Search

Background: In the PhD research described herein, I used the female genital cosmetic surgery (FGCS) industry to illustrate a contemporary challenge to traditional representations of female genital anatomy. The most popular of the FGCS procedures, labiaplasty, involves trimming the labia minora so that they sit level with or are completely obscured by the labia majora. The labiaplasty market is booming. The anatomical criterion behind the justification for labiaplasty is problematic, because normal labia, which show a range of size, shape and asymmetry, are being confused with idealised labia, as promulgated on social media and cosmetic surgery websites. Cosmetic surgery websites use the term hypertrophy for protruding labia to imply a pathological condition requiring surgery, even though the labia have an important role in sexual response. Critically, anatomists have been absent from public and medical discourse about the FGCS industry, despite playing a pivotal role in the education of the next generation of doctors. It has been claimed that all medical and non-medical curricula lack genital anatomy education. My research explored whether the teaching of anatomy has, can or should play a role in informing frontline practitioners about the normal variation in structure and functions of female genitalia. Methods: I employed a qualitative methodological approach to explore how female genital anatomy is represented in the scientific literature, anatomical textbooks and anatomy education, and whether that content has changed over time. Results: My literature review identified an evidence base for normal in 12 population-based studies that recorded labial dimensions and showed wide variation in labial width and length. Protruding labia and asymmetry were common. An analysis of 78 historic and contemporary anatomy texts mapped representations of female genital anatomy over time, and confirmed that the spectrum of normal appearance for the vulva was not acknowledged in Eng

OBJECTIVE: To assess whether radiation completion within a planned timeframe in locally advanced squamous cell vulvar cancer impacts overall survival (OS). METHODS: The National Cancer Database from 2004 to 2017 was used to identify women ≥18 years old with stage II-IVA squamous cell vulvar cancer. We included women who received radiation alone (RT) or concurrent chemoradiation (CRT) for initial vulvar cancer treatment. Primary outcome was overall survival associated with time of delay in radiation completion. RESULTS: There were 2378 women identified (n = 856 RT and n = 1522 CRT). Median age was 67 (IQR 56-78), majority (88.35%) were white with advanced stage III or IVA (72.29%) disease. Median radiation dose was 5720 c-Gray (IQR 5040-6300). Radiation completion with delay ≥7 days resulted in reduction in survival compared to delay of <7 days (unadjusted HR 1.183 [95%CI: 1.066-1.313], p = 0.0016). When delays extended to ≥14 days compared to <14 days there was increased hazard of death (unadjusted HR: 1.263 [95%CI:1.126-1.416], p < 0.0001). Survival improved for patients with <7 versus ≥7 days delay whether treatment was with RT (median OS: 34.9 months versus 21.6 months, p < 0.01) or CRT (Median OS:58 months versus 41.3 months, p < 0.01). Stage IVA disease was associated with the greatest increase in hazard of death (HR 1.759 [95%CI 1.517-2.039], p < 0.0001) compared to stage II. CONCLUSION: Radiation completion with <7 days delay is associated with improved overall survival, independent of concurrent chemotherapy. This suggest that strategies to minimize delays in radiation are crucial in locally advanced vulvar cancer.

In this issue of PLOS Biology, Lattmann and colleagues report a new function for proteins of the DNA prereplication complex promoting the anchor cell to invade through the basement membrane and initiate vulval development in Caenorhabditis elegans.

A 37-year-old woman presented with a right labium majus thickening with no palpable mass, which had been evolving for a few months. A partial right labium majus ablation was performed at the request of the patient for esthetic reasons. The lesion was most histologically similar to CALME (childhood asymmetric labium majus enlargement). The lesion was benign, but several other differential diagnoses were considered. Two years after the surgery, there had been no recurrence. To our best knowledge, this is the first such case reported in an adult., SCOPUS: ar.j, info:eu-repo/semantics/published

Primary vulvar and vaginal cancers are rare female genital tract malignancies which are staged using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging. These cancers account for approximately 2,700 deaths annually in the USA. The most common histologic subtype of both vulvar and vaginal cancers is squamous cell carcinoma, with an increasing role of the human papillomavirus (HPV) in a significant number of these tumors. Lymph node involvement is the hallmark of FIGO stage 3 vulvar cancer while pelvic sidewall involvement is the hallmark of FIGO stage 3 vaginal cancer. Imaging techniques include computed tomography (CT), positron emission tomography (PET)-CT, magnetic resonance imaging (MRI), and PET-MRI. MRI is the imaging modality of choice for preoperative clinical staging of nodal and metastatic involvement while PET-CT is helpful with assessing response to neoadjuvant treatment and for guiding patient management. Determining the pretreatment extent of disease has become more important due to modern tailored operative approaches and use of neoadjuvant chemoradiation therapy to reduce surgical morbidity. Moreover, imaging is used to determine the full extent of disease for radiation planning and for evaluating treatment response. Understanding the relevant anatomy of the vulva and vaginal regions and the associated lymphatic pathways is helpful to recognize the potential routes of spread and to correctly identify the appropriate FIGO stage. The purpose of this article is to review the clinical features, pathology, and current treatment strategies for vulvar and vaginal malignancies and to identify multimodality diagnostic imaging features of these gynecologic cancers, in conjunction with its respective 2009 FIGO staging system guidelines.

[ES] El presente trabajo final de grado es un proyecto conjunto que realizo con Magdala García Ruíz de Alarcón. En esta memoria explico mi trabajo individual dentro del proyecto colectivo. Consiste en la elaboración de una animación a partir de dibujos propios, así como su contextualización dentro de un marco teórico. Podemos dividir este documento en un primer bloque teórico, en el que se investiga desde la representación de los genitales femeninos a lo largo de la historia del arte y su consecuente influencia en la sociedad del momento, hasta el impacto que generan los medios de comunicación y la pornografía sobre la imagen corporal de las mujeres. En base a esto, en el segundo bloque desarrollo mi aportación práctica, que abarca la producción dibujística, videográfica, además de una pieza pictórica colaborativa., [EN] The present final degree project is a joint project that I carry out with Magdala García Ruíz de Alarcón. In this memory, I explain my individual work within the collective project. It consists of the elaboration of an animation from own drawings, as well as its contextualization within a theoretical framework. We can divide this document into a first theoretical block, which investigates from the representation of female genitalia throughout art history and its consequent influence on society at the time to the impact generated by the media and pornography on the body image of women. Based on this, in the second block I develop my practical contribution, which includes drawing, videographic production, as well as a collaborative pictorial piece.

[ES] El presente trabajo final de grado es un proyecto conjunto que realizo con Magdala García Ruíz de Alarcón. En esta memoria explico mi trabajo individual dentro del proyecto colectivo. Consiste en la elaboración de una animación a partir de dibujos propios, así como su contextualización dentro de un marco teórico. Podemos dividir este documento en un primer bloque teórico, en el que se investiga desde la representación de los genitales femeninos a lo largo de la historia del arte y su consecuente influencia en la sociedad del momento, hasta el impacto que generan los medios de comunicación y la pornografía sobre la imagen corporal de las mujeres. En base a esto, en el segundo bloque desarrollo mi aportación práctica, que abarca la producción dibujística, videográfica, además de una pieza pictórica colaborativa., [EN] The present final degree project is a joint project that I carry out with Magdala García Ruíz de Alarcón. In this memory, I explain my individual work within the collective project. It consists of the elaboration of an animation from own drawings, as well as its contextualization within a theoretical framework. We can divide this document into a first theoretical block, which investigates from the representation of female genitalia throughout art history and its consequent influence on society at the time to the impact generated by the media and pornography on the body image of women. Based on this, in the second block I develop my practical contribution, which includes drawing, videographic production, as well as a collaborative pictorial piece.

[ES] El presente trabajo final de grado es un proyecto conjunto que realizo con Magdala García Ruíz de Alarcón. En esta memoria explico mi trabajo individual dentro del proyecto colectivo. Consiste en la elaboración de una animación a partir de dibujos propios, así como su contextualización dentro de un marco teórico. Podemos dividir este documento en un primer bloque teórico, en el que se investiga desde la representación de los genitales femeninos a lo largo de la historia del arte y su consecuente influencia en la sociedad del momento, hasta el impacto que generan los medios de comunicación y la pornografía sobre la imagen corporal de las mujeres. En base a esto, en el segundo bloque desarrollo mi aportación práctica, que abarca la producción dibujística, videográfica, además de una pieza pictórica colaborativa., [EN] The present final degree project is a joint project that I carry out with Magdala García Ruíz de Alarcón. In this memory, I explain my individual work within the collective project. It consists of the elaboration of an animation from own drawings, as well as its contextualization within a theoretical framework. We can divide this document into a first theoretical block, which investigates from the representation of female genitalia throughout art history and its consequent influence on society at the time to the impact generated by the media and pornography on the body image of women. Based on this, in the second block I develop my practical contribution, which includes drawing, videographic production, as well as a collaborative pictorial piece.

[ES] El presente trabajo final de grado es un proyecto conjunto que realizo con Magdala García Ruíz de Alarcón. En esta memoria explico mi trabajo individual dentro del proyecto colectivo. Consiste en la elaboración de una animación a partir de dibujos propios, así como su contextualización dentro de un marco teórico. Podemos dividir este documento en un primer bloque teórico, en el que se investiga desde la representación de los genitales femeninos a lo largo de la historia del arte y su consecuente influencia en la sociedad del momento, hasta el impacto que generan los medios de comunicación y la pornografía sobre la imagen corporal de las mujeres. En base a esto, en el segundo bloque desarrollo mi aportación práctica, que abarca la producción dibujística, videográfica, además de una pieza pictórica colaborativa., [EN] The present final degree project is a joint project that I carry out with Magdala García Ruíz de Alarcón. In this memory, I explain my individual work within the collective project. It consists of the elaboration of an animation from own drawings, as well as its contextualization within a theoretical framework. We can divide this document into a first theoretical block, which investigates from the representation of female genitalia throughout art history and its consequent influence on society at the time to the impact generated by the media and pornography on the body image of women. Based on this, in the second block I develop my practical contribution, which includes drawing, videographic production, as well as a collaborative pictorial piece.

OBJECTIVE: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate. METHODS: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria. RESULTS: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32,7±7,6 years. Two hundred sixty-three (95,3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4,7%) developed vulvo-vaginal endometriosis spontaneously i.e. without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98,2% of the patients, n=278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97,5%) showed a vulvo-perineal nodule, mass or swelling while 6 presented with bluish cutaneous lesions (2,1%) and 1 with bilateral polyps of the labia minora (0,4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28,1%) received additional hormonal therapy. The recurrence rate was 10,2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies). CONCLUSION: Vulvo-perineal endometriosis is poorly reported with only approximately 300 cases identified in the literature

Objectives: All cervical cancers and some vulvar, vaginal and anal cancers are caused by high-risk human papillomavirus (hrHPV). However, little is known about the association between cervical HPV infection and subsequent intraepithelial neoplasia and cancer at other anogenital sites. In this prospective cohort study, we estimated the risk of vulvar, vaginal and anal intraepithelial neoplasia grade 2/3 or cancer (VIN2+, VaIN2+, AIN2+) according to cervical hrHPV status. Methods: Liquid-based cervical cytology samples were collected from 40,399 women screened against cervical cancer in Copenhagen, Denmark, during 2002–2005. Samples were tested for hrHPV using Hybrid Capture 2 (HC2) and genotyped using INNO-LiPA. We linked the cohort with Danish nationwide registries to identify cases of VIN2+, VaIN2+ and AIN2+ during up to 15 years of follow-up. We estimated age-adjusted hazard ratios (HRs) using Cox regression and cumulative incidences using Aalen-Johansen's estimator. Results: Women with cervical HPV16 infection had increased hazard of VIN2+ (HR = 2.6; 95% confidence interval [CI], 1.2–5.5), VaIN2+ (HR = 23.5; 95% CI, 6.8–81.6) and AIN2+ (HR = 3.7; 95% CI, 1.1–12.2) compared with HC2 negative women. Women with other hrHPV types than HPV16 also had increased hazard of VaIN2+ (HR = 7.1; 95% CI, 2.3–22.3) and a borderline statistically significantly increased risk of AIN2+ (HR = 2.2; 95% CI, 0.9–4.9) compared with HC2 negative women. The 10-year cumulative incidences of VIN2+, VaIN2+ and AIN2+ in women with cervical HPV16 were 0.3% (95% CI, 0.2%–0.7%), 0.2% (95% CI, 0.1%–0.5%) and 0.1% (95 CI, 0.0%–0.4%). Conclusions: Cervical HPV16 infection is associated with increased risk of VIN2+, VaIN2+ and AIN2+.

Acquired lymphangiectasia of the vulva is very uncommon. Owing to the non-specific papillomatous manifestation and the vast array of possible differential diagnoses, lymphangioma circumscriptum (LC) still presents a diagnostic challenge. In this report, we present a very rare form of acquired vulvar LC in a 71-year-old patient with a longstanding history of asymptomatic lesions over the labia majora that had been previously treated as genital warts. On examination, the patient had multiple clustered translucent papules up to 15mm in diameter, morphologically reminiscent of vesicles, that oozed clear fluid throughout her groin and swollen labia majora. The patient also suffered concomitant bilateral lower-extremity lymphedema. A skin biopsy showed multiple, irregular-shaped lumina containing eosinophilic material in the upper dermis. Dilated lymphatic channels were lined by a single layer of flattened endothelial cells and the overlying epidermis showed acanthosis, hyperkeratosis, focal mild pseudoepitheliomatous hyperplasia. There is still no consensus on the optimal management of LC. Our patient was referred to a plastic surgeon for further evaluation and treatment. Although there are a variety of therapeutic modalities for LC, positive results are few and relapses are observed.

ObjectiveTo elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options.Materials and methodsThe Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment.ResultsThe contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed.ConclusionLS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.

The speed at which a cell fate decision in nematode worms evolves is due to the number of genes that control the decision, rather than to a high mutation rate.

Adenoid cystic carcinoma (ACC) of the Bartholin gland is a rare gynaecological entity. Despite its slow growth and inconspicuous presentation, vulvar ACC has a propensity for perineural invasion and is therefore associated with high local recurrence rates. We report a case of vulvar ACC in a 61-year-old woman with a prolonged swelling of the Bartholin gland. This patient presented with pulmonary metastases at the moment of histological diagnosis. The vulvar and the pulmonary lesions showed identical histology. Despite a history of human papilloma virus (HPV)-related usual type vulvar intra-epithelial neoplasia and cervical squamous cell carcinoma, the vulvar ACC was negative for both p16 immunohistochemistry and HPV-DNA. We conclude that HPV is not involved in the pathogenesis of pure ACC of the Bartholin gland. Additionally, we advocate a low threshold for performing biopsies of vulvar swellings in women aged >40 years, to rule out malignancy and to prevent diagnostic delays.

Objectives: All cervical cancers and some vulvar, vaginal and anal cancers are caused by high-risk human papillomavirus (hrHPV). However, little is known about the association between cervical HPV infection and subsequent intraepithelial neoplasia and cancer at other anogenital sites. In this prospective cohort study, we estimated the risk of vulvar, vaginal and anal intraepithelial neoplasia grade 2/3 or cancer (VIN2+, VaIN2+, AIN2+) according to cervical hrHPV status. Methods: Liquid-based cervical cytology samples were collected from 40,399 women screened against cervical cancer in Copenhagen, Denmark, during 2002–2005. Samples were tested for hrHPV using Hybrid Capture 2 (HC2) and genotyped using INNO-LiPA. We linked the cohort with Danish nationwide registries to identify cases of VIN2+, VaIN2+ and AIN2+ during up to 15 years of follow-up. We estimated age-adjusted hazard ratios (HRs) using Cox regression and cumulative incidences using Aalen-Johansen's estimator. Results: Women with cervical HPV16 infection had increased hazard of VIN2+ (HR = 2.6; 95% confidence interval [CI], 1.2–5.5), VaIN2+ (HR = 23.5; 95% CI, 6.8–81.6) and AIN2+ (HR = 3.7; 95% CI, 1.1–12.2) compared with HC2 negative women. Women with other hrHPV types than HPV16 also had increased hazard of VaIN2+ (HR = 7.1; 95% CI, 2.3–22.3) and a borderline statistically significantly increased risk of AIN2+ (HR = 2.2; 95% CI, 0.9–4.9) compared with HC2 negative women. The 10-year cumulative incidences of VIN2+, VaIN2+ and AIN2+ in women with cervical HPV16 were 0.3% (95% CI, 0.2%–0.7%), 0.2% (95% CI, 0.1%–0.5%) and 0.1% (95 CI, 0.0%–0.4%). Conclusions: Cervical HPV16 infection is associated with increased risk of VIN2+, VaIN2+ and AIN2+.

ResumenLa tuberculosis (TB) es una de las principales causas de mortalidad en el mundo. En Venezuela, la TB, es una causa de morbilidad frecuente, pero la TB de la vulva es una rara localización de esta enfermedad. Una paciente de 40 años de edad fue referida con un cuadro clínico de nueve años de evolución, caracterizado por un incremento de volumen en el labio izquierdo de la vulva, bien delimitado, sin adenopatías y dolor. La lesión fue drenada y se indicaron antibióticos sin mejoría. En enero de 2018, se realizó una prueba de reacción en cadena polimerasa para Mycobacterium Tuberculosis, siendo positiva. El tratamiento anti-tuberculoso fue iniciado con mejoría de la lesión y curación cuando las fases del tratamiento fueron completadas. Se debe considerar a la TB de la vulva como una posibilidad diagnóstica ante toda lesión ginecológica.AbstractThe tuberculosis (TB) is one of the principal causes of mortality in the world. In Venezuela, TB is a frequent cause of morbidity, but TB of the vulva is a rare location for this disease. A 40 years-old female patient was referred with a clinical picture of nine years of evolution, characterized by an well delimited, increased volume in the left major lip of the vulva, with no adenopathies and painful. The lesion was drained and antibiotics were indicated without improvement. The clinical picture persisted. In January 2018, a sample was found positive by Polymerase Chain Reaction for the Mycobacterium Tuberculosis. Anti-tuberculous treatment was initiated with improvement of the injury and healing, when the treatment phases were completed. TB of the vulva should be considered as a diagnostic possibility for any gynecological lesion.

Genital lichen sclerosus (LS), a chronic noninfectious dermatosis, is not rare in pediatric dermatology. The histopathological diagnosis in children and adults in both genital and nongenital LS is considered to be the same and encompasses a broad range of possible characteristics. Clinical manifestations and treatment options of genital LS in children are different depending on gender. The vast majority of boys are treated with circumcision, making for a larger amount of information on the histopathology of genital LS in boys, whereas substantial information on the histopathology of juvenile vulvar LS is lacking. In girls, vulvar LS almost always persists beyond puberty and, therefore, presents a particular challenge to clinicians and cause for concern for the patient. Vulvar LS in childhood and adolescence (juveniles) is underreported, and there are uncertainties with regard to the long-term course of the disease when it occurs at an age when the vulva is still developing. The present study investigates biopsie

Adenoid cystic carcinoma (ACC) of the Bartholin gland is a rare gynaecological entity. Despite its slow growth and inconspicuous presentation, vulvar ACC has a propensity for perineural invasion and is therefore associated with high local recurrence rates. We report a case of vulvar ACC in a 61-year-old woman with a prolonged swelling of the Bartholin gland. This patient presented with pulmonary metastases at the moment of histological diagnosis. The vulvar and the pulmonary lesions showed identical histology. Despite a history of human papilloma virus (HPV)-related usual type vulvar intra-epithelial neoplasia and cervical squamous cell carcinoma, the vulvar ACC was negative for both p16 immunoh

Background: Malignant eccrine spiradenoma is one of the rarest sweat-gland tumors. Here, we describe a rare case of low grade malignant eccrine spiradenoma located at the vulva. Case presentation: The vulvar lesion was described as a mass measured 3.5 cm and located in the dermis and subcutis with no attachment to the epidermis. The neoplasm was arranged in ragged sheets or solid nodules sometimes with focal necrosis. The tumor cells had hyperchromatism, pleomorphism, and prominent nucleoli with high mitotic index and KI-67 estimated at 70-80%. Conclusions: It's only the fifth case of malignant eccrine spiradenoma localized at the vulva. This is the first time that an HPV genotyping was made in this type of lesion with no HPV found while the p16 expression was diffuse. Moreover, it's the first time that a p53 mutation is detected by sequencing in this location., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: The extent of surgical treatment for vulvar lesions is predominantly guided by the histopathologic diagnosis rendered on the pre-operative biopsy. For premalignant lesions, local excisions are performed, whereas for vulvar squamous cell carcinoma (VSCC), more radical procedures are mandatory. However, even in the absence of a conclusive diagnosis of VSCC on biopsy, the surgeon may opt for a radical excision on grounds of strong clinical suspicion, with a view to avoiding repeat surgeries. We studied a retrospective, 10-year cohort of patients who underwent vulvar excisions, in the absence of a conclusive biopsy diagnosis of VSCC. We aimed to identify the factors predictive of VSCC in these patients, and assess their treatment. Study design: All patients who underwent vulvar excision (2005–2016) at Erasmus MC, without a definitive diagnosis of VSCC on the preoperative biopsy were included. Logistic regression analysis was performed to identify the factors predictive of a final diagnosis of VSCC. Surgical treatment was categorized as definitive, incomplete, or over-treatment, based on histopathology of the excision specimen and previous surgical history. Results: In 57 % (64/113) of all included patients, the final diagnosis was VSCC. Higher patient age (p

The precursor lesion of vulvar squamous cell carcinoma (VSCC), namely vulvar intraepithelial neoplasia (VIN), is classified as: human papillomavirus (HPV)-related high grade squamous intraepithelial lesion (HSIL), and HPV-independent differentiated VIN (dVIN). Traditionally, histology and immunohistochemistry (IHC) have been the basis of diagnosis and classification of VIN. HSIL shows conspicuous histological atypia, and positivity on p16-IHC, whereas dVIN shows less obvious histological atypia, and overexpression or null-pattern on p53-IHC. For both types of VIN, other diagnostic immunohistochemical markers have also been evaluated. Molecular characterization of VIN has been attempted in few recent studies, and novel genotypic subtypes of HPV-independent VSCC and VIN have been identified. This systematic review appraises the VSCC precursors identified so far, focusing on histology and biomarkers (immunohistochemical and molecular). To gain further insights into the carcinogenesis and to identify additional potential biomarkers, gene expression omnibus (GEO) datasets on VSCC were analyzed; the results are presented.

The speed at which a cell fate decision in nematode worms evolves is due to the number of genes that control the decision, rather than to a high mutation rate.

Acquired lymphangiectasia of the vulva is very uncommon. Owing to the non-specific papillomatous manifestation and the vast array of possible differential diagnoses, lymphangioma circumscriptum (LC) still presents a diagnostic challenge. In this report, we present a very rare form of acquired vulvar LC in a 71-year-old patient with a longstanding history of asymptomatic lesions over the labia majora that had been previously treated as genital warts. On examination, the patient had multiple clustered translucent papules up to 15mm in diameter, morphologically reminiscent of vesicles, that oozed clear fluid throughout her groin and swollen labia majora. The patient also suffered concomitant bilateral lower-extremity lymphedema. A skin biopsy showed multiple, irregular-shaped lumina containing eosinophilic material in the upper dermis. Dilated lymphatic channels were lined by a single layer of flattened endothelial cells and the overlying epidermis showed acanthosis, hyperkeratosis, focal mild pseudoepitheliomatous hyperplasia. There is still no consensus on the optimal management of LC. Our patient was referred to a plastic surgeon for further evaluation and treatment. Although there are a variety of therapeutic modalities for LC, positive results are few and relapses are observed.

ObjectiveTo elucidate current understanding on the pathophysiological mechanism of genital lichen sclerosus (LS), urologic manifestations, and treatment options.Materials and methodsThe Medline/PubMed and Embase databases were systematically reviewed for publications pertaining to LS. After applying inclusion and exclusion criteria, references were assessed for relevance to the pathophysiology, presentation, and treatment of LS by title and abstract review by 2 independent reviewers, yielding 186 articles for assessment.ResultsThe contemporary understanding of the epidemiology and histology of LS is reviewed herein. Additionally, we explore in detail the 3 hypotheses regarding the pathophysiological mechanism contributing to disease presentation: infectious etiology, primary immune dysregulation, and the isotraumatopic response. We summarize the available biological evidence supporting each hypothesis. This discussion provides context for understanding LS morbidity and may spur new avenues of research. For the clinician, we review the clinical presentation of disease, including the risk of progression to squamous cell carcinoma. The current medical and surgical treatment options are also detailed.ConclusionLS remains a potentially insidious disease which may lead to debilitating urinary and sexual dysfunction. Cross disciplinary research should aim for earlier detection, as well as more effective and durable treatment. The exact cause of LS remains unknown.

We report a rare case of vulvar Majocchi granuloma and kerion formation secondary to Trichophyton in an immunocompetent woman. The patient responded well to oral terbinafine and a short course of oral corticosteroids with a slow taper. Resolution of deep dermatophytosis requires prompt pathogen identification and treatment to avoid scarring and hair loss. Herein, we aim to increase clinical awareness and early recognition of this atypical presentation of a Majocchi granuloma with kerion formation.

Die Arbeit widmet sich der sozialwissenschaftlichen Debatte um kosmetische Intimchirurgie. Ein Diskurs, welcher sich im Spannungsverhältnis von Selbstermächtigung und -unterwerfung verorten lässt.

Bartholin's cysts are common problems in women at reproductive age. Abscesses are three times more common than cysts. Most Bartholin's cysts reach a diameter from 1 to 4 cm, and are usually asymptomatic. Tumors originating from the Bartholin’s glands are very rare. Duct cysts and inflammation are the more common lesions in these glands., Los quistes de la glándula de Bartholino son problemas comunes en mujeres en edad reproductiva. Los abscesos son tres veces más comunes que los quistes. Estos quistes alcanzan diámetros de 1 a 4 cm, y suelen ser asintomáticos. Los tumores que se originan en las glándula de Bartholino son muy raros . Los quistes de los conductos y la inflamación son las lesiones más comunes en estas glándulas.

We report a rare case of vulvar Majocchi granuloma and kerion formation secondary to Trichophyton in an immunocompetent woman. The patient responded well to oral terbinafine and a short course of oral corticosteroids with a slow taper. Resolution of deep dermatophytosis requires prompt pathogen identification and treatment to avoid scarring and hair loss. Herein, we aim to increase clinical awareness and early recognition of this atypical presentation of a Majocchi granuloma with kerion formation.

We present a patient with the bullous form of lichen sclerosus of the vulva. She had no lesions in other cutaneous and mucosal areas. We used topical tacrolimus and topical clobetasol propionate. The patient was lesion free at the first-year follow-up.

We present a case of eruptive generalized syringoma with vulvar involvement. This case is unique in terms of being a nonfamilial, linear variant, leading to pseudohypertrophy of the labia majora.

Differentiated vulvar intraepithelial neoplasia (dVIN) is the precursor lesion of HPV-negative v

We present a patient with the bullous form of lichen sclerosus of the vulva. She had no lesions in other cutaneous and mucosal areas. We used topical tacrolimus and topical clobetasol propionate. The patient was lesion free at the first-year follow-up.

We present a case of eruptive generalized syringoma with vulvar involvement. This case is unique in terms of being a nonfamilial, linear variant, leading to pseudohypertrophy of the labia majora.

La vulva es el conjunto de los órganos genitales externos de la mujer y comprende el área topográfica delimitada por el monte de Venus anteriormente, el periné en su parte posterior, los pliegues inguinales a ambos lados y el anillo himeneal medialmente. Las afecciones de la vulva impactan considerablemente en la calidad de vida de quienes las padecen, afectando sobre todo el bienestar personal y en lo referido a la esfera psicológica y psicosexual. Debido a la conjunción de los sistemas urinario, genital y gastrointestinal en un área mucocutánea, la patología es muy variada y precisa de un enfoque multidisciplinar. En este trabajo se ha realizado una revisión descriptiva de los distintos procesos que se pueden presentar en la vulva, incluyendo la patología inflamatoria, las lesiones pigmentadas, los tumores benignos y malignos, la vulvodinia y enfermedades sistémicas que pueden manifestarse con algún tipo de afectación de la región genital femenina., Grado en Medicina

Whole-genome and transcriptome sequencing were performed to identify potential therapeutic strategies in the absence of viable treatment options for a patient initially diagnosed with vulvar adenocarcinoma. Genomic events were prioritized by comparison against variant distributions in the TCGA pan-cancer data set and complemented with detailed transcriptome sequencing and copy-number analysis. These findings were considered against published scientific literature in order to evaluate the functional effects of potentially relevant genomic events. Analysis of the transcriptome against a background of 27 TCGA cancer types led to reclassification of the tumor as a primary HER2+ mammary-like adenocarcinoma of the vulva. This revised diagnosis was subsequently confirmed by follow-up immunohistochemistry for a mammary-like adenocarcinoma. The patient was treated with chemotherapy and targeted therapies for HER2+ breast cancer. The detailed pathology and genomic findings of this case are presented herein.

Human papilloma virus (HPV) is considered to be responsible for a large part of vaginal and vulvar carcinomas, and the p53 codon 72 polymorphism has been implicated in susceptibility to cancer induced by this virus, but with contradicting results. In this study, we have investigated the prognostic value of the codon 72 polymorphism by real-time PCR (qPCR) in two cohorts of vaginal (n = 66) and vulvar (n = 123) carcinomas. In vaginal carcinoma, arginine homozygous patients were significantly associated with a higher primary cure rate (p = 0.023) but also associated with a higher recurrence rate (p = 0.073), significant at distant locations (p = 0.009). No significant differences were found in overall survival rate (p = 0.499) or cancer-specific survival rate (p = 0.222). A higher frequency of arginine homozygosity was noted in HPV-positive tumors (p = 0.190) in comparison with HPV-negative tumors. In vulvar carcinoma, the genotype homozygous for arginine was significantly associated with a larger tumor size at diagnosis in the entire cohort (p = 0.015) and a lower cancer-specific survival rate (p = 0.024) compared with heterozygous (arginine/proline) in HPV-negative tumors. Our results indicate that the relation between HPV and the p53 codon 72 polymorphism is complex and the significance and mechanisms responsible for this relationship need to be further elucidated., Funding Agencies:Region Örebro County through ALFÖrebro County Council Research Committee

Papular acantholytic dermatosis of the vulva is a rare,chronic disorder and is an entity that remains to be fullyunderstood. It shares clinical and histopathologicaloverlap with Darier disease and Hailey-Hailey disease.We describe a 30-year-old woman with papularacantholytic dermatosis of the vulva. The lesionsconsisted of whitish papules and erosions on the labiamajora. Histologically, there was hyperkeratosis andfocal parakeratosis with acantholytic and dyskeratoticcells. She did not respond completely to topicalsteroids but clinical improvement occurred after theuse topical tacrolimus.

Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.

La vulva es el conjunto de los órganos genitales externos de la mujer y comprende el área topográfica delimitada por el monte de Venus anteriormente, el periné en su parte posterior, los pliegues inguinales a ambos lados y el anillo himeneal medialmente. Las afecciones de la vulva impactan considerablemente en la calidad de vida de quienes las padecen, afectando sobre todo el bienestar personal y en lo referido a la esfera psicológica y psicosexual. Debido a la conjunción de los sistemas urinario, genital y gastrointestinal en un área mucocutánea, la patología es muy variada y precisa de un enfoque multidisciplinar. En este trabajo se ha realizado una revisión descriptiva de los distintos procesos que se pueden presentar en la vulva, incluyendo la patología inflamatoria, las lesiones pigmentadas, los tumores benignos y malignos, la vulvodinia y enfermedades sistémicas que pueden manifestarse con algún tipo de afectación de la región genital femenina., Grado en Medicina

Objective: Ablative surgery for vulvar cancer can involve the resection of perineum, vagina, urethra, groins, mons pubis, and abdominal wall creating complex defects. In our opinion, ALT flap is an ideal flap for reconstruction, because of low incidence of complications, long pedicle outside the radiotherapy field, capability of carrying fascia and muscle, possibility of sensate reconstruction, and low donor site morbidity. The purpose of this report is to describe our experience with ALT flap for reconstruction after vulvar cancer extirpative surgery, discussing our indications for complex defects and focusing on its versatility. Patients and Methods: We performed a retrospective review of 15 cases of complex postoncologic gynecological wounds, reconstructed with 16 pedicled ALT flap, after vulvar cancer ablative surgery between 2014 and 2016. Age of the patients ranged from 44 to 77, with mean age of 62.6. Postoperative outcomes were evaluated. Results: The flap size ranged from 12 × 8 cm to 22 × 15 cm., in two cases we harvested vastus lateralis to fill the dead space after pelvic exenteration. In nine flaps, we could include only 1 perforator, in 7 we could use two, 5 were septocutaneous and 18 myocutaneous with a pedicle length ranging from9cm.to15cm.We had no flap necrosis.3 flaps showed dehiscence of a part of the wound that healed by dressings. In one case of obese patient the donor site showed partial wound edge necrosis, and required secondary grafting. During follow-up that ranged from 1 month to 2 years, cancer relapsed locally in 5 patients. Global performance and specific pain improved after surgery. Conclusion: ALT flap should be included in the first line options for reconstructions of complex defects resulting from vulvar cancer surgery because of its reliability and versatility. © 2016 Wiley Periodicals, Inc. Microsurgery 37:516–524, 2017.

Human papilloma virus (HPV) is considered to be responsible for a large part of vaginal and vulvar carcinomas, and the p53 codon 72 polymorphism has been implicated in susceptibility to cancer induced by this virus, but with contradicting results. In this study, we have investigated the prognostic value of the codon 72 polymorphism by real-time PCR (qPCR) in two cohorts of vaginal (n = 66) and vulvar (n = 123) carcinomas. In vaginal carcinoma, arginine homozygous patients were significantly associated with a higher primary cure rate (p = 0.023) but also associated with a higher recurrence rate (p = 0.073), significant at distant locations (p = 0.009). No significant differences were found in overall survival rate (p = 0.499) or cancer-specific survival rate (p = 0.222). A higher frequency of arginine homozygosity was noted in HPV-positive tumors (p = 0.190) in comparison with HPV-negative tumors. In vulvar carcinoma, the genotype homozygous for arginine was significantly associated with a larger tumor size at diagnosis in the entire cohort (p = 0.015) and a lower cancer-specific survival rate (p = 0.024) compared with heterozygous (arginine/proline) in HPV-negative tumors. Our results indicate that the relation between HPV and the p53 codon 72 polymorphism is complex and the significance and mechanisms responsible for this relationship need to be further elucidated., Funding Agencies:Region Örebro County through ALFÖrebro County Council Research Committee

La vulva es el conjunto de los órganos genitales externos de la mujer y comprende el área topográfica delimitada por el monte de Venus anteriormente, el periné en su parte posterior, los pliegues inguinales a ambos lados y el anillo himeneal medialmente. Las afecciones de la vulva impactan considerablemente en la calidad de vida de quienes las padecen, afectando sobre todo el bienestar personal y en lo referido a la esfera psicológica y psicosexual. Debido a la conjunción de los sistemas urinario, genital y gastrointestinal en un área mucocutánea, la patología es muy variada y precisa de un enfoque multidisciplinar. En este trabajo se ha realizado una revisión descriptiva de los distintos procesos que se pueden presentar en la vulva, incluyendo la patología inflamatoria, las lesiones pigmentadas, los tumores benignos y malignos, la vulvodinia y enfermedades sistémicas que pueden manifestarse con algún tipo de afectación de la región genital femenina., Grado en Medicina

Gynecologist and plastic surgeons pioneered the application of lasers in medicine and surgery almost 5 decades ago, initially used to treat cervical and vaginal pathologies. Ever since, energy-based devices have been deployed to treat pelvic pathologies and improve fertility. Recent technological developments triggered an unprecedented wave of publications, assessing the efficacy of fractional laser, and radiofrequency on the vaginal wall in reversing natural aging processes. Studies have shown that a certain degree of thermal energy deposited on the vaginal wall stimulates proliferation of the glycogen-enriched epithelium, neovascularization, and collagen formation in the lamina propria, and improves natural lubrication and control of urination. This review aimed to review such data and to guide future research. A unique assembly of experts from around the globe, compiled and edited this manuscript based on a thorough literature review and personal experience. Lasers Surg. Med. 49:137-159, 2017. © 2017 Wiley Periodicals, Inc.

Papular acantholytic dermatosis of the vulva is a rare,chronic disorder and is an entity that remains to be fullyunderstood. It shares clinical and histopathologicaloverlap with Darier disease and Hailey-Hailey disease.We describe a 30-year-old woman with papularacantholytic dermatosis of the vulva. The lesionsconsisted of whitish papules and erosions on the labiamajora. Histologically, there was hyperkeratosis andfocal parakeratosis with acantholytic and dyskeratoticcells. She did not respond completely to topicalsteroids but clinical improvement occurred after theuse topical tacrolimus.

Background: Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular condition that manifests on the skin as a firm, blue-black colored nodule or papule. Lesions range in size from 0.25 to 5 centimeters in diameter and may be tender or painless. In some individuals, nodules appear red colored, mimicking hemangioma or pyogenic granuloma. Histologically, intravascular papillary endothelial hyperplasia is characterized by the presence of an organizing thrombus in the vascular lumen with accompanying hyperplastic endothelial cell proliferation. Common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region.Purpose: We describe the clinical and pathologic findings of a woman who developed intravascular papillary endothelial hyperplasia of the vulva. We also review the characteristics of other patients with intravascular papillary endothelial hyperplasia of the vulva and summarize the differential diagnosis and treatment options for this condition.Materials and methods: The features of a woman with intravascular papillary endothelial hyperplasia of the vulva are presented. Using PubMed, the following terms were searched and relevant citations assessed: intravascular papillary endothelial hyperplasia, IPEH, labia majora, Masson hemangioma, Masson pseudoangiosarcoma, Masson tumor, and vulva. In addition, the literature on intravascular papillary endothelial hyperplasia is reviewed.Results: A 32-year-old woman presented with a 3 x 2 millimeter painless, black colored submucosal papule on her left labia majora. The lesion was removed by excisional biopsy. Microscopic examination revealed a re-canalizing thrombus and a proliferation of erythrocytes within a dilated vascular structure. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of intravascular papillary endothelial hyperplasia was established. The patie

Introduction and Objectives: The utilisation of elective female cosmetic genital surgery (FCGS) is on the rise in Australia with many perceiving an 'abnormality' in the external appearance of female genitalia. We set out to review the current literature on female external genital anatomy and its context in FCGS. The objectives of this study are to: 1. Investigate the available measurable parameters of female external genitalia in the global literature. 2. Investigate the search trends of the term 'labiaplasty' on Google Trends given the surge in utilisation of FCGS in recent years. 3. Review Medicare data in Australia on the item number 35 533 (Vulvoplasty and Labiaplasty) to determine if the surge in public interest in labiaplasty can be correlated with the utlisation of Medicare services for FCGS. Method(s): A review of the literature using PUBMED, EMBASE, PSYCHINFO, OVID, Embase, CINAHL, Google Scholar and Web of Science was conducted with search terms 'Vulva AND/OR Vagina AND/OR Labia minora AND/OR Labia majora AND/ OR Clitoris AND OR Labiaplasty AND/ OR Vulvoplasty. ' A global search for the term labiaplasty was performed using Google Trends with the search period conducted between January 2004 to December 2014. Australian Medicare Government data for item number 35 533 (Vulvoplasty including labiaplasty) was utilised to assess trends in the uptake of female cosmetic genital surgery in Australia. Result(s): Very little exists in the current literature about parameters for the variation in the appearance of female external genital anatomy, with only one study found to measure such parameters in women. Despite the significant lack of literature, several classification systems on labia minora hypertrophy and its justification in female genital cosmetic surgery were found. Our global search using Google Trends indicated an increasing trend over time for the expression of interest in female cosmetic genital surgery (labiaplasty) in Australia and the world. Australia

Objectives Prevalence of vulvar-vaginal atrophy (VVA) has been always investigated by phone or web interview without any objective evaluation. Objective signs associated with symptoms of VVA are now termed genitourinary syndrome of menopause (GSM). This multi-centric study was performed in order to provide nation-wide data on the prevalence and management of GSM. Methods Nine hundred thirteen females, 59.3 ± 7.4 years old asking for a routine gynecological examination were recruited. Diagnosis of GSM was based on patient sensation of vaginal dryness, any objective sign of VVA and a pH > 5. Results A 722/913 (79.1%) women were diagnosed with GSM with a prevalence ranging from 64.7% to 84.2%, starting from 1 to 6 years after menopause. Sedentary women were at higher risk of GSM (OR 1.8, 95% CI: 1.3-2.5; p = 0.0005). Recent vaginal infection was more likely in women with GSM (OR 2.48, 95% CI: 1.33-4.62; p = 0.0041). Symptoms reported by women with GSM were vaginal dryness (100%), dyspareunia (77.6%), burning (56.9%), itching (56.6%) and dysuria (36.1%). Signs detected by gynecologists were mucosal dryness (99%), thinning of vaginal rugae (92.1%), pallor of the mucosa (90.7%), mucosal fragility (71.9%) and petechiae (46.7%). Only 274 (30%) of women had had a previous diagnosis of VVA/GSM. These were treated either with no therapy (9.8%), systemic hormone (9.2%), local hormone (44.5%) or local non-hormonal (36.5%) therapy. At the time of our investigation 266 of them (97.1%) still had the disorder. Conclusions GSM is a common, under-diagnosed and under-treated disorder. Measures to improve its early detection and its appropriate management are needed.