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Introduction and Hypothesis: Vaginal dimensions have clinical and surgical implications. We sought to quantify the differences between vaginal and labial dimensions in healthy ethnic Chinese and Western women with normal pelvic organ support. Methods: This is a cross-sectional study of a convenience sample of ethnic Chinese nulliparas (n = 33) and Western nulliparas (n = 33) recruited for research purposes. For each subject, magnetic resonance imaging was used to quantify the vaginal and labial dimensions. Specifically, we identified the anterior and posterior vaginal wall, the outline of the cervix in the mid-sagittal and coronal planes, and the distance from the labia majora to the hymenal ring at the urethral meatus. Results: There were significant differences in age and weight between groups. Substantial variation in vaginal and labial dimensions was found within each group. The vaginal and labial dimensions of ethnic Chinese women ranged from 9–21% smaller than those of Western women; In the ethnic Chinese group, increasing weight and BMI correlated with greater labial distance (r = 0.66 and r = 0.63 respectively); as did height and the distance from the vaginal opening to the cervical os (r = 0.5). In the Western group, only weight correlated with the labial distance (r = 0.51). Conclusions: Significant group differences in vaginal and labial dimensions were found, with the dimensions of Chinese nulliparas being up to 21% smaller than those of Western nulliparas. [ABSTRACT FROM AUTHOR]

Meihua He,1– 5,* Mingqiang Liu,1– 5,* Xiaohua Tao1– 5,* 1Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China; 2Jiangxi Provincial Clinical Research Center For Skin Diseases, Nanchang, Jiangxi, People’s Republic of China; 3Candidate Branch of National Clinical Research Center for Skin Diseases, Nanchang, Jiangxi, People’s Republic of China; 4Dermatology Institute of Jiangxi Province, Nanchang, Jiangxi, People’s Republic of China; 5The Affiliated Dermatology Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaohua Tao, Department of Dermatology, Dermatology Hospital of Jiangxi Province, Nanchang, Jiangxi, 330001, People’s Republic of China, Tel +86 15979086756, Fax +86-0791-85207512, Email taoxiaohua@126.comPurpose: Verruciform xanthoma (VX) is a rare, chronic, and benign lesion affecting the skin and mucous membranes. We reported a case of VX in the vulva of a female child.Patients and Methods: A 12-year-old female had vulvar lesions for over 10 years without any discomfort. Physical examination revealed red lobulated patches on the left labia majora with a few scales attached to the surface. Histopathological examination indicated excessive and incomplete keratinization, hypertrophic spinous layer hyperplasia, neutrophil infiltration in the epidermis, and foam-like tissue could be seen in the dermal papilla. Lymphocyte-dominated inflammatory cell infiltration was scattered around the blood vessels. Immunohistochemical results showed positive CD68.Results: The final diagnosis confirmed the presence of VX.Conclusion: Surgical intervention proved successful in achieving favorable outcomes for the patient.Plain Language Summary: Verruciform xanthoma (VX) is a rare and non-cancerous skin condition that usually appears in the mouth but can occur on the genitals. In this case, a 12-year-old girl had red, warty lesions on her left labia majora for over 10 years. The cause of VX is not well understood but may be linked to inflammation, trauma, or immune disorders rather than lipid metabolism. The girl’s condition was confirmed through a biopsy, and she underwent surgical removal with no recurrence after a year. VX in the genital area is known as Vegas xanthomas. Though VX can look like other skin issues, a detailed examination of tissue samples is crucial for an accurate diagnosis. Treatment options include surgery, laser therapy, or topical creams. While VX is generally benign, seeking medical attention is important to rule out other concerns.Keywords: verruciform xanthoma, labia, child, diagnose, treatment

Objectives: Vulvar tumor is a relatively uncommon female genito-urinary tumor, occurs mainly in post-menopausal females. Incidence and patterns of vulvar tumor differ from nation to nation, depending upon multiple factors. The aim of this study was to evaluate epidemiological patterns and clinical profile of vulvar tumor in our institution retrospectively. Methods: This is a retrospective study done in a regional cancer centre of India over10-years period. Data of all vulvar tumor patients, regarding demographic profile and tumor characteristics were collected from record section and reviewed. These data were analysed to get an idea about clinic-epidemiological trends of vulvar malignancy. Results: Total 47-patients with biopsy proven vulvar malignancy were found. Mean age at presentation was 63.4 years. Majority of the patients belonged to rural origin, were post-menopausal and multiparous. Most of them had pruritus as typical presenting symptoms. Histopathologically, squamous cell carcinoma constituted the major bulk. Labia was the commonest site of presentation. Bilateralism was found in one-third among them, inguinal lymphadenopathy and extensive disease were found in five and four patients, respectively. Conclusions: The hallmark about the present article is that it was conducted in the only referral cancer institute of this state. Limited studies from different region of India have published local patients’ data on vulvar tumor. A nationwide collaboration in this regard will help to understand the exact burden of this relatively rare malignancy, epidemiological trends and risk factors as well as an idea about how to manage these patients.

Venous malformations (VMs) involving the vulva are rare but often cause debilitating pain, aesthetic concern, and functional impairment. Treatment with medical therapy, sclerotherapy, operative resection, or a combination thereof may be considered. The optimal therapeutic approach remains unclear. We report our experience resecting labial VMs in a large cohort of patients. A retrospective review of patients who underwent partial or complete resection of a labial VM was conducted. Thirty-one patients underwent forty-three resections of vulvar VMs between 1998 and 2022. Physical examination and imaging demonstrated: 16% of patients had focal labial lesions, 6% had multifocal labial lesions, and 77% had extensive labial lesions. Indications for intervention included pain (83%), appearance (21%), functional impairment (17%), bleeding (10%), and cellulitis (7%). Sixty-one percent of patients underwent a single resection, 13% multiple partial resections, and 26% a combination of sclerotherapy and operative resection(s). Median age was 16.3 years at first operation. All patients requiring multiple operations had extensive VMs. Median blood loss was 200 mL. Postoperative complications included wound infection/dehiscence (14%), hematoma (2%), and urinary tract infection (2%). The median follow-up assessment was 14 months: 88% of patients had no complaints and 3 patients were experiencing recurrent discomfort. Surgical resection is a safe and effective approach to treating vulvar labial VMs. Patients with focal or multifocal VMs can be successfully treated with a single resection, whereas patients with an extensive VM may require multiple partial resections or combined sclerotherapy and resection(s) to achieve long-term control. Retrospective Study. IV. [ABSTRACT FROM AUTHOR]

Media uses implicit imagery to tell women which genital standards are deemed acceptable by society. Explicit depictions of genitals are usually reserved for pornographic materials, which women often describe as depicting uniform vulva appearance. It is possible that viewing invariable images of vulvas could have a negative impact on women's self-perceptions. To better understand the vulva representations women are exposed to, the current study collected images (N = 743) of vulvas from video pornography via two websites: Pornhub.com and Bellesa.co. We categorized images based on the level of pubic hair grooming and labia minora protrusion. Bellesa did not differ from Pornhub for the labia minora feature. We found that the majority of images from both websites had barely any protrusion of the labia minora past the labia majora. Pornhub showed vulvas with no hair most often, whereas Bellesa had slightly more variation in level of grooming. It is evident that both websites are depicting mostly uniform vulvas—small, groomed, and tidy. Undeviating depictions could influence women's genital ideals, pushing them to seek out extreme surgery and beauty measures in order to adhere to the standards presented. Much like clothing advertisements, which now present a range of body shapes and sizes, presenting a diverse set of images of vulvas could be beneficial to viewers. Based on the impact these images have on women's psychological wellbeing, makers of pornography should consider diversifying their search and hiring criteria when selecting actresses, while also providing image disclaimers for their viewers. [ABSTRACT FROM AUTHOR]

Objective: To measure the anatomical dimensions of the vulva in adult Indian women. To analyze their correlations with age, body mass index (BMI), parity, and mode of delivery. Methods: This cross-sectional study was conducted in a tertiary care university hospital in India, among 400 women aged 18 years and above. Various vulval measurements were taken, and Pearson's correction was applied to variables like age, BMI, parity, and mode of delivery. Results: Mean length of glans of clitoris was 5.2 ± 1.43 mm, the labia minora width was 2.6 ± 0.74 cm, length of introitus was 1.3 ± 0.59 cm, and perineal body length was 2.3 ± 0.60 cm. The range of some measurements was extensive, for example labia minora width ranged from 0.7 to 4.9 cm. Normal centile curves were constructed for vulval measurements according to age groups. Statistically significant positive correlations of age, BMI, and obstetrical history were seen with labia minora width (r = 0.165, P = 0.001; r = 0.284, P < 0.001; r = 0.246, P < 0.001, respectively). Conclusion: The centile curves can be used as a reference for the Indian population of different ages. These can be used when counseling women coming for female genital cosmetic surgery. [ABSTRACT FROM AUTHOR]

Labial fusion in adolescence is uncommon and is usually secondary to other skin disorders or trauma of the vulvar area. In a five-year period, we treated five patients with labial fusion in our facility with a mean age of 16.4 years. Based on clinical presentation and biopsy of the vulvar skin, lichen sclerosus (LS) was the causative factor. Four out of five had urinary problems and one suffered from an inflamed inclusion cyst. All of them had a long history of pruritus. In all cases, blunt separation of the labia minora under general anaesthesia was performed, followed by local application of a potent glucocorticoid cream and an emollient agent. One patient received additionally oral and local antibiotics. One recurrence was noted, which resolved after re-separation and more meticulous treatment. Early identification and treatment of LS are crucial to prevent distortion of the vulvar anatomy.Impact StatementWhat is already known on this subject? Labial fusion is an uncommon problem in adolescence and an underlying cause should always be investigated. Lichen sclerosus typically affects the anogenital area and can lead to fusion of the labia minora.What do the results of this study add? Urinary symptoms may be the presenting feature of LS in adolescents.What are the implications of these findings for clinical practice and/or further research? Delay in diagnosis and appropriate treatment can result in irreversible changes to the vulva. [ABSTRACT FROM AUTHOR]

In 1588 three Venetian private cargo ships (Balancera, Labia, and Ragazzona) were obliged by the king of Spain to participate in the Armada expedition. The paper describes the copious correspondence and controversy between the Spanish crown and the Venetian doge which, despite the insistence of the government of the Serenissima, ended with the ships' seizure. Since these ships had suffered considerable damage during the expedition, further correspondence continued with requests for compensation from the owners, only a small part of which seems to have been disbursed. [ABSTRACT FROM AUTHOR]

Labial adhesions or labial synechiae are adhesions formed between labia. They can be thick or thin flimsy. This condition is seen in young girls before their puberty and sometimes in postmenopausal women. Most common cause is deficiency of estrogen. It can also be associated with infections and inflammations. Signs and symptoms vary between cases. These cases are usually presented to an urologist before gynaecologist. Treatment most of the time is surgical involving both urologist and gynaecologist. This is a case report of 5-year-old young child who presented with complaints of painful urination. She was diagnosed with labial fusion and treated surgically with a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Highlights • Vertical skin separation in the labia with minimal trauma to the underlying tissues is described by the panel as a graze. • Vertical skin separation with involvement of the underlying tissues is described as a tear. • Current consensus is that tears should be sutured with 3.0 Vicryl Rapide and interrupted sutures. • Bilateral grazes are not an indication for suturing labial trauma. Abstract Objectives Primary objectives were to establish consensus of opinion for classification of post birth labial trauma and which types of post birth labial trauma require suturing. Secondary objectives were to establish optimal method, material and anaesthetic for suturing labial trauma. Design Delphi study consisting of 3 rounds. Setting UK and Europe Participants 8 midwives, 4 obstetricians, 7 specialist perineal midwives, 1 consultant midwife and 2 midwifery lecturers all with relevant expertise and or recent, regular clinical experience of assessing and suturing labial trauma from 2 United Kingdom (UK) universities, 12 UK healthcare trusts and 1 European healthcare organisation. Methods A Delphi study consisting of an initial round of 6 professional medical illustrations of labial trauma with 6 open questions attached to each sent to panel members. 2 further rounds developed from the first round with between 2 and 10 opt-in statements for the 6 questions for each illustration to 20 and 22 panel members respectively. Consensus was set at 70% opt-in for each statement. Findings Consensus was reached that unilateral or bilateral vertical skin separation with minimal trauma to underlying tissues was described as a graze and does not require suturing. Consensus was reached that unilateral or bilateral deeper vertical trauma with involvement of the underlying tissue and horizontal trauma across the labia does require suturing with interrupted technique, injected local anaesthetic and using Vicryl Rapide 3.0 or equivalent. Conclusion A pilot study and definitive randomised controlled trial are required to establish in vivo whether labial tears including those which are transverse, are less painful and heal better with interrupted suturing compared to continuous or subcuticular sutures. [ABSTRACT FROM AUTHOR]

Abstract Study Objective Female adolescents often present to health care providers with concerns about the appearance of their external genitalia. These patients might experience significant distress about their genital appearance and might request surgery to correct a perceived abnormality. Accurate descriptions of normal adolescent female genital anatomy are lacking in the literature. The purpose of this study was to examine a small sample of normal female adolescents to obtain measurements and descriptors of the external genital structures, with a focus on the size and morphology of the labia minora. Design, Setting, Participants, Interventions, and Main Outcome Measures Participants were female adolescent patients, ages 10-19 years, who underwent routine surgical procedures in the operating room. Results Forty-four patients were examined. The mean age was 14.4 years (range 10-19 years). Mean height was 159.6 cm and mean weight was 60.8 kg. Most were non-Hispanic ethnicity (n = 32/44; 72%) and were Caucasian race (n = 38/44; 86%). Right and left labia minora lengths were different in n = 19/44 patients (43%). Right and left labia minora widths also differed, in stretched (n = 20/33; 61%) and unstretched (n = 24/44; 55%) labia, with a difference ranging from 1 to 22 mm. There was no correlation between size and shape of labia minora and patient age, height, weight, or race. Conclusion Wide variability exists in female adolescent genital anatomy with no established normal range. This study provides a resource for physicians who care for adolescent girls, who need normative data to describe female genital anatomy. We propose that the role of labiaplasty in adolescents should be considered with extreme caution because of the wide range in size and morphology and paucity of data in this population. [ABSTRACT FROM AUTHOR]

Background: Childhood asymmetrical labium majus enlargement (CALME) has been described sparsely in recent surgery, pathology, pediatric and gynecology literature; however, no comprehensive description from a radiology perspective has been developed.Objective: The purpose of this case series is to describe the imaging findings of CALME and to review the current understanding of this recently described clinical entity with regard to clinical presentation, pathophysiology, differential diagnosis and treatment options.Materials and Methods: This is a retrospective analysis of 3 girls, ages 5-7 years, who presented for imaging evaluation with subsequent pathologically proven CALME. Each child's clinical history, length of symptoms, imaging appearance and pathological findings were reviewed.Results: All three girls presented with unilateral enlargement of the labium majus (two right-side, one left-side) with no history of trauma or other inciting cause. Two girls had painless labial enlargement that was recognized for weeks, and one had similar symptoms for 1 year prior to presentation. One girl was evaluated initially with sonography, and all three children underwent MR imaging. Sonographic evaluation showed asymmetrical labial enlargement without a definable mass. In each girl, the MR imaging findings were characterized by relatively ill-defined T1-weighted hypointense signal, T2-weighted hypo- to isointense signal with interspersed hyperintense septae, and heterogeneous patchy and feathery strands of enhancement on post-contrast imaging. Biopsy from each child showed benign fibrous tissue with intervening mature fibroadipose tissue, vessels and nerves without findings of inflammation or neoplasia.Conclusion: The MR imaging appearance of CALME is consistent. Recognition and appreciation of this unique pediatric entity by the radiologist may be essential for appropriate diagnosis and can help to guide therapy. Current preferred treatment approach is conservative. [ABSTRACT FROM AUTHOR]

The study investigated the effectiveness of two online resources aimed at improving women's knowledge of the variation in normal female genital appearance and their attitudes towards their own genitals. The first consisted of a photographic array of normal female genitals and the second consisted of a video addressing digital airbrushing of women's genitals in media images. A sample of 136 female undergraduate students were randomly assigned to view the photographs, video, both the photographs and video, or neither. The video significantly increased women's perceptions of genital appearance diversity as well as awareness of digital airbrushing of genital images. Owing to relatively low levels of genital appearance concern, there was no effect of either resource on women's attitudes towards their own genitals; however, women who viewed the video indicated they would pass on their knowledge to help other women. Our results suggest that an educational video could be a useful tool. [ABSTRACT FROM AUTHOR]

In this randomized, controlled clinical trial to compare efficacy and safety, 41 patients with labial discoid lupus erythematosus (DLE) were randomized to 2 groups, either receiving tacrolimus 0.03% ointment (n = 22) or triamcinolone acetonide 0.1% cream (n = 19). Each patient was treated with 3, 2, and 1 daily doses in the first, second, and third weeks, respectively, for 1 course. After the 3 week treatment, patients with complete disappearance of erosion were followed up for 3 months. After the 3 week application, 20 participants in the tacrolimus group and 19 in the triamcinolone acetonide group completed the study. The rates of complete response were 70% and 89.5% in tacrolimus-treated and triamcinolone acetonide-treated patients, respectively, with no significant difference ( P = .235). Reduction in erosion and erythema showed no significant difference between groups ( P > .05). Final reduction in reticulation areas and numeric rating scale scores were significantly greater in the tacrolimus group than in the triamcinolone acetonide group ( P = .013; P = .048, respectively). Only 1 patient receiving tacrolimus presented with slight discomfort. There was no significant difference in 3 month recurrence rate between the groups ( P > .05). Topical tacrolimus is considered as effective as triamcinolone acetonide for the management of labial DLE. [ABSTRACT FROM AUTHOR]

While the ageing process occurs both in males and females, the latter have the added effects of the changes brought about by the menopause. The review characterises the many menopausal changes that the decrease in oestrogens produces in neural, skeletal, circulatory and genital systems. Many of these changes can adversely affect the sexual functioning of women. The increase in female lifespan means that women can spend 30–40 years in the postmenopausal condition. Treatments need to be developed to ensure that their healthspan (those years spent without chronic-age related dysfunctions) is also increased. [ABSTRACT FROM PUBLISHER]

Introduction and hypothesis: Our goal was to determine psychosexual outcome after labiaplasty in the long-term with specific measures of genital body image and sexual dysfunction. Method: We conducted a prospective study with a matched-comparison group of women not wanting labiaplasty. Forty-nine women were compared against a group of 39 women matched for age, sexual orientation, ethnicity, and marital status. The labiaplasty group was assessed before, 3 months after and between 11 and 42 months after surgery. The comparison group was assessed at two time points 3 months apart to control for the passage of time. The primary outcome measure was the Genital Appearance Satisfaction (GAS) scale. Results: Of the 49 women receiving labiaplasty, 19 (38.8 %) were lost to follow-up but were reassessed clinically. Twenty-four of 25 (96 %) women in the labiaplasty group showed a reliable and clinically significant improvement on the GAS scale 3 months after the procedure; 21/23 (91.3 %) showed an improvement at the long-term follow-up. A large effect size was found for improvements on the GAS scale in the labiaplasty group. Small-effect sizes were found for improvements in sexual functioning. Nine women obtaining labiaplasty met diagnostic criteria for body dysmorphic disorder before the operation; eight lost that diagnosis at the 3-month follow-up; 26 % reported minor side effects. Conclusions: Labiaplasty is effective in improving genital appearance and sexual satisfaction, but larger studies are required to determine the prevalence of potential side effects. [ABSTRACT FROM AUTHOR]

BackgroundLabiaplasty is an increasingly popular surgical intervention but little is known about the characteristics and motivation of women who seek the procedure or the psychosexual outcome.MethodA total of 55 women seeking labiaplasty were compared with 70 women who did not desire labiaplasty. Various general measures of psychopathology as well as specific measures (Genital Appearance Satisfaction; Cosmetic Procedure Screening for labiaplasty) were used. Labia measurements of the women seeking labiaplasty were also obtained.ResultsWomen seeking labiaplasty did not differ from controls on measures of depression or anxiety. They did, however, express increased dissatisfaction towards the appearance of their genitalia, with lower overall sexual satisfaction and a poorer quality of life in terms of body image. Women seeking labiaplasty reported a significantly greater frequency of avoidance behaviours on all the domains assessed, and greater frequency of safety-seeking behaviours for most of the domains. Key motivations reported for labiaplasty were categorized as cosmetic, functional or sexual. Of the 55 women seeking labiaplasty, 10 met diagnostic criteria for body dysmorphic disorder.ConclusionsThis is the first controlled study to describe some of the characteristics and motivations of women seeking labiaplasty. We identified a wide range of avoidance and safety-seeking behaviours, which occurred more frequently in the labiaplasty group than the control group. These could be used clinically as part of a psychological intervention for women seeking labiaplasty. [ABSTRACT FROM AUTHOR]

In songbirds, two sound sources inside the syrinx are used to produce the primary sound. Laterally positioned labia are passively set into vibration, thus interrupting a passing air stream. Together with subsyringeal pressure, the size and tension of the labia determine the spectral characteristics of the primary sound. Very little is known about how the histological composition and morphology of the labia affect their function as sound generators. Here we related the size and microstructure of the labia to their acoustic function in two songbird species with different acoustic characteristics, the white-crowned sparrow and zebra finch. Histological serial sections of the syrinx and different staining techniques were used to identify collagen, elastin and hyaluronan as extracellular matrix components. The distribution and orientation of elastic fibers indicated that the labia in white-crowned sparrows are multi-layered structures, whereas they are more uniformly structured in the zebra finch. Collagen and hyaluronan were evenly distributed in both species. A multi-layered composition could give rise to complex viscoelastic properties of each sound source. We also measured labia size. Variability was found along the dorso-ventral axis in both species. Lateral asymmetry was identified in some individuals but not consistently at the species level. Different size between the left and right sound sources could provide a morphological basis for the acoustic specialization of each sound generator, but only in some individuals. The inconsistency of its presence requires the investigation of alternative explanations, e.g. differences in viscoelastic properties of the labia of the left and right syrinx. Furthermore, we identified attachments of syringeal muscles to the labia as well as to bronchial half rings and suggest a mechanism for their biomechanical function. [ABSTRACT FROM AUTHOR]

The increase in women's request for labia reduction surgery raises medical and ethical dilemmas for the gynecological surgeon. A bio-psycho-social approach is suggested; the problem is put forward from the perspective of the medical ethical principles and a practical guideline is proposed. [ABSTRACT FROM AUTHOR]

Introduction. Limited information is available regarding patients’ indication for seeking labiaplasty of the labia minora. Aim. The aim of this article is to investigate a patient's indications for seeking labiaplasty of the labia minora. Methods. This is a retrospective review of the medical records of all patients undergoing labiaplasty at our clinic over a 27-month period. Main Outcome Measures. Indications for surgery were assessed using standardized questionnaires during the patients’ initial history and physical. Patients were divided into three groups as based on the questionnaire, including: Group I—patients seeking the procedure strictly for aesthetic reasons; Group II—patients seeking the procedure strictly for functional impairment (i.e., pain and discomfort); and Group III—patients who feel they are having the surgery for both aesthetic and functional reasons. Patients undergoing the surgery for aesthetic reasons were also asked whether this was strictly a personal decision or was influenced by either another man or woman whether a friend, spouse, or partner. Results. The review revealed 131 patients had undergone a labia reduction surgery: Group I—those who received labia reduction surgery for strictly aesthetic reasons equaled 37% (49/131); Group II—those seeking the surgery strictly for functional impairment equaled 32% (42/131); and Group III—those seeking the surgery for both functional and aesthetic reasons equaled 31% (40/131). Conclusion. The majority of patients undergoing reduction of the labia minora do so for functional reasons with minimal outside influences affecting their decision for treatment. Miklos JR, and Moore RD. Labiaplasty of the labia minora: Patients's indications for pursuing surgery. J Sex Med 2008;5:1492–1495. [ABSTRACT FROM AUTHOR]

Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands OBJECTIVE To assess the cellular distributions of oestrogen receptors α and β (ERα and ERβ) and neuronal nitric oxide synthase (nNOS) in the labia minora, as knowledge about ER type and function may clarify the role of oestrogens in vaginal scar formation and improve outcomes in female genital surgery. SUBJECTS AND METHODS Labial samples were taken from 10 girls (aged 2–9 years) who underwent surgery for labial fusion. The waste tissue strips obtained were used for immunohistochemical identification of ERα and ERβ, and nNOS in the labia minora. RESULTS There was ERα nuclear staining in the stroma of the labia minora close to the clitoris, and basal and suprabasal in the epidermal cells membrane restricted to superficial sections of the labia minora. ERβ was found in the stroma of the labia minora closer to the clitoris and in superficial sections, in the basal epidermal cells membrane and apocrine glandular epithelial cells membrane. There was also ERβ cell membrane staining in the basal and suprabasal epithelial cells and fibroblasts in the lamina propria. CONCLUSIONS Established ER presence allows the consideration of the introitus of the vagina as a target for oestrogen therapy in various clinical and surgical situations. Continuing elucidation of the immunohistochemistry of this external genital tissue might assist in the development of molecular tools to treat genital abnormalities. Details of this immunohistochemistry may also advance the understanding of the effects of sexual differentiation on the brain and other organ systems. [ABSTRACT FROM AUTHOR]

A basic understanding of the mediators and related mechanisms involved in the genital physiology of the female sexual response, and, in particular, the physiology of arousal, is paramount for the clinical practitioner whose medical knowledge and practice pertain to female sexual dysfunction. Familiarity with established and evolving scientific principles relating to female genital physiology offers insight into functional aspects as well as disturbances of function relating to the female sexual response. Improved knowledge with regard to the central and peripheral nervous system components of female genital responses, chemical mediators, including endocrine factors determining the female sexual response, and other cellular and subcellular mechanisms should advance pharmacologic management for female sexual arousal disorder. [ABSTRACT FROM AUTHOR]

Summary: A flap is described for recreation of the labia majora. The flap was designed for a young woman who developed vulvar squamous cell carcinoma in-situ after immunosuppression for treatment of juvenile rheumatoid arthritis. The patient underwent removal of the labia majora, and was reconstructed with a bi-lobed abdominal flap tunneled through the mons pubis. The flap produced a normal genital contour and has functioned well to seven years follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Labia minora enlargement may constitute a cosmetic or functional problem for a woman, potentially leading to surgery. However, more rarely, the labia majora may also be problematic for women. This case describes the rare situation of a woman presenting with enlargement of both the labia minora and majora and her subsequent simultaneous surgical treatment. [Copyright &y& Elsevier]

Background Vulvar masses are rare in prepubertal girls. Lipoblastomas are benign adipose tumors that arise from embryonic white fat and occur almost exclusively in infants and children. Case An 18-month-old female infant presented with a 2-cm mobile mass in the left labia majora. Imaging and examination revealed normal prepubertal gynecologic structures and a 4.5 cm fatty mass in the left labia. Surgical excision revealed a 3.8 cm well circumscribed adipose tissue mass consistent with maturing lipoblastoma on microscopic examination. Cytogenetic analysis revealed 79,XXX [7]/46,XX[13], a near-triploid clone. Summary and Conclusion The differential diagnosis of vulvar masses in children should include lipoblastoma. Although preoperative imaging has limited ability to differentiate lipomatous tumors, magnetic resonance imaging is the modality of choice for evaluating tumor extension and for surgical planning. Treatment is complete surgical excision with close follow-up for at least 5 years because of the high recurrence rate. [ABSTRACT FROM AUTHOR]

Summary Introduction and aims Pediatric female genitalia size and morphology have not previously been well described. The aims of this study were to create a standard reference for the anterior vulval structures, and examine the relationship between the clitoral hood and labia minora. Method Female patients between 0 and 16 years of age, and with normal external genitalia had the following measurements taken: length of clitoral hood, length of sides of clitoral hood, clitoral diameter, apex of clitoral hood to base of pubic symphysis, apex of clitoral hood to urethral orifice, distance of clitoral hood to labia majora, and length and depth of labia minora. Qualitative descriptors of the clitoral hood and labia were recorded. Patients were grouped into age ranges for analysis: 0–3 years, 4–8 years, 9–12 years, and 13–16 years. Results Fifty-eight girls were examined. There was a linear relationship between age and genital structure size. In the majority of patients, the labia minora converged under the clitoral glans, separate to the clitoral hood. Four shapes of clitoral hood were observed: horseshoe, trumpet, coffee bean, and tent. Discussion This study observed great variation in size and morphology of pediatric female genitalia, which is in keeping with other studies. The study was limited by ability to recruit older patients to the study (girls aged 11–16 years) and, therefore, there were lower numbers in this age category. However, the trends that were observed were present in both younger and older girls. Conclusion External genitalia size and morphology are varied in the pediatric female population. The clitoral hood and labia minora were observed to be distinctly separate structures. This study provides a reference for surgeons undertaking genital reconstruction procedures. The study demonstrated that the clitoral hood and labia minora are anatomically distinct structures. Age category measurement (mm) 0–3 years ( n = 18) 4–8 years ( n = 18) 9–12 years ( n = 9) 13–16 years ( n = 13) Mean length of clitoral hood 8.7 14.3 16.9 20.9 Mean clitoral diameter 2.5 3.4 3.9 4.5 Length of sides of clitoral hood 21.6 36.2 47.8 56.4 Clitoral hood to pubic symphysis 14.7 27.6 34.6 44.5 Clitoral hood to labia majora 2.3 3.0 6.4 6.8 Clitoral hood to urethral orifice 12.4 17.1 24.8 39.4 Length of labia minora 9.4 10.7 15.2 40.0 Depth of labia minora 3.5 3.6 3.9 12.2 [ABSTRACT FROM AUTHOR]

We report a case of hair-thread tourniquet syndrome involving the labia majora of a 14-year-old autistic child.‘Hair-thread tourniquet’ refers to the process whereby a thread of hair leads to the ischaemic strangulation of an appendage or other piece of tissue. Uncommonly recognized, this syndrome has gradually gained recognition since its first description in 1612. As it remains infrequent, many have attributed its aetiology to abuse or socio-cultural practices. We review the published literature on this infrequent but important paediatric condition. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to characterize male preferences of vulvar appearance, their awareness of labiaplasty, and their knowledge of genital anatomy.Study Design: Men 18-80 years old were recruited via emails sent by an Internet provider to participate in a 27-question web-based survey. The questionnaire included images and queried demographics, men's familiarity with vulvar anatomy, preferences regarding labial appearance, and awareness of labiaplasty. Two deployments to >150,000 email addresses were sent. Demographic data were described using frequencies for categoric variables and mean measures of central tendency for continuous variables. Logistic regression models were used to analyze associations between demographics and responses.Results: Two thousand four hundred three men responded to the survey. After excluding incomplete and ineligible surveys, 1847 surveys were analyzed. The median age of respondents was 55 years. The majority was white (87%), married (68%), employed (69%), and had completed high school or beyond (97%). One-third of the respondents lived in the South, with the other regions nearly equally represented. A significant majority, 95%, reported having been sexually active with women, and 86% felt comfortable labeling the vulvar anatomy. With regard to preferences, more respondents considered smaller labia attractive compared to large labia; yet 36% of the men remained neutral. Men also showed a preference for partially or completely groomed genitals compared to natural hair pattern. Whereas 51% of participants believed the appearance of a woman's labia influenced their desire to engage in sexual activity, 60% denied it affected sexual pleasure. Only 42% of men were familiar with labiaplasty, and 75% of all respondents would not encourage a female partner to change her genital appearance. Multivariable analysis revealed younger age to be associated with preferences for small labia and complete genital hair removal, as well as familiarity with labiaplasty.Conclusion: In this national survey, men demonstrated familiarity with the female anatomy, but many did not feel it impacted sexual desire or pleasure. Moreover, the majority lacked strong preferences for a specific vulvar appearance and would not encourage a female partner to alter her genital appearance surgically. [ABSTRACT FROM AUTHOR]

During a period of 15 years, six young girls aged 18 months to 14 years with hypertrophy of the labia minora were treated at two pediatric surgical units in Athens. The clinical and laboratory investigations did not demonstrate any endocrinopathy. Surgical excision of the hypertrophied labia minora has been performed on each girl. No recurrence has been noted for at least 5 years postoperatively. [ABSTRACT FROM AUTHOR]