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Background Despite existing anthropometric data in the literature regarding the variation of female external genital anatomy, the ideal aesthetic characteristics have yet to be defined. Objectives The authors utilized crowdsourcing to better evaluate preferred anatomic characteristics of external female genitalia. Methods Fifty-six total images were digitally created by altering the proportions of the labia minora, labia majora, and clitoral hood. Images with differing ratios were presented in pairs to Amazon Mechanical Turk (Seattle, WA, USA) raters. Three different experiments were performed with each varying 2 of the 3 image characteristics to permit 2-factor modeling. The Bradley-Terry-Luce model was applied to the pairwise comparisons ratings to create a rank order for each image. Preferences for each anatomic variable were compared with chi-squared tests. Results A total of 5000 raters participated. Experiment 1 compared differing widths of the labia majora and labia minora and determined a significant preference for larger labia majora width and mid-range labia minora width (P = 0.007). Experiment 2 compared labia minora width vs clitoral hood length and showed a statistically significant preference for wider majoras (P Conclusions Raters preferred a labia majora to labia minora width ratio of 3:1 with minimal preference in clitoral hood length.

Labia minora reduction has become part of the treatment spectrum offered by most plastic surgeons. The author has performed many corrective procedures involving the outer female genital region, most of which involved reducing the labia minora of approximately 4300 women. Over the years, the number of corrective procedures to rectify poorly performed initial operations increased significantly at the author’s practice. The most common iatrogenic deformity is the overresection of the labia minora below the clitoris, leaving behind excess tissue in the area around and above the clitoral hood (small penis deformity). Two basic procedures may be used to reconstruct the labia minora below the clitoris: reconstructing the labia minora by redundant labial tissue above the clitoris to form bilateral preputial flaps being rotated downward into the defect and reconstructing the labia minora by vaginal skin advancement. Other reconstructions depend on the deformity itself. The postoperative outcome was assessed in an anonymous questionnaire answered by 544 patients. The outcome showed a significant improvement in functional and psychological impairment as a result of the deformities caused by the initial operation. Even if the reconstruction of the labia minora did not produce the desired initial result, overall satisfaction with the corrective surgery was very satisfactory. The increase of iatrogenic deformities after the initial labia reductions is alarming. The causes of this growth are manifold: underestimation of the procedure, misjudgment and a lack of detailed knowledge. This has a heavy psychological and physical impact on patients. Reconstruction of excessively shortened labia minora is often not easy and not always satisfactory. Training and the establishment of surgical standards should be used to avoid errors and achieve the best result. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background Complications caused by female genital mutilation (FGM), such as clitoral pain, reduced sensation, and diminished sexual function, can be alleviated by clitoral reconstruction, which can also improve the aesthetics and restore the anatomy of the genitalia. Objectives The aim of this study was to create sensate labial flaps to cover the neoclitoris and assess the outcome of the procedure. Methods Between December 2018 and July 2020, 40 patients with FGM underwent clitoral reconstruction and coverage with sensate labial flaps donated by the remnant of the labia minora and were followed prospectively. Flaps were mapped on the less-mutilated labia minora according to recent descriptions of arterial anatomy and innervation. Before the surgery, the patients’ clitoral sensation was assessed on a 6-point scale and they were also given the Female Sexual Functional Index (FSFI) questionnaire to complete. Eight and 24 weeks postoperatively, the same assessment was repeated and the data compared. Results The mean Female Sexual Functional Index score increased significantly from 11.64 (range, 2.8-25.6) preoperatively to 29.14 (range, 12.8-35.4) postoperatively. Similarly, clitoral sensation increased significantly from 2.35 (range, 1-4) before the surgery to 4.9 (range, 2-6) after the surgery. In total, 95% of patients benefited from the surgery. Conclusions Clitoral reconstruction with sensate labial flaps after FGM resulted in significant improvements in sexual function, clitoral sensation, genital aesthetics, and self-esteem. Level of Evidence: 4

Introduction Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldes in France. The technique was then modified by different authors. Aim This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris. Methods We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris. Main Outcomes A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting Results We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldes, We included the technical modifications and contributions described in articles published subsequently. Conclusion Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM. Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;18:996–1008.

"Hair-thread tourniquet syndrome" (HTTS) describes the condition in which fibers of hair or thread wrap around an appendage (ie, toes, fingers, genital structures, tongue, uvula, and neck), eventually causing ischemia and tissue necrosis. To date, few cases of female genitalia HTTS have been described. We report a case of female genitalia HTTS in a 5-year-old girl and report the state of the art by systematically reviewing all existing evidence about female genital HTTS. A total of 29 studies, describing a total of 34 patients, were identified. The presence of a hair-thread wrapping genitalia should be suspected in prepubertal girls complaining of genital pain associated with vulvar/vaginal swelling, wide-based gait, and voiding symptoms. Genital examination disclosing an extremely tender, swollen, and erythematous lesion on the clitoris or labia minora encircled by a hair confirms the diagnosis. The aim of the management is to remove the hair-thread in the shortest time possible, with the use of forceps, scissors, or scalpels, and this is often performed under sedation/anesthesia because of the patient's pain reaction. When the hair-thread is difficult to find or when the lesion is necrotic, excision of the lesion itself can be the only option. Complications include partial or total amputation because of tissue necrosis and recurrence.

Background Metoidioplasty is a gender-affirming surgical option for individuals who desire masculine genitalia while preserving erogenous sensation and avoiding the morbidity of phalloplasty. Concurrent urethral lengthening offers patients the potential to stand to urinate. Objective To demonstrate an adaptation of the Belgrade technique of gender-affirming metoidioplasty and describe outcomes. Methods We identified 33 patients of which 12 underwent simple metoidioplasty and 21 underwent metoidioplasty with urethral lengthening between 2016 and 2020. Prior to surgery, all patients underwent at least 1 year of testosterone therapy to maximize clitoral growth. The clitoris is degloved and the superficial suspensory ligament divided to maximize phallic length. Labia minora flaps are developed and the urethral plate is divided to allow for maximal ventral extension. The resultant urethral defect is bridged with a buccal mucosa graft. To construct the ventral aspect of the urethra, an anterior vaginal wall flap and labia minora flap are sutured to the urethral plate and tubularized over a 16 Fr catheter. The medial aspect of the contralateral labia minora is de-epithelialized and overlaps the urethra, serving as ventral skin coverage for the phallic shaft. Bilateral labia majora flaps are then rotated anteriorly and superiorly to create a neoscrotum using the Ghent technique. Results For metoidioplasty with urethral lengthening, the median operative time was 408 minutes, estimated blood loss 400 mL, and length of stay 3 days. Of the 21 patients, 10 (47%) elected to undergo second stage scrotoplasty, 7 (33%) underwent testicular implant placement, and 2 (9%) required revision urethroplasty. Of the 10 patients (48%) who experienced postoperative complications, 7 were Clavien-Dindo grade I-II. There were no fistulae at a median follow-up time of 5.5 months (range 1-27.2). Conclusion We provide a stepwise approach to metoidioplasty with urethral lengthening using a modified Belgrade technique, which was associated with a low rate of urethral complications.

BACKGROUND: Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment. AIM: This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS). MATERIALS AND METHODS: The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located. RESULTS: These studies showed significant variation in labial length (range 5-100 mm) and width (range 1-60 mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets. CONCLUSION: This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.

Purpose of ReviewTo examine the ‘zero tolerance’ policy for female genital cutting (FGM/C) in the international health community in light of the growing popularity of FGCS (female genital cosmetic surgery) worldwide.Recent Findings‘Traditional’ FGM/C performed in Egypt and Sudan and cosmetic labiaplasty performed in Europe, the Americas, and Antipodes by medically trained gynaecologists and plastic surgeons are based on similar aesthetic logics: labia minora that protrude beyond the labia majora are deemed ugly, masculine, and ‘abnormal’. Drawing on the burgeoning medical, social science, and humanities literature surrounding labiaplasty, the paper documents the narrowing of aesthetic standards governing ‘normal’ genital appearance and finds that, in addition to adult women, thousands of (mainly Caucasian) adolescents have undergone these operations whose long-term health consequences are unknown.SummaryWestern heteronormativity, gender binarism, ageism, and the colonial association of protruding labia minora with animality contribute to body image insecurities and fuel the labiaplasty phenomenon, despite the ethical challenge that the procedures are clearly defined by the WHO as type II (a–c) female genital mutilations.

To better understand details of the fine anatomy of the labia minora, present images of the vascular anatomy and characterize the nerve and lymphatic distribution of the labia minora. Two fixed and five fresh cadaveric specimens were perfused and dissected, and the vascular network was photographed. Labia minora samples, prepared from cadavers, and tissue resulting from labia reduction surgery underwent hematoxylin and eosin staining and S100 and D2-40 immunohistochemical staining. Arteries emanated from the base to the edge of the labia minora, where there was a larger feeding artery, and the arteries were anastomosed. The veins formed anastomotic branches in the same direction as the edge of the labia minora. Arteries and veins that accessed the labia minora were successfully perfused at the same time with no obvious association. Sensory nerve endings were abundant, mostly larger with myelinated nerve trunks and Schwann cells in the central area with suggested neurovascular associations and smaller with no obvious aggregation at the edge. The medial area had 23.63 ± 11.82 nerves/view, the lateral area 21.30 ± 11.49 nerves/view (P > 0.05). The thickest nerve bundle was 3.16 ± 1.41 mm from the medial epidermis and 3.13 ± 1.47 mm from the lateral epidermis. Lymphatic vessels showed no obvious regional distribution. Labia minora were 21.77 ± 5.69 mm wide with 252.87 ± 63.01 lymphatic vessels at 3.67 ± 1.61/mm2 density. The shortest inner diameter of dilated lymphatic vessels was 161.09 ± 49.99 μm. A larger feeding artery exists in the labia minora, which should be noticed in the pre-surgery design of labiaplasty. No difference was observed in the nerve distribution between the medial and lateral sides. Lymphedema might not be the cause of labial hypertrophy.

OBJECTIVE The objective of this study was to evaluate the functional results of dorsal onlay labia minora graft urethroplasty in the treatment of female urethral strictures. MATERIALS AND METHODS Data were retrospectively examined for 13 patients who underwent augmentation urethroplasty through the dorsal approach using labia minora grafts between September 2017 and January 2019. Demographic, intraoperative, and postoperative data and follow-up conditions were recorded for all patients. RESULTS The mean age of the patients was calculated as 48.2±7 years. The etiology of urethral strictures was found to be trauma in 2 patients, iatrogenic in 4 patients, and idiopathic causes in 7 patients. The mean urethral stricture length of the patients was 1.5±0.4 cm (range, 1-2.5 cm). The mean surgical duration was 95±11.4 minutes (range, 70-110 minutes). The mean postoperative American Urology Association symptom score, maximum urine flow rate, and postmictional residue values were statistically significantly different compared with preoperative data (P < 0.05). No peroperative and postoperative complications were detected in any patients. The mean follow-up duration of the patients was 19±5.3 months, and no recurrence of stricture was observed in any patients based on the cystourethroscopic examinations. All patients are being followed up in our clinic without any stricture recurrence or symptoms. CONCLUSIONS The dorsal onlay labia minora graft urethroplasty technique in female urethral strictures is an efficient and applicable method with postoperative anatomic and functional results. Studies with longer follow-up periods and larger patient populations are required to present the success and reliability of this technique.

Intermittent inflammation of the vulval pilosebaceous units is common and usually self-limiting, but some patients experience recurrent and more troublesome symptoms. There is a scarcity of information on this problem. We describe the clinical and histological features in these patients and the response to treatment. A retrospective, observational study of 16 patients with this phenomenon of recurrent, protracted folliculocentric inflammation of the vulval pilosebaceous unit was performed. Details on the clinical features, histology and response to treatment were collected. Mean age at presentation was 32 years (range 21-45). All patients reported recurrent painful papules and pustules on the labia majora and labia minora. Nine patients reported a cyclical pattern to the development of lesions, with premenstrual exacerbation being most common. Histological examination of these lesions showed a folliculocentric microabscess formation surrounded by an acute and chronic inflammatory cell infiltrate, with a focal foreign-body granulomatous reaction. All our patients responded well to tetracycline, antiandrogenic or retinoid therapy. We propose the term 'vulval acne' for this condition and propose a stepwise approach to its management. We hope to highlight this as a common but underreported entity.

Objective: To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception.Materials and Methods: This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured.Results: The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores.Conclusion: The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes. Amaç: Kadın genital organının anatomisine dair temel veri edinmek ve bu ölçümler ile cinsel işlev ve genital algı arasındaki korelasyonu araştırmak.Gereç ve Yöntemler: Bu prospektif kohort çalışma, 208 sağlıklı premenopozal kadın ile yapıldı. Kadın Cinsel İşlev indeksi (FSFI) ve Kadın Genital Benlik İmajı ölçeği (FGSIS) anketleri uygulandı. Katılımcılar kadın cinsel işlev bozukluğu (FSD) durumuna göre iki gruba ayrıldı. Dış genital ölçümler ile ön ve arka vajinal uzunluk ölçüldü.Bulgular: Dış kadın genital ölçümleri (cm, ortalama ± standart sapma): klitoral prepus uzunluğu 2,05±0,48; glans klitoris uzunluğu 0,87±0,21; glans klitoris genişliği 0,60±0,15; üretra-klitoris mesafesi 2,24±0,55; ön forniks derinliği 7,75±0,92; arka forniks derinliği 9,25±0,75; labia minora genişliği, sağ 2,12±0,86, sol 2,20±0,96. Toplam FGSIS skorları ile klitoral prepus uzunluğu arasında zayıf negatif korelasyon bulundu (p=0,01, r=-0,17), toplam FGSIS skorları ile anterior-posterior vajinal uzunluklar arasında zayıf pozitif korelasyon saptandı (p=0,04, r=0,13; p=0,02, r=0,15). FSD’li katılımcıların (n=82, %39,4) ve FSD’si olmayanların (n=126, %60,6) genital ölçümleri ile toplam FSFI skorları ve orgazm skorları arasında istatistiksel olarak anlamlı bir fark bulunmadı.Sonuç: Kadın genital ölçümlerini geniş bir aralıkta bulundu. Genital ölçümler ile genital algı arasındaki ilişki değişkenlik gösterse de, genital ölçümler ile cinsel işlevler veya orgazm arasında anlamlı bir ilişki bulunmamıştır. Bu bulgular, kozmetik amaçlı genital cerrahilere daha temkinli bir yaklaşım gerektiğini göstermektedir. WOS:000577569000006 2-s2.0-85104747758

This case report highlights the importance of a wide differential diagnosis in transgender patients. A 77-year-old transgender (female-to-male) with recurrent urinary tract infections (UTI) and obstructive voiding difficulties presented with a perineal cyst. Further examinations, including computed tomography (CT) and puncture, revealed that the patient had a symptomatic Bartholin gland cyst, a phenomenon that normally only affects women. In his gender confirmation surgery (GCS) 30 years before, the patient’s female labia minora and Bartholin glands were used to lengthen the urethra for the phalloplasty. This explains the unusual location and the prolonged time to the correct diagnose. We decided to perform an incision of the fluid collection from perineal. A follow-up sonography after one month revealed a remaining cyst size of 6 mL, which was assumed to be residual fluid or newly produced liquid; however, the patient has not had any UTIs since the incision of the cyst. Our case seems to be the first description of a symptomatic Bartholin gland cyst in a trans man. This stresses the importance of an expanded understanding of sex/gender concepts, and underlines one of the many possible diagnostic pitfalls when treating trans people.

Purpose Outcomes after female cosmetic genital surgery (FCGS) performed by plastic surgeons working in a group practice setting have not been well documented. This article aimed to assess outcomes and to describe FCGS techniques used in a large group private plastic surgery practice. Methods A retrospective chart review identified patients who underwent FCGS from 2009 to 2018. Demographic, clinical, and operative information was reviewed and recorded. Outcomes were assessed by evaluating postoperative complications and the need for revision surgery. Results Seventy-seven women between the ages of 14 and 53 years underwent FCGS performed by 1 of 6 surgeons. Forty-five patients underwent central wedge excision for labia minora hypertrophy, whereas 32 patients underwent extended central wedge excision for labia minora and clitoral hood hypertrophy. Four patients underwent liposuction of the mons pubis as an additional procedure. Over a mean follow-up of 37.4 months, postoperative asymmetry/redundancy occurred in 12 patients, requiring revision in 10. Wound dehiscence occurred in 12 patients, requiring revision in 9. There was one hematoma postoperatively requiring evacuation, one case of dyspareunia, and one case of decreased sensation. A single-layer wound closure (P = 0.050) and mons liposuction (P = 0.011) were risk factors for wound dehiscence. Conclusions Central wedge excision and extended central wedge excision labiaplasty were the techniques used in a large group plastic surgery practice. Postoperative asymmetry and dehiscence were the most common complications, and the revision surgery rate was high. A single-layer wound closure and additional mons liposuction were risk factors for dehiscence after central wedge labiaplasty.

Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics. A systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: “labiaplasty,” “vaginal rejuvenation,” and “liposuction mons pubis.” All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860). A total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I–III. Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.

Introduction Poor genital self-image is a common phenomenon leading to an increasing interest in female genital surgery over the last years. Aim The aim was to correlate objective measurements of the labia minora with the individual subjective perception of the labial size. Methods In a cross-sectional study with 200 premenopausal women (median age 33.5 years) presenting for gynecological issues other than vulvar diseases, labial width and length were measured, and psychological and physical complaints were assessed. Multivariable logistic regression analyses were performed to identify factors that influenced self-reported complaints and subjective perception of labia size. Main Outcome Measure The main outcome measure was labial appearance (width and length in mm, color), subjective perception of the labial size, and complaints. Results The median width of the labia minora was 19.0 mm (interquartile range = 12.6–27.5), and the median length was 35.5 mm (interquartile range = 27.8–48.9). The objective size of the labia was significantly associated with womens' subjective perception of the labial size, but not with self-reported complaints. Nearly one-third of the women (n = 53, 27%) reported complaints of their labia minora which were mainly physical (n = 41, 77%) or a combination of physical and psychological problems (n = 9, 17%), while only a small group reported experiencing only psychological complaints (n = 3, 6%). Predictors of complaints were previous cosmetic surgery and the subjective perception of the labia size. The latter was significantly associated with discomfort during intercourse and when visiting a sauna and by labia minora that protruded over the labia majora. Clinical Implications Cutoff values to define labial hypertrophy and to justify labial reduction surgery should be avoided. Strength & Limitations This is a large sample of labial measurements in women not seeking labiaplasty. Standardized and validated questions regarding quality of life, sexuality, and body image could have provided more insight into psychological aspects. Conclusion These data demonstrate the variability of labial anatomy and its perception.

Highlights • Anorectal malformation in adult was rare findings. • Transfistula anorecatoplasty procedure in adult never been published. • Good clinical outcome after procedure., Introduction Female anorectal malformation (ARM) is correctable congenital defects. Delayed presentation of patients with anorectal malformation is uncommon. However, presentation beyond teenage years is not commonplace. We describe a case of ARM with rectovestibular fistula and anal atresia. Presentation of case A 31 years old woman with chief complaint of small vaginal introitus. Gynecology examination showed urethra, labia majora, labia minora, and small vaginal introitus. Vaginal length was 6 cm. There was no anal canal. The patient underwent transfistula anorectoplasty and modified Fenton procedure. Discussion The important step of transfistula anorectoplasty (TFARP) procedure is the placement of neoanus in the center of external spinchter to provide continence. The absence of skin incision in anterior and posterior to the neoanus provide good cosmetic result. Compared to PSARP procedure, TFARP procedure has advantage which is the absence of separation of the skin in the midline buttock, the levator muscle, and the external spinchter complex. This lead to optimal fecal continence. In our experience, TFARP is a safe and effective procedure. Daily vaginal dilation in postoperative period is unnecessary. This technique also give good cosmetic result with optimal fecal continence and sexual function. Conclusion Transfistula anorectoplasty procedure for ARM give give good cosmetic result and optimal fecal continence and sexual function.

Objective: The aim of this research was to evaluate the efficacy and safety of Er:YAG lasers to improve signs and symptoms of vulvar lichen sclerosus. Methods: The study population consisted of 28 women with symptomatic vulvar lichen sclerosus. Three nonablative, thermal-only Er:YAG laser treatment sessions (7 J/cm2, 2 Hz, 7 mm spot) were performed at 4-week intervals. Each patient was asked about the presence of symptoms, such as itching, pain, and coital pain. Clinical diagnosis was established on the basis of the presence of lesions such as hypopigmentation, ecchymosis, hyperkeratosis, excoriations, or fissures. The affected areas were divided by zones (clitoris, introitus, labia minora, labia majora, perineum, labial fusion, and effacement) and were visually evaluated. Based on the presence of symptoms, lesions, and affected zones, a scale with a maximum of 14 scores was established for use before and after treatment. The impact of lichen sclerosus on patients' lives before and after treatment was evaluated with an 11-point visual analogue scale, and treatment discomfort was assessed at each session. Results: After analysis of each scoring component, individual statistically significant reductions were observed in itching, pain, ecchymosis, excoriations, and hypopigmentation. Conclusion: The Er:YAG laser is a safe, well tolerated, and effective method for the adjuvant treatment of vulvar lichen sclerosus. Three sessions with monthly intervals using the indicated parameters can quantifiably reduce the impact of lichen sclerosus on patients' lives. Keywords: erbium laser, vulvar lichen sclerosus

Introduction: High-frequency ultrasonography enables visualization the layered structure of the skin and shows the epidermis, dermis, subcutaneous tissue and skin appendages: hair follicles, sebaceous glands, sweat glands and blood vessels. The aim of this study was to apply high-frequency ultrasonography to evaluate the structure of the vulva, vagina and cervix, and to describe their anatomy in ultrasound. Material and method: The examinations were conducted with the use of high-frequency probes: DermaView 48 MHz and Episcan 50 MHz, by three operators experienced in performing classical ultrasound scans (with 30-, 10- and 9-year experience). The study involved 50 women aged 20-80 years who reported for a periodical gynecological check-up and presented no symptoms within the reproductive system. Results: In this study, the individual layers of the skin in the area of the mons pubis, labia majora (together with hair follicles and sweat glands) and labia minora were successfully visualized in all the patients. The subepidermal low-echogenicity band was seen in the area of the mons pubic and labia majora in 40 cases. This concerned 100% of women who underwent cosmetic skin treatments. In all the patients, HFUS demonstrated the layered structure of the anterior and posterior vaginal walls, the walls of the urinary bladder and rectum, layers of the vaginal portion of the cervix and the external opening of the cervix. Conclusions: High-frequency ultrasonography offers new quality of vulvar, vaginal and cervical imaging. It can be used for evaluation of the vulva and vagina, and confirms their layered structure. It also enables accurate measurements of the thickness of the vulvar epidermis and dermis as well as the thickness of the vaginal walls.

Background Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis of the genital skin, with up to 20% of cases in the pediatric age group. Limited data exist concerning the prognosis of pediatric VLS, particularly the likelihood of permanent architectural change and whether this can be prevented by compliance with topical corticosteroid treatment (TCS). Objective To evaluate the extent to which compliance to TCS treatment influences the risk of developing vulvar structural abnormalities, including clitoral phimosis and diminutive or fused labia minora. Methods A retrospective chart review of case records of pediatric-age females with VLS between January 31, 2004 and January 31, 2021. Results One hundred eighteen cases of VLS were identified, with a mean age at diagnosis of 7.25 years and a mean follow-up period of 42.7 months. Thirty-four girls were "partially compliant," whereas 84 were "compliant." The risk ratio (RR) of developing any vulvar structural abnormality or clitoral phimosis was 5.76 (95% CI 2.96-11.3) and 21.2 (95%CI 5.23-85.9) times higher, respectively, in partially compliant compared with compliant subjects. The RR of a partially compliant female with pre-pubertal onset VLS having a vulvar structural abnormality persisting beyond menarche was increased 3.54-fold relative to compliant females (95% CI 1.75-7.17). Limitations The retrospective nature of our data, lack of a control group, wide variability in follow-up duration, and nonstandardized method of stratifying compliance. Conclusion Vulvar structural abnormalities are common in prepubertal onset VLS. Compliance to TCS appears to be critical in the prognosis of pediatric VLS although attitudes underpinning noncompliance to TCS treatment require further elucidation.

Female genital alteration (FGA) encompasses a wide range of procedures. Minimal FGA consists of a simple nick with a sharp instrument, leaving no residua. Most Malay and Indonesian girls probably undergo such a vulvar nick. The other extreme of FGA is to remove the entire external genitalia and to surgically narrow the vaginal orifice to render penile penetration difficult or impossible. This procedure, called infibulation, has been prevalent in the Horn of Africa. FGA performance in various places by poorly trained operators under unhygienic conditions increases the risk of all variants of FGA. The frequent absence of analgesia augments likely psychological trauma, though these procedures have become increasing medicalized. All forms of ritual FGA in children are illegal in Western nations, so that outcomes have not been well studied. States in which FGA is indigenous must deal with FGA in the context of their own cultural and legal environment. Where it is tolerated, it is hoped that objective evidence of its effects will be forthcoming, so that policies can be informed by data. In the West, some ritual FGA procedures have acceptable comparable secular procedures. Aesthetic labia minora reduction and clitoral hood retraction (in physically mature women), for example, are legal. Application of the State Intervention Test shows no acceptable application of FGA in physically immature girls except, in some cases, for a vulvar nick. More extensive procedures, performed in physically mature and mentally maturing minors, should be evaluated for acceptability on the basis of individual procedures, in the context of mainstream practices.

BACKGROUND Hypertrophy of the labia minora with lateral clitoral hood redundancy is common, but the excess clitoral hood is often overlooked during labiaplasty, which may result in imbalanced and unsatisfactory outcomes. The purpose of this study was to present an easy method of three-step excision for composite labia minora and lateral clitoral hood reduction. METHODS The procedure was performed in three steps: the prominent clitoral hood skin parallel to the labia majora and the clitoral hood sulcus was removed first; then, the protuberant portion of the labia minora was removed by wedge resection; and finally, a triangle at the junction between the labia minora and the clitoral hood was trimmed. Patients were required to return for examination on the first day and within 14 days after surgery. Follow-ups were arranged on the Internet or at the outpatient clinic. Satisfaction questionnaires were completed during follow-up. RESULTS Between January of 2016 and January of 2020, 136 patients underwent composite labia minora and lateral clitoral hood reduction. Ages ranged from 9 to 55 years. Six patients experienced complications (4.4 percent) and five underwent revision surgery (3.7 percent). The overall satisfaction rate within 14 days and after 3 months following surgery was 91.0 percent and 95.5 percent, respectively. Preoperative discomfort was resolved in 43.0 percent and significantly relieved in 54.2 percent, and sex life was improved in 70.9 percent. CONCLUSIONS Three-step excision is effective and safe for composite labia minora and lateral clitoral hood reduction with very high satisfaction. Considering the advantages of easy preoperative design and controllable tissue removal, this method could be a better alternative to the present procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

An otherwise healthy 71-year-old woman presented to our clinic with a history of pruritus and burning of the vulva. On examination, we observed an atrophic, white, shiny plaque involving the vulva, perineum and perianal areas. The clitoral hood and labia minora were completely scarred and the

Introduction Female genital cosmetic surgery includes traditional surgical procedures resulting in alterations in genital size, appearance, and function as well as cosmetic vulvar and labial procedures. Vaginal labiaplasty, the surgical reduction of the labia minora as a treatment for labia hypertrophy, is becoming more and more common and there are many different techniques with no optimal approach suggested. Aim The purpose of this study is to report on a “sutureless” laser labiaplasty and to evaluate the efficacy and safety of this technique. Methods A retrospective chart review analysis of all 80 patients who underwent laser labiaplasty between February 2015 and April 2018 was conducted. Main Outcome Measures Women were asked about or checked for side effect and answered a questionnaire regarding their satisfaction. Results Majority of women did not report of any side effect, 7 reported wound infection, bleeding was reported by 1 patient, and 1 woman reported hematoma formation. All of the patients reported high satisfaction. There were no partly satisfied or dissatisfied patients. Conclusion Sutureless laser labiaplasty is a safe and effective way of improving women's lives and is associated with a high degree of patient satisfaction.

Labial adhesion is characterised by complete or partial fusion of the labia minora. It occurs rarely in postmenopausal women. Although various methods have been proposed, there is no established treatment for postmenopausal patients with labial adhesions due to its low prevalence in this age group. Severe cases require surgical intervention, and the postoperative recurrence rate is relatively high at 14–20%. In this study, a novel therapeutic method was designed to treat labial adhesions: a combination of Z- and Y-V-plasty. An 82-year-old woman was diagnosed with severe long labial adhesion during an episode of urinary tract infection. The labia could not be separated manually; hence, Z-plasty was performed on the ventral side and Y-V-plasty on the anal side under general anaesthesia. No recurrence was noted eight months postoperatively. This method is relatively easy and produced the desired therapeutic effect with decreased risk of recurrence. This is a novel approach for postmenopausal patients with severe labial adhesion., Highlights • Labial adhesions can manifest as urinary tract infections in postmenopausal women. • Labial adhesion in postmenopausal women is characterised by severe fusion. • Z- and YV plasty on ventral and anal sides, respectively, is a novel approach. • Z and YV plasty produced desired therapeutic effect and decreased re-adhesion risk.

Vulval lichen planus (VLP) is a rare, but often chronic, inflammatory disease whose symptoms include genital pain, discomfort, and dyspareunia. The clinical manifestations include erythema, erosions, and scarring. The aim of this study was to longitudinally investigate patient-reported outcomes and clinical findings in patients with VLP. Patients (>18 years) with histologically confirmed VLP were included in the retrospective analysis. Patient demographics, clinical features, symptomatology, quality of life, management, clinical outcomes, and comorbidities associated with VLP were analyzed. Twenty-four patients were identified with a mean (standard deviation [SD]) follow-up time of 19.3 (13.8) months. Classical VLP with glazed erythema was found in seven (29.2%) patients, erosive VLP was present in 15 (62.5%) patients, and hypertrophic VLP in two (8.3%). Seven patients had additional cutaneous involvement, while six patients had both vulval and oral mucosal involvement. The labia minora was the most frequently affected anatomical site (83.3%), followed by the clitoris (58.3%). Scarring lesions were found in 62.5% (n = 15) of patients. All study participants received treatment with potent and/or superpotent topical corticosteroids but 50% required systemic therapy (acitretin, corticosteroids, or hydroxychloroquine). Five (20.8%) patients underwent surgery due to adhesions and scarring resulting from VLP. One patient was diagnosed with a vulval squamous cell carcinoma during long-term follow-up. The mean (SD) Dermatology Life Quality Index score was 8.4 (5.5) at presentation and 8.9 (6.8) at the end of follow-up. In conclusion, VLP was associated with moderate quality of life impairments which persisted despite treatment, suggesting that current treatments for VLP are inadequate.

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

INTRODUCTION AND OBJECTIVE:Ring flap urethroplasty is a useful technique for creation of the pars fixa urethra during single stage gender affirming phalloplasty, particularly when significant ureth...

1. R. Kiran Chawla, MD* 2. Sinduja Lakkunarajah, MD 3. M. Susan Jay, MD* 1. *Division of Adolescent Medicine, Department of Pediatrics, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI A 10-year-old girl presents to a midwestern adolescent medicine (AM) clinic for evaluation of a labial lesion. Her medical history is significant in that she has entered puberty but is still premenarchal. Her psychiatric history is noncontributory. She initially notes a 1-day history of genital pain that began during a dance recital. She is a competitive jazz dancer. The following day, her mother noticed that she had a wide-based gait when ambulating. She was brought to her pediatrician for evaluation. On physical examination she was found to have redundant labial folds and a 1-cm erythematous mass on the right labia with overlying crusting (Fig 1). She was discharged with instructions to apply petroleum jelly to help with irritation. The same day, her mother brought her to a pediatric urgent care clinic for a second opinion, and she was referred to the AM clinic at a midwestern children’s hospital. She reports wearing a tight leotard at the time of symptom onset but denies any history of behavioral issues, injury, infections, use of new soaps or detergents, being sexually active, engaging in hair removal in the genital area, and any history of abuse. Furthermore, there is no family history of skin conditions or cancers. Figure 1. A redundant labial fold is noted, as is a 1-cm erythematous mass on the right labia with overlying crusting inferiorly. This lesion is also noted to be hyperpigmented. She comes to the AM clinic 2 days after her urgent care visit due to increasing redness and swelling surrounding the “stuck-on” lesion as well as an increase in size and pigmentation. Review of systems is otherwise negative. Aside from applying petroleum jelly, she …

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which may present in a prepubertal or adolescent patient. The most popular theories are its autoimmune and genetic conditioning, although theories concerning hormonal and infectious etiology have also been raised. The most common presenting symptoms of VLS is vulva pruritus, discomfort, dysuria and constipation. In physical examination, a classic “Figure 8” pattern is described, involving the labia minora, clitoral hood, and perianal region. The lesions initially are white, flat-topped papules, thin plaques, or commonly atrophic patches. Purpura is a hallmark feature of VLS. The treatment includes topical anti-inflammatory agents and long-term follow-up, as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with a history of lichen sclerosus. This article reviews vulvar lichen sclerosus in children and provides evidence-based medicine principles for treatment in the pediatric population. A systematic search of the literature shows recurrence of VLS in children. Maintenance regimens deserve further consideration.

Genitourinary syndrome (GUS) is a very frequent disease after menopause and is caused by a sharp decline in estrogen levels (). According to the North American Menopause Society, the current concept of the syndrome includes a set of signs observed during a physical examination and associated symptoms due to estrogen deficiency, involving the labia majora, labia minora, vestibule, clitoris, urethra, and bladder (). Classical therapy consists of long-term use of topical estrogen (,). However, adherence to treatment is reduced over [...]

Introduction: Nodular malignant hidradenoma (NH) of vulva is a rare entity. It is a malignant, aggressive tumor of the eccrine glands that was first reported in literature as a clear cell eccrine carcinoma in 1954. It is a rare tumor with predilection for the head face and extremities. It usually present in sixth decade of life with equal male/female distribution but cases have also been reported in children and neonates. Here we present a case of malignant nodular hidradenoma vulva in a 20yr pregnant woman. Case Presentation: A 20yrs old primi patient at 38weeks pregnancy presented to our outpatient department with a painless vulval swelling since 3 months which had increased rapidly in size. On examination the swelling was arising from upper one third of right labia minora. The mass was 4 x 4 cm in size and was displacing the urethral meatus towards left and involving the vagina upto the fornices. The patient had history of excision of similar vulvar swelling 7 months back and the histopathology was suggestive of hidradenoma vulva. Patient delivered vaginally after 2 days. She was thoroughly investigated.CT scan lower abdomen and pelvis and chest x-ray revealed that it was a locally invasive tumor with distant metastasis. Patient was given neoadjuvant chemotherapy for 3 cycles after which surgical excision of the residual disease with bilateral inguinal lymphadenectomy done post operatively 3 more cycles of chemotherapy given. Patient was kept in regular follow up. Conclusion: Malignant hidradenoma of vulva is a locally aggressive tumor with rapid progression, poor prognosis and high recurrence. Early diagnosis and excision with adjuvant chemotherapy is imperative. Keywords: Malignant, Hidradenoma, Vulva, Metastasis.

The aim of this study is to evaluate the actual use of serological/DNA analyses in the investigations carried out on adult sexual violence victims in Italy during the years 2006–2015. The victims were assisted in the largest Italian rape center, in Milan (Soccorso Violenza Sessuale e Domestica – SVSeD - Service for Sexual and Domestic Violence). The total number of sexual violence victims examined during the years 2006–2015 (adults and minors) was 3521, in 1697 of cases, biological evidence had been collected, while the number of adult victims (>18 y.o.) examined was 2300, in 1211 of cases biological evidence had been collected. Biological evidence was collected from the victims’ bodies using two swabs in five anogenital areas (labia maiora, labia minora, perineum, perianal and anal/rectum regions) and two swabs in all other skin areas suggested by the victims as areas of possible contact (double swab technique). Clothes were also collected on a case by case basis for the search of biological stains. Despite the proper collection, handling and chain of custody for all the swabs/items collected, serological/DNA analyses were requested in 86 cases out of 1211 only (710%). This percentage dropped to 190% when considering adolescent victims (13–19 y.o.). The reason why Italian Magistrates make little use of the powerful tool of DNA analyses in sexual assault cases, still remains unclear. Legal and procedural aspects are therefore also discussed.

Improvements to vulvar aesthetics, particularly the clitoral complex and labia minora reconstruction, are difficult and remain the challenge of genital reconstructive surgeons. Various modifications of penile inversion technique have been introduced to improve vulvar aesthetics in recent years. Generally penile inversion vaginoplasty leaves limited penile tissue to reconstruct the natural labia minora. This article describes improvements made to overcome substantial limitations of the widely used traditional penile inversion vaginoplasty technique, with emphasis on creating a realistic vulvar aesthetic appearance in all respects, without compromising sexual sensation or vaginal depth.

The presented clinical case of a girl with a salt-wasting form of congenital adrenal hyperplasia in combination with chronic recurrent infection and lower urinary tract dysfunction demonstrates the need to change conventional two-staged approach to surgical feminization in favor of a one-stage intervention in order to prevent a progression of genitourinary complications. After controlling for the underlying condition, the one-stage feminization was performed, including modified tightening introitoplasty using a Passerini-Glazel flap and a correction of hypertrophic clitoris and labia minora. Good short- and long-term results were achieved.

High rates of misdiagnosis and delayed intervention in neonatal PWS are leading to poor prognoses. To determine the clinical and image characteristics of newborns with Prader–Willi syndrome (PWS). A total of 102 cases of newborns definitively diagnosed with PWS at the Children’s Hospital of Fudan University from 02/2014 to 12/2017 were retrospectively analyzed. We analyzed the modulated voxel-based morphology (VBM) of gray matter in PWS by T2 weighted imaging. Of 102 cases, 75 (73.5%) have paternal deletion of 15q11.2-q13, whereas 27 (26.5%) have maternal uniparental disomy (UPD). Of the 75 deletion cases, 75 (100%) week crying, 71 (94.7%) hypotonia, 70 (93.3%) poor feeding, 46 (61.3%) hypopigmentation, 43 (57.3%) male cryptorchidism, 10 (13.3%) female labia minora, 48 (64%) characteristic facial features. Of 27 UPD cases, 27 (100%) week crying and hypotonia, 25 (92.6%) hypophagia, 20 (74.1%) male cryptorchidism, 1 (3.7%) female labia minora, 19 (70.4%) characteristic facial features, 12 (44.4%) hypopigmentation. The modulated VBM analysis shows that the middle frontal gyrus, orbitofrontal cortex (middle), and inferior frontal gyrus are the most variable brain regions that determine the endo-phenotype difference between the two genotypes. Hypotonia, hypophagia, and maldevelopment of sexual organs are general characteristics of newborns with PWS in Chinese population. In UPD cases, the proportions of premature newborns, elderly parturient women and congenital malformations were higher than for paternal deletion cases. The differences in the gray matter volume of these three regions between the two genotypes may explain the differences in maladaptive behaviors and emotions.

Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. To present a case of type III FGM corrected by de-infibulation for treatment of sexual dysfunction. A 31-year-old woman who had FGM reporting unconsummated marriage presented to our clinic clinic. The patient had undergone type III FGM at age 7 in her country. Surgical correction was performed. By de-infibulation, the vaginal and urethral orifices were revealed after incision of scar tissue. The World Health Organization classifies FGM in four types. Type III FGM is narrowing of the vaginal orifice with the creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). De-infibulation surgery is recommended for resolving problems related with sexual dysfunction and child-birth.

Patient demand for aesthetic genital surgery has markedly increased. The International Society of Aesthetic Plastic Surgery reported 95,010 labiaplasties and 50,086 vaginal rejuvenation procedures in 2015. We performed an online anonymous survey to evaluate the teaching of female genital procedures in plastic surgery training programs worldwide. A total of 1033 board certified plastic surgeons answered the survey. Most respondents were from the USA, Brazil, Mexico and Colombia. The majority of plastic surgeons performing these procedures were in private practice (77.62%) and (22.38%) in academic settings. Most plastic surgeons (75.63%) did not receive formal education in female genital rejuvenation procedures however 54.31% did receive education in reconstruction procedures. During their training, most were exposed to vaginal reconstruction (15.94%), labia minora reduction (11.9%), vulva reconstruction (11.53%), flaps for vaginal agenesis (11.39%) and monsplasty (7.98%). Additional training for female genital procedures was mostly at meetings and shadowing experts. Sixty-two percent reported that patients seldom requested those procedures, and 63.73% reported these procedures comprised less than 5% of their practice. The most commonly performed procedures were labia minora reduction, labia majora augmentation or reduction and monsplasty. The materials used were mostly fat grafting, hyaluronic acid injections and lasers. Additional formal training during residency for aesthetic genital surgery would be beneficial. Additionally, courses at meetings would be useful for plastic surgeons who have had insufficient training. More studies need to be conducted on the different female genital rejuvenation procedures offered in order to evaluate patients’ long-term outcomes and satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The aim of this study was to introduce a new method of labiaplasty. Here, we describe the surgical procedure, outcomes and the advantages of this method. The medical records of 21 patients aged between 20 and 45 years who underwent reduction of the labia minora from February 2015 to June 2017 were reviewed. The procedures performed in these studies used posterior-lateral wedge resection with preservation of the central blood vessels and nerve bundle. All the surgeries were performed successfully, and 21 patients experienced an uneventful postoperative period. A minor dehiscence occurred in one patient, who recovered with no requirement for additional treatment. All of the patients were satisfied with the eventual esthetic appearance. The posterior-lateral wedge resection with preservation of the central blood vessels and nerve bundle is a simple and safe method that is associated with satisfactory outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Labiaplasty, an invasive surgical procedure that reduces the size of the labia minora, has dramatically increased in popularity, particularly among adolescent and young adult women in Western cultures. To understand this increase, we examined two possible underlying factors: self-objectification and system justifying beliefs. In Study 1, we predicted that system justifying beliefs would moderate the relationship between self-objectification and the desire to undergo labiaplasty. In Study 2, we also examined the unique role of labia-specific surveillance. Moreover, we predicted that system justification would be related to differences in the labia lengths that were considered normal versus desirable. In both studies, system justifying beliefs moderated the effect of self-objectification on dissatisfaction with one’s labia and consideration for getting a labiaplasty, but the nature of this effect was different for general indicators of self-objectification and labia-specific surveillance.

We present an interesting and unusual case of a 5 cm well-demarcated erosive plaque on the labia minora, extending to the vagina in an 85-year-old woman, causing pain and discomfort for 2 years. The patient was treated several times with topical and systemic anti-fungals without benefit. Histopathology revealed a typical superficial spreading basal cell carcinoma (BCC) and the patient was referred to a gynecologist for surgical excision. Our case is an alert of BCCs arising on the genital area because they are rare and patients usually present with large lesions, as they do not seek medical attention for what they consider simple irritation. Physicians easily misdiagnose these cancers as inflammatory or infectious dermatoses.

To report current results of vaginoplasty using the mucosa of the prepuce, and creating labia minora by penile skin in children with disorders of sex development (DSD). In 10 years, we have performed 22 vaginoplasties using the described technique of vaginoplasty, 21 patients with 46, XX DSD and 1 ovotesticular DSD. The assessment of the results of this technique of vaginoplasty was undertaken in several stages: (a) The evaluation of the cosmetic result. (b) The research for a urinary incontinence and urethrovaginal fistulas. (c) The research for a vaginal stenosis by the introduction of a lubricated feeding tube into the vaginal cavity. The labia minora was evaluated by three criteria: its skin should be thin and very supple, it should have a free edge which partially or totally covers the clitoris, urethral meatus, and vaginal orifice; and it is preferable that its color be darker than the rest of the skin. The cosmetic outcome was considered by parents and the surgeon as very satisfactory in 11 patients (50% of cases), satisfactory in 4 patients (18.2%), and unsatisfactory in 7 patients (31.8%). The postoperative complications were five cases of proximal stenosis (22.7%), one distal stenosis (stenosis of introitus) and two necrosis of the preputial flap. No urethrovaginal fistula and urinary incontinence were reported. In infant and young child, when it is difficult to make use of complete urogenital mobilization, the mucosa of the prepuce can be an alternative to create a neovagina, its histological constitution is identical to a vaginal wall, and it does not prevent to have a good labia minora.