followed up. All patients underwent systemic treatments, including 5 patients were treated with radiotherapy and 7 patients underwent surgical treatment. Additionally, patients who underwent pelvic reconstruction with 3D printed prostheses (4 cases) had significantly higher postoperative MSTS-93 scores than those who underwent reconstruction by other methods (P<0.05). The median survival time for these patients was 20.0 months (5.9~34.1 months). Multivariate Cox proportional hazards regression analysis showed that histological gradesⅡ&Ⅲ, non-primary pelvic metastasis, and bilateral pelvic metastasis were risk factors for patient prognosis, while asynchronous pelvic metastasis and comprehensive treatment were protective factors (all P<0.05). Conclusions Patients with gynecologic malignancies secondary to pelvic metastases have poor quality of life and unfavorable survival prognosis. The effect of 3D printed pelvic reconstruction on survival was not statistically significant; however, precise prosthetic design, strict surgical procedures, and reasonable postoperative management can improve patients' quality of life.

Objective To investigate the relationship between non-16/18 high-risk human papillomavirus (HPV) infection and cervical precancerous lesions. Methods A retrospective study was conducted on 1 154 patients who were positive for non-16/18 high-risk HPV and negative for liquid-based thin-layer cytology test (TCT) at Fuyang People's Hospital from January 2020 to October 2024. All patients underwent colposcopic cervical biopsy. The correlations between infection type, HPV subtype, age, and pathological results were analyzed. Results Among the patients, 861 cases (74.61%) had single-type infection, and 293 cases (25.39%) had mixed-type infection. The detection rate of mixed high-risk HPV cases was significantly higher than that of mixed high-and low-risk HPV cases (18.72% vs 6.67%, P<0.05). Pathological results showed that the detection rates of <low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), and squamous cell carcinoma (SCC) were 74.44%, 13.86%, 11.61%, and 0.09% respectively. The detection rate of HSIL in patients with mixed-type infection was significantly higher than that in patients with single-type infection (17.75% vs 9.52%, P<0.05). The top 8 subtypes of single-type infection were HPV 52, 58, 53, 68, 31, 39, 56, and 33 in sequence. The subtypes mainly associated with LSIL were HPV 68, 58, and 59, while those mainly associated with HSIL were HPV 68, 58, and 52. Significant differences were observed in HPV subtypes 33, 52, 59, and 68 between LSIL and HSIL groups (P<0.05). In terms of age distribution, patients aged 35~44 years accounted for the highest proportion (32.32%), and patients aged ≥65 years had the highest detection rate of precancerous lesions (42.86%). The detection rate of HSIL increased with the increase in age groups. Conclusions Patients with non-16/18 high-risk HPV infection still have a relatively high risk of lesions above HSIL. For cases with non-16/18 high-risk HPV infection and negative TCT results, it is still necessary to perform a colposcopic cervical biopsy.

Objective To explore the clinical effect of niraparib combined with bevacizumab in the treatment of BRCA1/2 wild-type homologous recombination defect (HRD)-negative advanced ovarian cancer. Methods A retrospective analysis study design was used. The clinical data of 98 patients with BRCA1/2 wild-type and HRD-negative advanced ovarian cancer admitted to the First Affiliated Hospital of Army Medical University were collected from January 2022 to December 2024. 58 patients who received maintenance treatment with bevacizumab alone were set as control group, and 40 patients who received maintenance treatment with niraparib combined with bevacizumab were set as observation group. The progression-free survival (PFS), toxicity reactions and blood test indexes were analyzed. Results The median progression-free survival of patients in study group was 24 months and that in control group was 20 months, revealing a significant difference between two groups (P=0.002). After treatment, the levels of serum carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), B-cell lymphoma-2 (Bcl-2) and Bcl-2 binding anti-apoptotic gene-1 (Bag-1), translocators protein (TSPO) and cell-free mitochondrial DNA (cf-mtDNA) and levels of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), interleukin-1β (IL-1β) and cysteine protease 1 (Caspase-1) in peripheral blood mononuclear cells in study group were lower than those in control group (P<0.05). The level of serum Bcl-2 related X protein (Bax) was higher in study group than that in control group (P<0.05). The toxicity reactions in both groups were mainly mild-to-moderate systemic reactions, digestive system toxicity and cardiovascular system toxicity, with no significant differences between groups (P>0.05). Conclusions Niraparib combined with bevacizumab for first-line maintenance treatment of BRCA1/2 wild-type HRD-negative advanced ovarian cancer can prolong the progression-free survival of patients. Its possible mechanism is to exert anti-tumor effects by improving the imbalance of cell apoptosis and relieving inflammatory responses, and its safety is controllable.

Objective Based on the 2020 WHO classification of female genital tumors, this study aims to systematically compare the differences in clinicopathological and molecular characteristics between ovarian endometrioid carcinoma (OEC) and ovarian clear cell carcinoma (OCCC). Methods Clinicopathological data from 268 OEC cases and 120 OCCC cases were collected. Molecular subtyping data were obtained for 124 OEC and 41 OCCC cases. Targeted sequencing was performed on 91 OEC and 19 OCCC cases. Results ① Compared to OCCC patients, OEC patients were younger, had smaller tumors, and a higher rate of bilateral ovarian involvement. They underwent comprehensive staging surgery and chemotherapy at lower rates, and exhibited higher positive immunohistochemical expression rates of ER, PR, and WT1 (all P<0.001). ② The prognosis of OEC was significantly better than that of OCCC patients. Histological grade showed a significant negative correlation with progression free survival (PFS) of OEC patients (HR=3.9, P=0.032). ③ The WHO molecular classification had prognostic stratification significance for overall survival (OS) in OEC patients (P=0.041). ④ High-frequency mutations in OEC were concentrated in the RAF-MEK-ERK, PI3K-AKT-mTOR, and Wnt/β-catenin signaling pathways, whereas OCCC mutations were mainly found in the PI3K-AKT-mTOR and chromatin remodeling signaling pathways. Conclusions OEC and OCCC exhibit significant differences in clinicopathological characteristics and core molecular pathways. OCCC, grade 3 OEC, and the p53abn subtype of OEC should all be considered high-risk subtypes, and it is recommended that they receive heightened attention and intensified intervention in clinical management.

Objective To investigate the effects of transvaginal cervical cerclage (CC) on pregnancy outcomes and on women's fertility desire at different gestational weeks during different timing of the procedure. Methods Retrospective analysis of the pregnancy outcomes of 211 cases of cervical incompetence (CIC) in Hubei maternal and Child Health Hospital from January 2020 to August 2023. They were divided into non-emergency group and emergency group. Each group was further divided into pregnancies<24-week group and≥24-week group. Pregnancy outcomes, fertility desire and the influencing factors of surgical success were analyzed. Results For non-emergency group, there were no statistically significant difference in abortion rate, preterm birth rate, full-term birth rate, gestational weeks of delivery and surgical success rate between pregnancies<24-week group and≥24-week group (P>0.05), and fetal survival rate in pregnancies≥24-week group was higher than<24-week (P<0.05). For emergency group, there were no statistically significant difference in abortion rate, gestational weeks of delivery and surgical success rate between pregnancies<24-week group and≥24-week group (P>0.05). Compared with pregnancies<24-week group, the fetal survival rate and the preterm birth rate in pregnancies≥24-week group was higher (P<0.05), the full-term birth rate was lower (P<0.05). A Shorte of cervical length was a risk factor for surgical failure (OR=2.479, 95%CI: 1.522~4.038, P=0.000). Among the follow-up women (191 individuals), 26 women had fertility desire (13.6%), while 90 women had no fertility desire due to concerns about surgical complications (47.1%), 6 women were not sure to have fertility desire (13.6%), 69 women had no fertility desire due to other reasons (36.1%), the differences between the four groups were statistically significant (P<0.05). Conclusions CC should be performed after 24 weeks to improve pregnancy outcomes. Monitoring of cervical length during pregnancy should be strengthened, especially in women with a history of mid-term miscarriage or premature birth. CC might affect women's fertility desire.