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Epidermal cysts are the most common benign cutaneous cysts derived from the follicular epithelium and most commonly occur over the face, trunk, extremities, and scalp. We report a 34-year-old female who presented to our outpatient department with multiple yellowish raised lesions over the genital region for 3 years associated with itching. On examination, multiple yellowish papules were noted over the vulva. On puncturing one of the cysts, yellowish cheesy material was seen. A provisional diagnosis of steatocystoma multiplex was considered based on the morphology of the lesions. Histopathological examination showed findings leaning towards the diagnosis of an epidermal cyst.

Objectives. Hematoma of the vulva – extravasation of blood into the soft tissues of the external genitalia without lysis of the skin tissue. As a rule, nonobstetric hematomas of the vulva are associated with genital trauma and are very rarely presented in the specialized literature. Case presentation. Until now, there is a lack of consensus and clinical recommendations in the specialized literature regarding the treatment of traumatic hematoma of the vulva, and the treatment tactic is based on the case-by-case principle. Taking into account the rarity of traumatic hematoma of the vulva, we present our own clinical case. Patient S.I., 17 years old, came to the inpatient department of the IMSP Mother and Child Institute with vulva trauma that occurred after falling on a hard object. Upon admission, she complained of violent, expanding pain in the region of the labia majora on the right, the presence of a tumor formation in the region of the external genitalia that presented difficulties in movement. In the region of the labia majora on the right, a 10x6 cm hematoma is determined, cyanotic in color, suddenly painful on palpation with transposition to the left, which completely closes the entrance to the vagina, clitoris and urethra. Over 40 min. from admission under general anesthesia with spontaneous breathing, with a longitudinal incision along the right labia majora from its inner side, ≈ 50 ml of clotted blood was drained. For the purpose of hemostasis, three vicryl sutures were applied. She was discharged in satisfactory condition on the fourth postoperative day. Conclusions. Traumatic hematomas of the vulva present a rather rare phenomenon and are presented sporadically in the specialized literature. In the case of large and expanding hematomas of the vulva, surgical treatment is the method of choice. The surgical intervention involves the opening and evacuation of the hematoma of the vulva, the achievement of definitive hemostasis in the remaining cavity and adequate drainage.

The labia majora become saggy with aging. Although filling with hyaluronic acid provides significant rejuvenation, it can also lead to the formation of true vulvar testicles if poorly indicated, especially in excessively flaccid vulvas, which do not support any further volumization. In these cases of excessive flaccidity, we believe that collagen biostimulators would be the best initial treatment, as their injection would lead to the replacement of dermal collagen and improvement in laxity, without a significant increase in volume. We have been using calcium hydroxyapatite, l-polylactic acid, and PDO threads since 2019, with good results.

Background: Vulvar leiomyoma is a rare soft tissue tumor, with only around 300 cases described in the literature. Owing to its low incidence of just 0.03% of all gynecological tumors, it often poses a great diagnostic challenge, especially in teenagers. We report this rare occurrence of vulvar leiomyoma in a teenage girl who was primarily left untreated due to cultural taboos and fear of loss of virginity. The main aim in presenting such rare case studies is to raise awareness and expand the diagnostic horizon of the surgeon for appropriate management. Case presentation: We describe a case of a 15-year-old North Indian, sexually inactive unmarried girl, who presented with a history of painless swelling in the left labia majora for the last 1 year, which gradually increased in size. There was no associated pain or any other difficulty. Local examination revealed a 14 × 10 cm solid, unilateral nonpedunculated mass on the left labia majora with superficial vascularity. Differential diagnoses of sarcoma, lipoma, Bartholin cyst, and fibroid were kept in mind. Ultrasonography revealed a solid mass with superficial vascularity with normal internal genitalia. The mass was enucleated with an intact capsule under anesthesia. Histopathology confirmed it to be benign vulvar leiomyoma. The patient was discharged after 3 days in a satisfactory condition. Conclusion: Leiomyoma of the vulva is an exceptionally rare tumor and is seldom seen in teenagers. It is often misinterpreted as a Bartholin cyst and should be kept as one of the differential diagnosis in teenage girls presenting with unilateral vulvar swelling. Vulvar leiomyoma can be completely cured by surgical removal if diagnosed timely without compromising virginity, so should never be missed in adolescents. [ABSTRACT FROM AUTHOR]

The current study examined whether reading the chapter titled "Cliteracy for Him" from the book Becoming Cliterate is an effective intervention for increasing young heterosexual men's sexual functioning. Specifically, this study compared an intervention group (i.e., those who read the chapter) to a waitlist control group at three points in time: before reading the chapter, immediately after reading the chapter, and three weeks later. Outcome measures included clitoral knowledge, sexual self-esteem, sexual depression, communication during sexual activity, and dysfunctional beliefs about sexuality (e.g., beliefs about women's satisfaction, about being "macho," and sexual conservatism). Participants who read the bibliotherapy chapter showed immediate improvement on clitoral knowledge, dysfunctional beliefs about women's sexual satisfaction, and sexual communication. Longer-term improvements were found on clitoral knowledge, and dysfunctional beliefs about both women's sexual satisfaction and being "macho." Additionally, compared to the waitlist control group, men in the intervention group demonstrated better sexual communication and fewer dysfunctional beliefs about women's sexual satisfaction immediately after reading the chapter, and more clitoral knowledge, fewer dysfunctional beliefs about women's sexual satisfaction, fewer dysfunctional macho beliefs, and lower sexual depression three weeks after reading the chapter. Clinical implications and future research directions are discussed. [ABSTRACT FROM AUTHOR]

To evaluate utilization of sentinel lymph node biopsy (SLNB) for early-stage vulvar cancer at minority-serving hospitals and low-volume facilities. Between 2012-2018, individuals with T1b vulvar squamous cell carcinoma were identified using the National Cancer Database. Patient, facility, and disease characteristics were compared between patients undergoing SLNB or inguinofemoral lymph node dissection (IFLD). Multivariable logistic regression, adjusted for patient, facility, and disease characteristics, was used to evaluate factors associated with SLNB. Kaplan-Meier survival analysis using log rank test and Cox regression was performed. Of the 3,532 patients, 2,406 (68.1%) underwent lymph node evaluation, with 1,704 (48.2%) undergoing IFLD and 702 (19.8%) SLNB. In a multivariable analysis, treatment at minority-serving hospitals (OR 0.39, 95% CI 0.19–0.78) and low-volume hospitals (OR 0.44, 95% CI 0.28–0.70) were associated with significantly lower odds of undergoing SLNB compared to receiving care at non-minority-serving and high-volume hospitals, respectively. While SLNB utilization increased over time for the entire cohort and stratified subgroups, use of the procedure did not increase at minority-serving hospitals. After controlling for patient and tumor characteristics, SLNB was not associated with worse OS compared to IFLD in patients with positive (HR 1.02, 95% CI 0.63–1.66) or negative (HR 0.92, 95% CI 0.70–1.21) nodal pathology. For patients with early-stage vulvar cancer, treatment at minority-serving or low-volume hospitals was associated with significantly decreased odds of undergoing SLNB. Future efforts should be concentrated toward ensuring that all patients have access to advanced surgical techniques regardless of where they receive their care. • The uptake of sentinel lymph node biopsy for early-stage vulvar cancer remains low, though is increasing over time. • Patients receiving care at minority-serving or low-volume hospitals were less likely to undergo sentinel lymph node biopsy. • Escalation of sentinel lymph node biopsy use was most evident in low-volume hospitals. • Sentinel lymph node biopsy was not associated with worse overall survival compared to full groin dissection. [ABSTRACT FROM AUTHOR]

Cervico-vaginal (CV) localization of extra-mammary Paget's disease (EMPD) of the vulva is extremely rare. In order to investigate the incidence risk and the pathognomonic clinical and pathological features of this condition, a retrospective analysis was conducted including 94 women treated for vulvar EMPD at the European Institute of Oncology, Milan, Italy, from October 1997 to May 2020. Overall nine patients developed CV involvement from EMPD, with a cumulative incidence of 2.5% (95% CI: 0.5–8.0%) at 5 years, 6.5% (95% CI: 1.9–15.1%) at 10 years and 14.0% (95% CI: 4.8–27.8%) at 15 years, respectively. All cases except one were firstly detected by abnormal glandular cytology. None reported vaginal bleeding or other suspicious symptoms. The colposcopic findings were heterogeneous and could sometimes be misdiagnosed. Cervical and/or vaginal biopsies were always performed for histopathological diagnosis by identification of Paget cells in the epithelium or stroma. Most patients developed invasive EMPD (5/9) of the cervix and/or vagina and underwent hysterectomy with partial or total colpectomy. CV involvement from EMPD should not be underestimated in women with a long-standing history of vulvar Paget's disease. Liquid-based cytology with immunocytochemistry represents a valuable tool for early diagnosis and should be routinely performed during the required lifelong follow-up. [ABSTRACT FROM AUTHOR]

Summary: A new species of the genus Talanema , T. ibericum sp. n., collected in natural areas of southeastern Iberian Peninsula, is characterised, including morphological description, line, LM and SEM illustrations, and molecular (18S, D2-D3 28S rDNA sequences) study. The new species is distinguished by its 1.27-1.59 mm long body, lip region offset by constriction and 14-16.5 μ m wide with perioral liplets, odontostyle 16.5-19.5 μ m long, neck 285-359 μ m long, pharyngeal expansion occupying 42-48% of the total neck length, uterus tripartite and 147-228 μ m long or 2.6-4.0 body diam., vulva transverse (V = 53-59), presence of cuticular irregularities at both sides of vulva, female tail conical with a dorsal concavity (27-40 μ m, c = 36-54, c′ = 1.0-1.3), male tail short and rounded conoid (24 μ m, c = 66, c′ = 0.8), spicules 58 μ m long, and 17 almost contiguous ventromedian supplements with hiatus. Morphological and molecular data reveal that the new species is similar to (but easily separable from) T. baqrii , with which it is compared. Present results support the monophyly of the genus Talanema. [ABSTRACT FROM AUTHOR]

Summary: Hemicycliophora species are migratory root ectoparasites of higher plants, commonly known as sheath nematodes. The present study describes a new species, Hemicycliophora geraerti n. sp., recovered from the rhizosphere of peach tree (Prunus persica) in Zhejiang Province, China. This species is characterised by a cuticular sheath loosely fitting to the body, a lip region slightly set-off with body contour bearing 3-4 annuli, oral plate narrow, ovate, and non-protruding, amphidial apertures plugged, dorsoventrally flanked in the first lip annulus, stylet 110 (103-116) μ m long and flexible, excretory pore located 4-7 annuli posterior to the base of the pharyngeal bulb; vulval lips modified with a small vulval sleeve, anus located 16 (13-21) annuli posterior to vulva, tail elongated, having a narrowly rounded slightly offset spike. The molecular characterisation and phylogenetic analyses based on D2-D3 expansion segments of the 28S rRNA, ITS rRNA, and COI mtDNA gene indicated the unique status and support the novelty of this population of Hemicycliophora , therefore herein described as H. geraerti n. sp. [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]

Background: There is a broad spectrum of vulvar pigmented lesions that differ based on their histopathological and clinical features. Chronic vulvar purpura is a rare entity, associated with a broad morphological spectrum, from lichen aureus, Zoon's vulvitis, pigmented purpuric dermatosis and with lichen planus as in our case. Case presentation: In this article we discuss a case of an 86-year-old white woman with hyperpigmentation on her upper vulva, next to the introitus, with complaints of urine incontinence. Biopsy revealed subepithelial stromal lichenoid inflammatory infiltrate containing plasma cells, lymphocytes and some neutrophilic granulocytes as well as dilated and congested vessels. Hemosiderin deposits and erythrocyte extravasation were found. There was evidence of hyperkeratosis with hyper granulosis and erosions. Spongiosis was also noted. Few melanocytes were identified with no sign of malignancy. These findings correlate with the diagnosis of vulvar lichen planus. Conclusions: Chronic vulvar purpura is a clinical term used for different chronic inflammatory dermatoses presenting as red bluish or violaceous discolorations on the vulva, often associated with cayenne-pepper-like speckling. Considering a great overlap of possible diseases, the final diagnosis could be challenging. It is important to exclude a melanocytic tumour in these cases. [ABSTRACT FROM AUTHOR]

Traditional methods of cow estrus monitoring technology are not suitable for the current needs of large-scale, intensive and welfare-based farming. There is a need to improve the detection rate of cow estrus and to reduce the emergency response caused by wearing contact devices. Furthermore, it is necessary to verify the practical effectiveness of the LOGISITC and SV (support vector machine) models for modeling cow estrus. In this paper, we have proposed a non-contact cow estrus monitoring method based on the thermal infrared images of cows and have proposed a lab-color-space-based feature extraction method for the thermal infrared images of cow eyes and vulvas. The test subjects were 10 Holstein cows, monitored on a fixed basis, to determine the best segmentation contour. The LOGISTIC and SVM (support vector machine) models were used to establish the cow estrus model using the thermal infrared temperature variation in cows in estrus and cows not in estrus. The experimental results showed that the heat detection rate of the LOGISTIC-based model was 82.37% and the heat detection rate of the SVM-based model was 81.42% under the optimal segmentation profile. The highest temperature in the eye and vulva of cows was the input, and the recall rate was above 86%. The heat monitoring method based on thermal infrared images does not cause stress to cows and meets the needs of modern dairy farming for welfare breeding. [ABSTRACT FROM AUTHOR]

Ectaesthesius bifrons Rathbun, 1889, an unusual brachyuran crab so far only known from the Galápagos Islands, initiated a re-evaluation of the systematic position of the species, until now grouped under superfamily Trapezioidea Miers, 1886. This reappraisal involved the application of several new characters, including the structure of the vulva and epistome, on Ectaesthesius and several species belonging to 13 trapezioid genera. As a result, we describe a new family, Ectaesthesiidae, and re-diagnose Calocarcinidae, new status, Sphenomeridinae, new status, Domeciidae, Tetraliidae, and Trapeziidae. [ABSTRACT FROM AUTHOR]

A new species belonging to the genus Laimydorus , and a known species of the genus Labronema , collected from the rhizosphere of grassland plants in West Azarbaijan province, Iran, are presented. The new species is characterized by its body length (1.56–1.81 mm in females and 1.39–1.57 mm in males), lip region offset by weak constriction and wider than adjacent body (11–14 μm), odontostyle 17–20 μm long, neck length 312–434 μm, vulva longitudinal (V = 42.2–46.5), uterus well-developed and with Z-differentiations, tail long (219–237 μm, c = 6.9–8.3, c´ = 8.2–10) in females, short and convex-conoid with blunt terminus (19–22 μm, c = 68–72.5, c´ = 0.77–0.84) in males, spicules 40–45 μm long, and 18–20 contiguous ventromedian supplements with hiatus. Molecular analyses, using Bayesian inference based on D2-D3 expansion segments of the 28S rRNA (LSU), placed the new species in a clade comprising representatives of the genera Nevadanema , Dorylaimus , Labronema , Calcaridorylaimus , Mesodorylaimus , and Prodorylaimus , which all belong to Dorylaimidae. In addition, new data (molecular, morphometrics, images, and geographic distribution) are presented for the Iranian population of Labronema vulvapapillatum. [ABSTRACT FROM AUTHOR]

A variety of reduction labiaplasty techniques have been introduced to date, but no single technique will offer the optimal solution for every patient. Rather, the technique should be chosen based on anatomical, configurational, and technical considerations, as well as on patients' personal preferences regarded maintenance of the labial rim, maintenance of labial sensitivity, and prevention of iatrogenic thickening of the labium. We reviewed, defined, and assessed labial configurational variety, neurovascular supply, reduction techniques, and patient's preferences as the considerations relevant to the choice of labiaplasty technique. Based on this review, an algorithm was constructed that leads to a choice of reduction technique through five decisions to be made regarding (1) resection or (partial) retention of the labial free rim, (2) the measure of required labial width reduction, (3) labial vascular status, (4) prevention of iatrogenic labial thickening, and (5) preservation of labial sensibility. The choice of techniques includes edge trimming, central spindle form de-epithelialization or full-thickness resection, and three modifications of the wedge resection or de-epithelialization technique. These three modifications comprised a modified anterior resection or de-epithelialization combined with posterior flap transposition, a custom flask resection or de-epithelialization, and a modified posterior wedge resection or de-epithelialization combined with anterior flap transposition. Use of the five decisional steps and the inclusion of modifications of all three conventional reduction techniques offer an improved algorithm for the choice of labioplasty technique. [ABSTRACT FROM AUTHOR]

Intersex is an anomaly in the reproductive system, which characterizes animals that have ambiguity in the genital system. The documented report is of a dog that presented abnormalities in the external genitalia, with the presence of a hemipenis in its vulva. The animal was submitted to hormone dosage of progesterone, testosterone and estrogen. Imaging tests such as ultrasound and X-rays were performed, with an exploratory celiotomy and histopathology being chosen as the therapeutic approach. According to the fi ndings in the imaging exams, testicular structure was observed in the location of the ovaries, and in the x-ray images it was possible to observe the presence of underdeveloped penile bone in the hemipenis. Hormone dosage indicated signifi cant changes in testosterone increase 2,300 pg/ml, estrogen concentrations were 8.00 pg/ml being normal and high progesterone 0.91 ng/ml. Microscopic fi ndings in histopathology indicated testicular structure present in the ovaries, thus concluding the diagnosis of true hermaphroditism. [ABSTRACT FROM AUTHOR]

A new species and a new record of free-living marine nematode of genus Diplolaimelloides (Monhysteridae) inhabiting the sediment of mangrove reservation in Shenzhen, China are described and illustrated. Diplolaimelloides contortus sp. nov. is characterized by the combination of the following characters: ocelli present; four pairs of post-cloacal papillae arranged in (2+2) pattern, two midway on bursa and two near posterior extremities; spicules complicated in shape, twisted and curved at middle portion; gubernaculum wedge-shaped, with distal dorsal ridge well cuticularized, proximal dorsal ridge obscure sleeve-like, proximal end wrap the spicule; vulva located at 52.1%–53.6% of body length; male tail slender, 10.0–11.4 times of anal body diameter, and female tail long filiform, 13.1–13.6 times of anal body diameter. Diplolaimelloides delyi Andrássy, 1958 is first recorded from China and redescribed in detail, it differs from the original description by Andrássy in 1958 for having larger body size of male, shorter tail, and posterior situation of vulva. However, it is much conform to the redescription to specimens from East Pakistan by Timm in 1966, except for shorter tail in female and absent pre-anal seta. Specimens are deposited in the Institute of Oceanology, Chinese Academy of Sciences. [ABSTRACT FROM AUTHOR]

The present investigation was undertaken to study the estrus behaviour in Kankrej cattle at an organized farm during 3 different seasons. In each of three seasons, seven (07) Kankrej heifers and seven (07) Kankrej cows showing estrus were considered. In Kankrej cattle, majority of the animals showed acceptance of teaser bull (100%), estrual mucus discharge (88.10%), homosexuality (78.57%), excitement, and edema erythema and wetness of vulva (76.19% each), frequent micturition (59.52%) and bellowing (16.67%). None of the Kankrej cattle went partial or complete off-feed during estrus phase. Overall it was revealed that the estrus signs were manifested more during summer season than monsoon and winter, which shows the heat tolerance capability of the Kankrej cows in the area. Nearly three forth (73.81%) of the total Kankrej cows exhibited normal and above normal estrus intensity score, whereas one forth (26.19%) animals showed weak estrus intensity score. The difference between Kankrej cows and heifers for overall intensity score was found non-significant (p>0.05). The serum estradiol concentrations in Kankrej heifers and cows were significantly higher on the day of estrus than the corresponding levels on 11th day of estrus with inverse trend of serum progesterone in all three seasons. On the day of estrus the mean estradiol level in Kankrej heifers and progesterone levels in cows were higher in summer than winter and monsoon. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are limited data on the etiology, clinical characteristics, and optimal treatment of vulvar basal cell carcinoma (BCC). OBJECTIVE: This retrospective review may aid in treatment decisions for vulvar BCC. MATERIALS AND METHODS: A retrospective review of our institutional CoPath database was performed, using search terms to identify cases of vulvar BCCs from 2000 to 2018. RESULTS: A total of 35 cases of vulvar BCC were included. Patient age ranged from 33 to 97 years with a mean age of 70 years. Of the 35 cases, 28 (80%) involved the cutaneous vulva, 6 (17%) involved the suprapubic area, and 1 (3%) involved the clitoris. Most vulvar BCCs were treated by wide local excision (46%) and vulvectomies (37%), with 3 cases treated with Mohs (11%) and 2 with electrodesiccation and curettage (6%). Preoperative tumor sizes were 0.86 cm2 for Mohs, 0.94 cm2 for excision, and 1.54 cm2 for vulvectomy. The mean margins were 3 mm for Mohs, 4.4 mm for wide local excision, and 6 mm for vulvectomy. Most cases (77%) were identified and treated by gynecology. CONCLUSION: Mohs micrographic surgery should be considered for the advantages of being tissue sparing, evaluating the complete peripheral and deep margin, and avoiding the costs and risks of general anesthesia. [ABSTRACT FROM AUTHOR]

Purpose The following case report discusses probable clitoral priapism secondary to duloxetine and pregabalin. While this is a rare adverse effect, it is possible given the mechanism of action and potentiating effects of the combined therapy. This adverse drug reaction was reported to MedWatch and shows that additional research into the physiology of clitoral erection is warranted given the scarcity of information on how drugs influence this reaction. Summary A 53-year-old African American female with uncontrolled anxiety was started on duloxetine. Pregabalin was added 1 month later due to continued feelings of anxiety. Three weeks later, the patient reported symptoms of clitoral pain, as well as a swollen, tender, and erect clitoris. These adverse effects remained for 4 days, prompting the patient to present to the emergency department where a physical exam was completed with no significant finding except as noted above. Pregabalin was immediately discontinued by the attending physician based on the probability that the swelling was likely drug-induced clitoral priapism. During follow-up, the patient continued to note clitoral erection and pain. The psychiatric pharmacist tapered off duloxetine over 2 weeks with resolution of symptoms. In an examination of the mechanism of action of both drugs, pregabalin can amplify duloxetine's inhibitory effects on voltage-dependent calcium channels. It is likely this mechanism that causes smooth muscle relaxation and led to clitoral priapism. Conclusion This case suggests that pharmacological agents affecting vasoconstriction through serotonergic receptors or calcium-dependent channels can also influence clitoral erection. [ABSTRACT FROM AUTHOR]

Objective： To investigate the clinical characteristics, diagnosis procedure and treatment method of the patient with recurrent vulvar angiomyofibroblastoma (AMFB)，and to improve the understanding of clinical doctors to this disease. Methods：The clinical data, imaging examination results, pathological examination results and immunohistochemical examination results of 1 patient with recurrent vulvar AMFB were collected； the above clinical data were analyzed, and the relevant literatures were reviewed. Results：A 50-year-old female patient underwent excision of vulvar mass 5 years ago in the local hospital for a vulvar mass，the postoperative pathology suggested AMFB. The patient was now admitted to the hospital due to a 6-month self-reported vaginal mass and a high degree of suspicion of recurrence of AMFB. The gynecological examination suggested a swelling under the labia major on the left side, with complete skin surface, deep protrusion towards the rectum and unclear boundary with the bowel；the size of tumor was about 5. 0 cm×4. 0 cm×4. 0 cm，with regular shape, clear boundary，and poor activity，and there was no obvious tenderness，ulceration and skin lesion. Superficial ultrasound showed a slightly low anechoic light mass with a range of 5. 0 cm×4. 0 cm×4. 0 cm at the left labia major, in which multiple mass hyperechoics were observed. Color Doppler flow imaging （CDFI) showed visible blood flow signals in and around the labia major. Conclusion：Although recurrence and malignancy of AMFB are rare, postoperative follow-up of AMFB should be given high priority to reduce the recurrence and increase the cure rate. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) includes a range of procedures involving partial or total removal of the external female genitalia. It is a harmful procedure that violates human rights of girls and women. FGM has been associated with obstetric anal sphincter injury (OASI), among other adverse obstetric complications. However, the obstetric outcomes in high-income countries are not clear. The aim of this study was to compare the risk of OASI among primiparous women, with and without a history of FGM, giving birth in Sweden. Method: A population-based cohort-study based on data from the Swedish Medical Birth Register during the period 2014–2018. The study included primiparous women with singleton term pregnancies. We compared the risk, using multivariable logistic regression, of our main outcome OASI between women with a diagnosis of FGM and women without a diagnosis of FGM. Secondary outcomes included episiotomy and instrumental vaginal delivery. Result: A total of 239,486 primiparous women with a term singleton pregnancy were identified. We included 1,444 women with a diagnosis of FGM and 186,294 women without a diagnosis of FGM in our analysis. The overall rate of OASI was 3% in our study population. By using multivariable logistic regression analysis, we found that women with a diagnosis of FGM had a significantly increased odds ratio (OR) of OASI (OR 2.69, 95%CI: 2.14–3.37) compared to women without a diagnosis of FGM. We also found an association between FGM and instrumental delivery as well as the use of episiotomy. Conclusion: Women with a history of FGM have an almost tripled risk of OASI in comparison with women without FGM, when giving birth in a Swedish setting. Increased knowledge and awareness regarding FGM, and its potential health implications is crucial in order to minimise the risk of OASI among women with FGM giving birth in high-income countries. A limitation in our study is the lack of information about the specific types of FGM. [ABSTRACT FROM AUTHOR]

Two female Philodromus specimens were found with genital structures similar to those described for Philodromus depriesteri Braun, 1965, currently considered a nomen dubium. Molecular analysis revealed that the two specimens belong to the species Philodromus collinus C. L. Koch, 1835. The opisthosomas of both spiders each contained a parasitoid, and one of the worms was identified as a member of the nematode family Mermithidae. It is very likely that the parasitoids interfered with the development of the female genital organs, resulting in the characteristic depriesteri vulva structure. Consequently, we propose Philodromus depriesteri Braun, 1965 = Philodromus collinus C. L. Koch, 1835 syn. nov., thus releasing P. depriesteri from being considered a nomen dubium. [ABSTRACT FROM AUTHOR]

Angiomyofibroblastoma (AMF), a rare benign vulvovaginal mesenchymal tumour, poses a diagnostic challenge due to histologic and immunohistochemical overlap with other vulvar mesenchymal tumours. Recently, MTG1‐CYP2E1 fusion transcripts were reported in 5/5 AMFs; no other genetic alterations have been described to date. Herein, we sought to investigate the frequency of the MTG1‐CYP2E1 fusion and the presence of other potential genetic alterations in a cohort of AMFs (n = 7, patient age range: 28–49 years). Tumours demonstrated classic morphologic features including alternating hypo/hypercellular areas, capillary channels surrounded by epithelioid/spindled tumour cells, and variable amounts of mature adipose tissue. reverse transcription‐polymerase chain reaction (RT‐PCR) for MTG1‐CYP2E1 fusion, performed in all seven cases, showed the fusion transcript in five of six cases (one case with technical failure). Two tumours, including the one lacking the fusion, were subjected to targeted next‐generation sequencing (104 genes) and a sarcoma fusion assay (28 genes); the fusion negative AMF also underwent RNA sequencing. No additional mutations, copy number alterations, or fusion genes were identified with the assays employed. We conclude that the majority of AMFs harbour recurrent MTG1‐CYP2E1 fusion transcripts and identification of this fusion may aid in the diagnosis. [ABSTRACT FROM AUTHOR]

The study aimed to examine the multi-organs toxicity of zearalenone on prepubertal gilts. A total of 48 (Landrace × Yorkshire) prepubertal gilts were randomly divided into 4 groups with 12 replicates in each group. The control group were fed with basal diet, the experimental groups were fed test diets supplemented with 0, 200, 800 and 1600 μg/kg zearalenone in the basal diet. The experiment lasted for 28 days. The results showed that the average daily feed intake of prepubertal gilts in each group had no significant change (p >.05). Diets supplemented with zearalenone significantly reduced the serum immunoglobulin G, immunoglobulin M, follicle stimulating hormone concentrations and total antioxidant capacity activity of prepubertal gilts (p <.05). Diets supplemented with zearalenone significantly increased the vulva area, the serum concentration of interleukin-4 and activities of alanine aminotransferase and alkaline phosphatase of prepubertal gilts (p <.05). In conclusion, dietary supplementation of zearalenone has no obvious effect on the average daily feed intake of prepubertal gilts. However, it can increase its vulva area, produce reproductive toxicity, cause liver damage, reduce the serum immunoglobulin concentrations and antioxidant capability and disrupt the secretion of sex hormones. Dietary supplementation of zearalenone significantly increases the vulva area of prepubertal gilts. Dietary supplementation of zearalenone significantly increases serum ALT and ALP activities of prepubertal gilts. Dietary supplementation of zearalenone reduce serum immunoglobulin levels and antioxidant capability of prepubertal gilts. Dietary supplementation of zearalenone decreased the secretion of FSH of prepubertal gilts. Zearalenone exerts its toxic effects in multiple ways simultaneously. [ABSTRACT FROM AUTHOR]

Oestrogen plays a vital role in maintaining a normal vulvovaginal epithelium, vaginal lubrication, as well as a healthy microbiome to ensure an acidic pH. The decrease in oestrogen levels in women going through menopause results in both physiological and physical changes of the genitourinary system, and more specifically the vulva. We conducted a literature review on the effects of low oestrogen levels on the physiology and function of the vulva and the vulvovaginal epithelium. 'Genitourinary syndrome of menopause' (GSM) is the term used to describe the signs and symptoms of a low oestrogen state. The symptoms and signs of GSM can overlap or coexist with other vulval dermatoses. Expert opinion is needed to diagnose and manage vulval dermatoses in menopause. This article will discuss the signs and symptoms of GSM, as well as the different management options available. Other vulval dermatoses that can be affected by hypo‐oestrogenism are also reviewed. [ABSTRACT FROM AUTHOR]

We describe four cases of feline progressive histiocytosis (FPH) including three females (one intact, two spayed) and one castrated male cat, with a mean age of 5.95 years at diagnosis. Masses were found under the skin of head, lip, neck, and vulva. Histologically, proliferative round cells had ovoid nuclei, foamy eosinophilic cytoplasm, distinct cytoplasmic processes, and numerous mitotic figures. Immunohistochemically, all cases were positive for Iba1 and MHC II (Dako). One case showed cytoplasmic positive staining for E-cadherin. To the best of our knowledge, this is the first documented report of FPH in Korea. [ABSTRACT FROM AUTHOR]

The ovipositor comprises the external genitalia of female insects, which plays an important role in the mating and ovipositing process of insects. However, it remains rudimentary of regional gene expression and physiological function in the ovipositor during structural development. Here, we analysed the basic structure and characteristics of the ovipositor in the migratory locust Locusta migratoria. RNA‐seq analysis revealed the specialization of chitin metabolism, lipids synthesis and transport, tanning and cuticular protein genes in the ovipositor. Among them, two cuticle protein genes, LmCP8 and LmACP79, were identified, which are specifically expressed in the ovipositor. Functional analysis based on RNA interference showed that deficiency of LmCP8 affected the structural development of the ovipositor resulting in the retention of a large number of remaining unproduced oocysts in the ovary of the locusts. Our results provide a fundamental resource to investigate the structural development and physiological function of the ovipositor in L. migratoria. [ABSTRACT FROM AUTHOR]

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by enzyme deficiencies required for cortisol biosynthesis in the adrenal cortex. The majority of CAH are due to the deficiency of the 21-hydroxylase enzyme, while 3β-hydroxysteroid dehydrogenase type 2 deficiency accounts for less than five percent of all CAH cases. We report two Moroccan twins from a spontaneous triplet pregnancy. The 46,XY newborn exhibited a disorder of sexual differentiation (DSD) with hypo virilization, while the 46,XX newborn had normal female external genitalia. In the first week of life, they showed hyponatremia and primary adrenal insufficiency with a slight 17OHP elevation and increased DHEAS and renin levels. The aCGH-SNP analysis disclosed a 8.36 Mb long contiguous stretch of homozygosity (LCSH) on chromosome 1p13.2-p11.2 including the candidate HSD3B2 gene, a LCSH of 7.3 Mb on 14q31.1-q32.11, and a 7 Mb duplication on 10q22.3-q23.2. Clinical exome sequencing revealed the biallelic c.969T > G (p.Asn323Lys) HSD3B2, likely pathogenic, variant in both of the affected twins. This case emphasizes the importance of a prompt molecular diagnosis performed through the combination of aCGH and clinical exome, both for establishment of correct therapy and for follow-up, as the newborns also carry a genomic rearrangement with possible clinical implications. [ABSTRACT FROM AUTHOR]

Purpose: To report a new species: Sprentascaris pampayensis, a Raphidascarididae parasite from the Neotropical region. Methods: During a parasitological survey, specimens were collected of a new species of Sprentascaris from Hypostomus commersoni Valenciennes from urban lakes in Santa Fe City, Santa Fe Province, in the Pampean region of Argentina. Morphological and morphometric descriptions, and molecular analyses were performed. Results: The new species, S. pampayensis n. sp., is characterized by having slightly extended lateral wings in both sexes, oral structure with three well-developed lips with double papillae, ventrolateral lips with an amphidial pore. Triangular buccal opening with three well-developed lips with flattened extensions at their bases, which end in a pointed manner towards the back. Males have 17 pairs of preanal papillae, 1 pair of adanal papillae, 3 pairs of postanal papillae and 1odd median postanal papilla located between the first and second pairs, unusual shape of caudal papillae with the central tubular part conspicuously elevated. Females have pre-equatorial vulva, smooth-shelled eggs, and mature embryonated eggs. Discussion: Sprentascaris pampayensis n. sp. differs morphologically and genetically from S. manherti Petter and Cassone, 1984, S. lanfrediae Melo, Santos, Giese, Santos and Santos, 2011 and S. andersoni Malta, Paiva, Elisei, Tavares and Pereira, 2018. Morphological and morphometric comparison also distinguishes it from S. pimelodi Petter and Cassone, 1984, S. hypostomi Petter and Cassone, 1984, S. marano Ramallo, 2009, and S. saltaensis Ailán-Choke, Ramallo and Davies, 2017. Sprentascaris pampayensis n. sp. is a new parasitic nematode of Hypostomus commersoni. [ABSTRACT FROM AUTHOR]

Extramammary Paget's disease (EMPD) is a rare variant of adenocarcinoma, the most common localization of which is a vulva. Clinical manifestations are nonspecific and can be initially diagnosed as manifestations of other dermatoses, which makes early diagnosis difficult. The most effective diagnostic method is a pathomorphological and immunohistochemical examination of the skin biopsy. We present a clinical case of EMPD in a 42-year-old HIV-infected female patient.

Abstract Background Vulvar neuroendocrine carcinomas with small cell morphology need an appropriate differential diagnosis with respect to primary Merkel cell carcinomas, primary small cell neuroendocrine carcinomas, and secondary/metastatic carcinomas. Herein, we report a woman with a history of endometrial carcinoma led to neuroendocrine vulvar carcinoma. Case presentation An 82-y-old woman with right vulvar swelling was transferred to our hospital. Computed tomography scan showed a 75 mm irregular mass in her right vulva. Three years ago, she had been diagnosed with endometrial endometrioid carcinoma stage IA and had undergone surgery. Vulvar biopsy revealed neuroendocrine carcinomas with small cell morphology. Immunohistochemical staining showed that the vulvar tumor was positive for CD56 and chromogranin A, but negative for Merkel cell polyomavirus and cytokeratin 20. Incidentally, her endometrial carcinoma was also positive for CD56 and chromogranin A. Human papillomavirus DNA typing analysis of vulvar tumor was negative. Hence, the vulvar tumor seemed to be a recurrence of the endometrial cancer rather than a primary vulvar neuroendocrine carcinoma. The patient died of the disease within a month. Conclusion We report a case of vulvar neuroendocrine carcinoma that is independent of Merkel cell polyomavirus and human papillomavirus, thereby suggesting a recurrence of endometrial cancer. Immunohistochemical and virological analyses helped in the differential diagnosis of the neuroendocrine carcinoma.

High-dose rate brachytherapy (HDR) presents a promising alternative for the treatment of various types of skin cancer. In this work, we aim to delineate the emerging trends in the utilization of custom, patient-specific, 3D-printed surface brachytherapy applicators. Given the increasing adoption of HDR brachytherapy for dermatologic malignancies, understanding these trends can provide valuable insights into treatment practices and patient outcomes. In this study, we conducted an assessment of utilization of custom, patient specific, 3D-printed devices designed using Adaptiiv 3D Bolus and/or 3D Brachy software during the year 2023. Our evaluation focused on identifying the specific treatments and anatomical sites for which these devices were employed. Additionally, we analyzed surface brachy applicator parts utilized over the past year to identify emerging trends in treatment modalities and patient demographics. Surface brachytherapy applicators were utilized in 13% of all Adaptiiv devices (including custom bolus and surface brachy applicators) involving skin treatments in 2023. Among these cases, extremities were the most frequent treatment site, accounting for 64% of the total. Approximately 20% of cases involving nasal treatment and 15% of ear treatments utilized custom surface brachy applicators. Additionally, a significant percentage (22%) of head and neck (H&N) and facial cases employed surface brachy applicators. Notably, there is a growing interest in treating other areas such as scalp and vulva using surface brachytherapy applicators. We have demonstrated the successful utilization of custom patient-specific surface brachytherapy applicators for skin cancer treatments, particularly in treating specific body sites such as nose, ear, extremities, scalp and vulva. [ABSTRACT FROM AUTHOR]

Vulvar fibromas are benign tumours that primarily occur in women of reproductive age but very rarely among postmenopausal women. Evidence of its occurrence in Sub-Saharan Africa is scant, with hardly any data among postmenopausal women. A 54-year-old multiparous (para 4) Ghanaian female presented at the Gynaecology Outpatient Department of Korle Bu Teaching Hospital, with a three-year history of a painless vulval mass. Her general condition was satisfactory. Vulvar examination revealed a prominent, 20 cm × 15 cm cauliflower-like mass originating from the right labium majus, attached by a 5 cm long and 1 cm thick stalk. There was no inguinal lymphadenopathy. Mass was excised under regional anesthesia and histology confirmed benign vulva fibromatosis. The patient made a satisfactory post-operative recovery. This case was managed successfully surgically, and histology confirmed a benign tumour. These benign vulval tumours typically occur in younger premenopausal women, but very rarely after menopause as was in the case of our patient who was 7 years postmenopausal. This further emphasizes the exceptional nature of this pathology. Our report adds valuable insight to the limited literature on vulvar fibromatosis, particularly in postmenopausal patients, emphasizing the need for careful diagnostic and management strategies for best patient outcomes. • Giant vulvar fibromatosis are rare in postmenopausal women • These rare masses sometimes pose clinical diagnostic challenges. • Data is limited especially from the Sub-Sharan African region on this condition. • We successfully managed a giant vulvar fibromatosis in a postmenopausal woman • Limited literature on vulvar fibromatosis, in postmenopause underscores the need for careful assessment and management [ABSTRACT FROM AUTHOR]

This article discusses a rare case of vulvar angiomyofibroblastoma (AMF), a benign tumor of uncertain origin. The article highlights the importance of ultrasound in diagnosing this condition, as it was instrumental in identifying the tumor in a routine gynecological evaluation. The treatment of choice for vulvar AMF is simple total excision, which is typically curative. The article also mentions the differential diagnoses for this condition, including aggressive angiomyxoma, Bartholin cyst, or lipoma. [Extracted from the article]

Sclerosing lichen (SL) of the external genitalia is a chronic slowly progressive disease with pronounced focal atrophy of the skin of the perineum and visible mucous membranes of the vulva and has two main peaks of clinical manifestations: childhood and perimenopausal age. It is associated with an increased risk of developing vulvar cancer, even though it is not a malignancy in itself. The true precursor of SL-associated cancer is intraepithelial vulvar neoplasia (VIN). The diagnosis is usually clinical, but in some cases a biopsy may be performed, especially to rule out VIN or cancer. In this study, 180 patients with SL vulva were examined on the basis of two clinical bases (National Cancer Institute, MC "Verum"). After examining the patients, the diagnosis was made on the basis of examination, complaints, advanced biochemical blood test, detailed blood test, hormonal examination and ultrasound. In most cases, the diagnosis of SL vulva is clinical. As a result of a number of examinations of patients of reproductive age in patients with SL vulva, it was found that SL vulva is a consequence of thyroid disease (82.2%) of different types compared with patients in the control group (32.7%). The diagnosis of SL vulva was established in young patients mainly with AIT (48.6%) and with AIT accompanied by hypothyroidism or nodular thyroid disease (27%). When comparing the diagnostic findings of thyroid disease in patients with SL vulva and the control group, no significant differences were found. Therefore, timely detection of latent forms of AIT, hypothyroidism, nodular goiter, adequate treatment of thyroid dysfunction will allow to normalize changes in the reproductive system and prevent the formation of pathological lesions of the reproductive organs of women.

Abstract Background Aggressive angiomyxoma of the vulva is a benign, slow-growing tumor originating from myxoid cells of connective tissue. The tumor is known for multiple local recurrences with a low tendency to metastasize. Only around 350 cases have been documented in the scientific literature so far. Case presentation We report a case of a 40-year-old North Indian, unmarried woman with a swelling on the left labium majora for 7 years, along with surface ulceration over the mass. Local examination showed a well-circumscribed, 8 × 8 cm pedunculated mass arising from the left labium majora with an overlying ulcer measuring 6 cm × 4 cm. After taking informed written consent, wide local excision of the mass and surrounding margins was done under anesthesia. Histopathology was suggestive of aggressive angiomyxoma. Immunohistochemistry was done, which was positive for estrogen and progesterone receptors. Her postoperative recovery was uneventful. The patient was given three doses of gonadotropin-releasing hormone agonist (injection, leuprolide 3.75 mg) once a month. No recurrence has been reported so far on follow-up visits for 1 year. Conclusion Aggressive angiomyxoma is one of the differential diagnoses for vulvovaginal growth in a female. As the tumor is well known for local recurrences, correct diagnosis and appropriate management using a multidisciplinary approach are crucial to managing such patients.

PurposeTo investigate the shape of labia minora in Chinese adult women.MethodsWomen who visited the Genital Plastic Surgery Center from January 2021 to February 2022 were included and the vulvar regions were photographed. The shape of the labia minora was converted into quantifiable values [left side line segment 1–9 (L1–L9 values) and right side line segment 1–9 (R1–R9 values)]. The 400 enrolled patients were grouped by age, parity, and the types of vulvar surgeries they planned to undergo.ResultsAfter a graphic-to-digital and digital-to-graphic conversion, the simulated average image of the labia minora in Chinese adult women was constructed based on the mean values of L1–L9 and R1–R9. Comparing the values of Ln and Rn in the four age groups revealed that the mean values of Ln and Rn gradually decreased with age, but only two subgroups showed statistically significant differences (P-value 0.05).ConclusionTo measure and evaluate the labia minora, a new assessing method was used. It is an innovative attempt to transform the simple rough description of the shape of the labia minora into more precise data reflecting the shape features. It allows the comparison of labia minora shape between individuals by comparing quantifiable values. Besides, the average shape of labia minora in Chinese adult women was provided visually. Factors including age, parity, and whether the patient planned to undergo labiaplasty were not significantly associated with the shape of the labia minora.