Search

This study aims to assess the diagnostic accuracy of targeted ultrasound examination in prenatal diagnosis of hypospadias and to evaluate the predictive values of defined ultrasonographic findings of hypospadias. The cases diagnosed with hypospadias in our fetal medicine center were identified on an electronic database. The ultrasound reports, images and hospital records were reviewed retrospectively. The predictive value of prenatal ultrasound diagnosis and the predictive values of each sonographic finding were assessed according to the postnatal clinical examinations. Thirty-nine cases were diagnosed with hypospadias on ultrasound during the 6 years. Nine fetuses with missing postnatal examination records were excluded. Twentytwo of the remaining fetuses had their prenatal diagnosis of hypospadias confirmed in postnatal examinations, indicating a 73.3 % positive predictive value. Normal external genitalia was detected in postnatal examinations of three fetuses. Five fetuses were diagnosed with other external genital abnormalities, including micropenis (n=2), clitoromegaly (n=2), and buried penis with bifid scrotum (n=1) in postnatal examinations. The positive predictive value of prenatal ultrasound for any external genital abnormality was 90 %. Although the positive predictive value of ultrasound for genital anomalies is satisfying, it is slightly lower for the specific diagnosis of hypospadias. This reflects overlapping ultrasound findings of different external genitalia anomalies. Standardized, systematic evaluation of the internal and external genital organs, karyotyping and genetic sex determination are essential to achieve a precise prenatal diagnosis of hypospadias. [ABSTRACT FROM AUTHOR]

Background: Vulvar masses in adolescents have a broad differential diagnosis, yet few reports exist detailing masses of mammary origin.Case: A nulliparous, healthy 16-year-old adolescent presented with a longstanding, ulcerated, 17-cm vulvar mass of unknown origin and pronounced inguinal lymphadenopathy. The patient underwent a left radical partial vulvectomy, with pathology revealing terminal duct lobular units consistent with polymastia.Conclusion: Differential diagnosis of a vulvar mass in an adolescent should include polymastia. [ABSTRACT FROM AUTHOR]

Background: Labiaplasty is one of the top cosmetic procedures patients are seeking in the past two years. However, treatment of disease in posterior fourchette caused by various etiological factors was less investigated and neglected., Methods: Three types of posterior fourchette deformity were proposed: (1) Redundant posterior fourchette, (2) Relaxed posterior fourchette, and (3) Constricted posterior fourchette. Local flap transfer technique was applied. Y-V-plasty and 5-Z-Flap-plasty were used to treat web type and tight type of the constricted posterior fourchette, respectively. Follow-ups were arranged on the Internet or at the outpatient clinic. Visual analogue scale (VAS) was utilized to evaluate sexual discomfort in the satisfaction questionnaires during follow-up., Results: A total of 48 patients with constricted posterior fourchette deformity from May 2022 to May 2023 were reviewed in the study. Y-V-plasty could decrease VAS in patients with web-type deformity by 4.13 ± 1.46 (p＜0.001). 5-Z-Flap-plasty could decrease VAS in patients with tight-type deformity by 3.76 ± 1.53 (p＜0.05). Satisfaction rates of the web type and tight type were 93.1% (27/29) and 86.7% (13/15) respectively. Complications include two cases of hematoma, one case of persistent pain and two cases of dehiscence., Conclusion: Constricted posterior fourchette seriously affects the quality of life. Y-V-plasty and 5-Z-Flap-plasty can be utilized to treat the two subtypes of constricted posterior fourchette, which can effectively reduce the pain score of patients with high satisfaction and few long-term complications., (Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate the effects of CO2 laser in the treatment of vulvovaginal atrophy (VVA) in postmenopausal women.Methods: VVA was assessed in 87 postmenopausal women (mean age 58.6 ± 6.9 years) before and after the treatment. The protocol consisted of three monthly treatments and included the treatment of vulva. Subjective measures included VAS (Visual Analog Scale) both for vaginal dryness and dyspareunia; DIVA (Day-by-day Impact of Vaginal Aging); a questionnaire on treatment satisfaction and one about the degree of pain during the procedure. Objective measures included VHI (Vaginal Health Index) and VVHI (Vulvo-Vaginal Health Index). Time points of the study were at the screening visit (T0), at baseline (T1), at week 4 (T2), at week 8 (T3), after 3 months since the last laser application (T4), after 6 months (T5), after 9 months (T6), after 12 months (T7) and after 15 months (T8).Results: Treatment induced significant improvement in the VAS score. After treatment, VHI and VVHI indicated no VVA and this improvement was long lasting. Multivariate analysis showed that the time of follow-up was correlated with better VHI and VVHI (p < 0.001). DIVA improved over time (p < 0.001).Conclusions: This study shows that CO2 laser treatment induces a significant and long-lasting improvement of symptoms. [ABSTRACT FROM AUTHOR]

The vulva is an under-studied area of the female genitourinary tract which is prone to maceration, overgrowth of organisms, and atypical presentations of common dermatologic conditions. In current practice, dermatologists must recognize and manage vulvar infections and infestations beyond the more commonly recognized sexually transmitted infections. Herein, this article reviews the literature on a selection of under-recognized viral, bacterial, fungal, and parasitic vulvar infections and infestations. [ABSTRACT FROM AUTHOR]

The article presents a recommendation on the management of a range of vulval disorders which may present to genitourinary medicine (GUM) clinics. Particular focus is given to a selected group of conditions,which may be managed by genitourinary physicians, either alone or in conjunction with other specialists, who depend on local expertise. Also included is guidance for onward referral.

Acquired perineovulvar defects are usually the result of excision of vulvar intra-epithelial neoplasia (VIN) or invasive squamous cell carcinoma. Because both VIN and vulvar carcinoma have a tendency toward local recurrence, future reconstructive options should be reckoned with during treatment of the primary and all subsequent (pre-) malignant perineovulvar lesions. Hence, a proposal of sequence of reconstructive options for these defects is called for. In cases where local skin flaps suffice, these are preferably designed in such a fashion as not to sever the branches of the internal pudendal vascular system. In cases where either a pudendal thigh flap or an infragluteal flap may be used to close the perineovulvar defect, the pudendal thigh flap is to be preferred to preserve the infragluteal flap for future use. Only when these flaps no longer are available or sufficient to cover the defect should the gluteal thigh flap be applied. The use of myocutaneous flaps is rarely indicated to close isolated superficial perineovulvar defects. [ABSTRACT FROM AUTHOR]

Objective: To report 3 cases of pseudoclitoromegaly and to describe the strategies used for differential diagnosis and treatment.Methods: Three cases and a literature review were described in this study.Results: Three cases referred for treatment of clitoromegaly were in fact cases of pseudoclitoromegaly caused by a hamartoma, a neurofibroma, and a hemangioma of the clitoral prepuce. Abnormal virilization was excluded and the tumors were successfully treated by surgical resection and genital esthetic reconstruction.Conclusion: Clitoral abnormalities not associated with virilization syndromes are rare. Isolated abnormalities may affect the clitoris and the clitoral prepuce (pseudoclitoromegaly) and have multiple causes. The most frequent are inclusion cysts secondary to female circumcision, but a multiplicity of tumors, usually benign, may be found. Treatment is surgical, except for most infantile hemangiomas. Before deciding to offer surgical treatment, one should consider the degree of genital deformity and the risks of sensitivity loss and/or clitoral ischemia. [ABSTRACT FROM AUTHOR]

There are a number of conditions affecting the vagina and vulva that can be optimally assessed with the use of high-resolution magnetic resonance imaging (MRI). This paper gives a suggested protocol for MRI technique and sequences for imaging the pelvis and perineum and reviews the MRI appearances of many of the common pathologies affecting the vagina and vulva. Congenital anomalies, inflammatory and neoplastic entities such as vaginal and vulval carcinoma are discussed, with rarer malignancies also reviewed. [ABSTRACT FROM AUTHOR]

There is a wide variety in the appearance of normal female external genitalia. Nevertheless a specific prototype is promoted by the media, leading to a false sense that all other appearances are abnormal. As adolescents become sexually aware at an earlier age, most of them are worried about the appearance of their genitalia, especially when labia minora protrude beyond labia majora. This is a prospective audit of adolescents presenting for assessment of their perceived abnormal genitalia. Sixteen girls aged 10.2 to 17.8 years presented between June 2009 and December 2010 to a specialist adolescent gynecology service. Their mean labial width was 36 mm (range: 20--55 mm). In six girls, the reason for attending the service was inequality of the size of labia ranging between 6 mm and 35 mm (mean of 20 mm). Among the remaining 10 girls, the concern had arisen through comparison with a prepubescent sibling (one case), change of genitalia during puberty (four cases), looking at internet pictures (four cases), and looking at an anatomy book (one case). Risks of Female Genital Cosmetic Surgery (FGCS) have not been adequately documented, especially with regards to sexual function and long-term patient satisfaction. External genitalia are likely to change during puberty and therefore, any genital operation in the absence of clear pathology should be deferred until adulthood. Even then, women should have clear expectations of what will be achieved with the operation in terms of appearance and function. [ABSTRACT FROM AUTHOR]

The spectrum of disorders of sexual development includes anatomical abnormalities of the external genitalia, the phenotypic variability of which and the underlying causes are numerous. However, female aphallia and ectopia of the labium majorum appear to be some of the rarest forms of external genitalia malformations. Aphallia is mostly described in males with a frequency of less than one per 40 000 male newborns. Although syndromic forms of aphallia in females have been reported, for example, in Robinow, CHARGE, and Prader-Willi syndrome, reports of isolated female aphallia are meager. Here, we describe the first case of isolated agenesis of the clitoris with an ectopic labium majorum and review the literature of this uncommon malformation and its potential dysmorphogenetic mechanism. We emphasize the need for a routine exhaustive physical examination to identify and characterize this unusual malformation correctly so that families can be appropriately counseled as to cause and potential complications.

A 17 wk old sexually intact female domestic shorthair kitten presented for an anogenital cleft and enlarged colon. The cat had experienced bacterial cystitis and constipation since weaning. Contrast referral images revealed an enlarged colon with a patent anus. Clinical examination revealed an anogenital cleft with a common anovulvar orifice. The rectum was patent upon digital rectal palpation, and fecal contamination of the vulva was present. Abdominal radiographs revealed two distinct colons, both filled with a moderate amount of formed fecal material. Contrast-enhanced computed tomography revealed segmental duplication of the descending colon with a dominant right colon and a smaller accessary left colon. The two structures conjoined at the transverse colon proximally and at the pubic brim distally. A common anogenital orifice with anovulvar communication was also noted. The anogenital cleft malformation was successfully repaired surgically. A celiotomy was performed to remove the smaller accessory colon. An ovariectomy and partial hysterectomy were also performed. The patient recovered uneventfully and showed no gross evidence of recurrent cystitis or urinary or fecal incontinence postoperatively. This is believed to be the first report of a congenital anogenital cleft and complete communicating colonic duplication in a cat.

Introduction: During the postpartum period, breast engorgement in preparation for lactation may trigger the onset of vulvar labial nodules that present with pain and discomfort. These labial nodules may originate from ectopic breast tissue and can rarely present in women during the postpartum period in the labia majora., Main Issue: A 37-year-old African American female, gravida 1 para 1, presented to the Loma Linda University Medical Center with complaints of new onset labial swelling worsening 6 days following her full term spontaneous vaginal delivery. Additionally, our respondent complained of difficulty breastfeeding due to intermittent lack of milk production. She reported bilateral breast engorgement with tenderness, despite frequent attempts at breastfeeding. The respondent's presentation did not meet the criteria for other common differentials due to the physical characteristics of the nodules. The location of the nodules along the milk line led physicians to believe that the respondent was presenting with engorged extra-mammary breast tissue in the labia majora., Management: The participant was told to observe her course over the next few days as she began to have milk production and ejection. The respondent was seen in clinic for her 6-week postpartum visit, and was no longer complaining of difficulty with breastfeeding. The labial nodules had resolved spontaneously., Conclusion: A literature search yielded no case reports that described a case of an extra-mammary vulvar mass that self-resolved with resolution of breast engorgement. The infrequent presentation of extra-mammary vulvar tissue makes it difficult to conclude a guideline for diagnosis and management.

This case discussion on urethral coitus in Mayer-Rokitansky-Küster-Hauser syndrome shows that this rare syndrome can have major physical and psychological consequences. Further consideration shows that a lack of common sense and a lack of action concerning sexual history-taking and careful vulvar examination is the reason that an iatrogenic sexual problem arose in this case. This was not the result of the initial denial of a rare diagnosis. Both attention to these aspects during training and supervision are necessary, since other disorders and medical treatments can also have a negative impact on sexuality.

Cystic (cavernous) lymphangioma of the vulva is a benign tumor of lymphatic vessels with only 10 cases previously reported in the medical literature worldwide. The following is a case of bilateral vulvar cavernous lymphangiomas in a 23-year-old woman with bilateral soft tissue masses of the labia majora. Prior unsuccessful management included aspiration, incision, and drainage. Surgical marsupialization of both masses led to resolution and the subsequent histologic diagnosis of cavernous lymphangioma. Although rare, cavernous lymphangioma should be included in the differential diagnosis of soft tissue masses of the distal labia. Cavernous lymphangioma can mimic other more common vulvar soft tissue masses such as Bartholin's cyst., Competing Interests: None of the authors identify any conflict of interest., (©Copyright 2019 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

The article presents the case of a 24-year-old woman with repeated vulval ulceration since when she was 15 years old. It mentions that the woman experiences the condition always after an upper respiratory tract infection and one or more spots that are enlarged appeared on her labia minora. The case discusses human herpes virus 7 with recurrent vulval ulceration.

The review focuses on the feminizing genitoplasty of the external genitalia in patients with disorders of sex development. The opinions of various surgeons and surgical schools on the timing, stages and methods of performing feminizing genitoplasty in girls with the virilization of the genitalia are presented. The development and improvement of surgical techniques for performing clitoroloplasty in patients with virilization of genitalia are described, as well as different types of labioplasty. The main methods of reconstruction of the urogenital sinus are given.

Background: Congenital fused labia (CFL) is defined as a failure or significant delay in the opening of the juvenile sealed labia majora. This phenotype is known to be variably common in adult captive female marmosets but has never been investigated in detail before., Materials and Methods: Here, we define, describe and quantify the variations in the degree of closure of the vulva in 122 captive marmosets (Callithrix jacchus) from 1.2 to 42 months old and include colony analysis., Results: There was a negative correlation between the degree of labial fusion and animal age after prepubertal period (P < 0.05). CFL females had higher number CFL relatives (4.3 ± 0.6 vs 2.4 ± 0.5 for non-CFL, P < 0.05) and more external ancestors compared to non-CFL (P < 0.05)., Conclusions: Our results therefore suggest that CFL phenotype is most likely associated with epigenetic effects induced by the captive environment and colony management strategy of extensive crossing of family lines to promote heterozygosity., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

AP endonuclease deficiency causes cell death and embryonic lethality in mammals. However, the physiological roles of AP endonucleases in multicellular organisms remain unclear, especially after embryogenesis. Here, we report novel physiological roles of the AP endonuclease EXO-3 from larval to adult stages in Caenorhabditis elegans, and elucidated the mechanism of the observed phenotypes due to EXO-3 deficiency. The exo-3 mutants exhibited developmental delay, whereas the apn-1 mutants did not. The delay depended on the DNA glycosylase NTH-1 and checkpoint kinase CHK-2. The exo-3 mutants had further developmental delay when treated with AP site-generating agents such as methyl methane sulfonate and sodium bisulfite. The further delay due to sodium bisulfite was dependent on the DNA glycosylase UNG-1. The exo-3 mutants also demonstrated an increase in dut-1 (RNAi)-induced abnormal vulval organogenesis protruding vulva (Pvl), whereas the apn-1 mutants did not. The increase in Pvl was dependent on UNG-1 and CHK-2. Methyl viologen, ndx-1 (RNAi) and ndx-2 (RNAi) enhanced the incidence of Pvl among exo-3 mutants only when combined with dut-1 (RNAi). This further increase in Pvl incidence was independent of NTH-1. These results indicate that EXO-3 prevents developmental delay and Pvl in C. elegans, which are induced via DNA glycosylase-initiated checkpoint activation.

The article presents a case study of a 24-year-old woman who was diagnosed with severe vulval swelling. She underwent physical examination and determined a significant swelling of the labia majora and labia minora. An oral examination was conducted and determined an aphthous ulcer on the right ventrolateral aspect of the patient's tongue.

Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy. This case series aims to establish awareness of this condition among pediatric dermatologists and provide recommendations regarding management., (© 2018 Wiley Periodicals, Inc.)

Amorphus globosus is a rare entity, more common in the cow but also reported in mares, buffaloes and goats. In respect of both development and clinical presentation, this abnormity can be evolved very variably. Previously, it has been discussed whether it is a form of twin pregnancy or placental teratoma. This case report deals with morphology and genetic observations in an unusual bovine amorphus globosus exhibiting a rudimentary clitoris and vulva, gut-like structures and rudimentary bones. The amorphus globosus was shown to be dizygotic to the normal male twin using the BovineSNP50 v2 BeadChip and had a genetical female sex. Aspects of aetiology and pathogenesis as well as the possible impact of amorphus globosus in the emergence of freemartinism are discussed., (© 2017 Blackwell Verlag GmbH.)

Abstract: Study Objective: To understand the timing and factors affecting diagnosis of phenotypically female 46XY children. Design, Setting, and Participants: We studied all phenotypically female 46XY children who attended our multidisciplinary disorders of sexual differentiation (DSD) clinic in Nottingham England in a 3-year period since its inception. Case notes from a prospectively maintained database were reviewed and data were analyzed on the age at presentation, family history, findings on genital examination, and underlying endocrine abnormality. Results: Eleven children were studied, all of whom were being raised as girls. The median age of presentation was 18 months (range birth-15 years). Although the newborn examination detected the possibility of DSD in only 3 cases; 10 of 11 children had at least one significant abnormality in their external genitalia at presentation. Conclusion: Careful neonatal genital examination can identify children with DSD. However, not all children with these conditions are identified early. Early diagnosis, when possible, is important, as it has the potential to make the management of this difficult condition more straightforward. [Copyright &y& Elsevier]

The article presents a case report of a 55-year-old woman who complained of vulval soreness. She had no postmenopausal bleeding after her menopause and was up-to-date with her smears and she does not smoke nor drink. She was given topical oestrogen antifungal creams but was not satisfied with the result. Histopathology revealed an epidermis with smooth muscle fibres in the dermis suggestive of smooth muscle hamartoma but no overt leiomyomatous component.

The article presents a case study of a woman complaining of absence of external genitalia and presence of a single small opening at the corresponding region through which both micturition and menstruation occurred. After diagnosis, surgical treatment was planned. A surgical incision was made vertically in the midline of the vulva after negotiation of a malleable metallic uterine sound through a small opening.

The article reports on the case of an 89-year-old, Caucasian women gravida 2, para 2 who was presented with vulval mass as the first manifestation of non-Hodgkin's lymphoma (NHL). The diagnosis of NHL was established by surgical excision of the vulval mass. Computed tomography findings supported the diagnosis of disseminated NHL secondarily involving the vulva.

The article discusses the case of a 44-year-old woman with a history of pruritic erythematous rash affecting the vulva, perineum and groin who consulted a dermatology clinic. A vulval biopsy showed features consistent with Darier's disease. She was treated with intermittent courses of topical steroids, emollients and antiseptic washes. Ciclosporin was started after measurement of blood pressure and renal function.

Background: Labia minora reduction interventions rise in Europe and in North America. Several techniques are described. The objective of this study was to compare postoperative complications of the two most practiced interventions: wedge resection and edge resection., Methods: Primary labia minora reductions realized in our unit between October 2009 and July 2016 have been retrospectively identified. Two techniques were used by two surgeons: edge resection technique and wedge resection technique. The main evaluation criterion was the occurrence and the quantity of wound dehiscence: superior to 50% (total or subtotal) and inferior to 50% (partial). Patients were systematically examined at 1 week, 1 month and 6 months postoperatively. Data analysis between both groups was made with an exact Fisher test., Results: Mean follow-up was 5.3 months after intervention. Sixty-four patients have been included, 42 wedge resections (group C) and 22 edge resections (group L). Global complication rate at 1 month was 13% (n=8). Among wedge resections 14% (n=6) developed complication and 2% (n=9) among edge resection. Seven surgical revisions were necessary: 5 for wound dehiscence (4 in the group C and 1 in the group L) and 2 for hematoma, one in each group. Three (5%) partial wound dehiscence (inferior to 50%) have been identified and let in secondary intention healing: 2 (19%) in the group C and 1 (27%) in the group L. Complication rates between both techniques were not significantly different., Conclusions: Postoperative wound dehiscence is the main labia minora reduction complication. Our global complication rate, 13%, matches with the current literature. A tendency can be shown where wedge resection is more likely to develop wound dehiscence than edge resection., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Angiokeratoma of fordyce occurring over on the vulva is a rare condition. Fordyce angiokeratoma is observed more frequently among men than women. In women, it is generally observed in later life, and appears as multiple dark purple papules, measuring 2-4 mm, on the vulva., Case Report: We present the case of a 17-year-old white teenage girl with giant Fordyce angiokeratoma on the right vulva. The angiokeratoma was removed and a V-Y advancement flap was made., Conclusion: In the literature, this is the first childhood case reported in which a reconstruction of the vulva was performed.

Signaling by the epidermal growth factor receptor (EGFR) generates diverse developmental patterns. This requires precise control over the location and intensity of signaling. Elucidation of these regulatory mechanisms is important for understanding development and disease pathogenesis. In Caenorhabditis elegans, LIN-3/EGF induces vulval formation in the mid-body, which requires LET-23/EGFR activation only in P6.p, the vulval progenitor nearest the LIN-3 source. To identify mechanisms regulating this signaling pattern, we screened for mutations that cooperate with a let-23 gain-of-function allele to cause ectopic vulval induction. Here, we describe a dominant gain-of-function mutation in swsn-4, a component of SWI/SNF chromatin remodeling complexes. Loss-of-function mutations in multiple SWI/SNF components reveal that weak reduction in SWI/SNF activity causes ectopic vulval induction, while stronger reduction prevents adoption of vulval fates, a phenomenon also observed with increasing loss of LET-23 activity. High levels of LET-23 expression in P6.p are thought to locally sequester LIN-3, thereby preventing ectopic vulval induction, with slight reductions in its expression interfering with LIN-3 sequestration, but not vulval fate signaling. We find that SWI/SNF positively regulates LET-23 expression in P6.p descendants, providing an explanation for the similarities between let-23 and SWI/SNF mutant phenotypes. However, SWI/SNF regulation of LET-23 expression is cell-specific, with SWI/SNF repressing its expression in the ALA neuron. The swsn-4 gain-of-function mutation affects the PTH domain, and provides the first evidence that its auto-inhibitory function in yeast Sth1p is conserved in metazoan chromatin remodelers. Finally, our work supports broad use of SWI/SNF in regulating EGFR signaling during development, and suggests that dominant SWI/SNF mutations in certain human congenital anomaly syndromes may be gain-of-functions., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The objective of the study was to report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVMs) using a staged, multidisciplinary approach. Study Design: Consecutive patients with symptomatic lesions treated over a 7 year period (2005-2012) were followed up for technical success, resolution of symptoms, aesthetic outcomes, and complications. Direct endovenous sclerotherapy (DEVS) using sodium tetradecyl sulfate (STS) foam was performed in all patients under ultrasound and contrast-enhanced fluoroscopic guidance. Surgical excision and layered primary closure was performed within 24 hours after the last DEVS session. Results: Eleven patients (mean age, 25 years; range, 4–43 years) were treated. Presenting symptoms included pain (n = 11), soft tissue swelling (n = 11), local heaviness (n = 11), dyspareunia (n = 2), and dysmenorrhea (n = 2). Most were isolated lesions (n = 8). There were 2 cases of Klippel-Trénaunay syndrome and 1 case of Maffucci syndrome. The latter required Nd:YAG laser photocoagulation prior to sclerotherapy. On average, approximately 3 DEVS sessions were required prior to surgical excision (range, 1–6). Mean estimated surgical blood loss was 130 mL (range, 20–400 mL). Mean follow-up was 23 months (range, 3–55 months). Elimination of pain and soft tissue redundancy was achieved in all patients with satisfactory aesthetic outcomes. All patients experienced minor pain and swelling after DEVS. Following surgical excision, there was 1 case of hematoma and wound dehiscence requiring surgical evacuation. No other reinterventions, endovascular or surgical, were required. Conclusion: VVMs require increased awareness and appropriate preoperative evaluation for proper identification and treatment. A multidisciplinary approach can provide improvement in clinical signs and symptoms with satisfactory cosmesis and minimal complications. [ABSTRACT FROM AUTHOR]

Objectives: Urologists daily evaluate many women with voiding disturbances, but proper physical examination has only rarely been previously performed., Case Description: Case 1: 16-year-old woman presenting augmented daytime urinary frequency and nocturia without enuresis, with drop-by-drop micturition. Case 2: 80-year-old woman with urgency. She referred normal voiding with insensitive urinary loss the hour after., Physical Examination: adhesion of the labia minora., Treatment: Surgical section of the adhered area in the midline was performed with satisfactory aesthetic and clinical results., Conclusions: The adhesion of the labia minora is an acquired disease, more frequent in girls under 2 years. Several predisposing factors have been proposed: oestrogen deprivation, inadequate personal care, local irritants, infections or previous trauma. Differential diagnosis is required among three congenital pathologies: vaginal agenesis, imperforated hymen and ambiguous genitalia. Cases in postpubertal or postmenopausal women, or refractory to medical treatment are considered for surgery.

Background: Many studies of techniques to reduce the labia minora have been published in recent decades, including case reports and retrospective case series. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques., Objectives: The authors performed a comprehensive literature review to determine outcomes and complications of labiaplasty techniques, including patient satisfaction., Methods: A search on PubMed/Medline was performed with the keywords labiaplasty, labioplasty, labial hypertrophy, and techniques plus labia minora reduction. The inclusion criterion was clinical studies in which techniques of labia minora reduction were described. Excluded from the study were publications not dealing with surgical procedures and review articles., Results: Thirty-eight studies, published from 1971 through 2014, were included; this represented 1981 treated patients. Eight labiaplasty techniques were identified from these studies: edge resection, wedge resection, deepithelialization, W-plasty, laser labiaplasty, custom flask, fenestration, and composite reduction. Satisfactory results, judged from clinical examination, were observed with all 8 techniques. Few postoperative complications occurred. In a small number of cases, complications required surgical revision or secondary resection., Conclusions: All 8 labiaplasty techniques resulted in good outcomes, including high patient satisfaction and low morbidity., (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Aesthetic surgery of the external genitalia in women encompasses many procedures and may address the labia minora, clitoral hood, labia majora, mons pubis, or vaginal opening. During the initial evaluation, the surgeon should consider all aspects of the external genitalia to develop an appropriate surgical plan. It may be necessary to perform 2 or more procedures during the same surgical session to achieve the desired aesthetic result. In this continuing medical education (CME) article, we review the literature and summarize the available cosmetic techniques for female external genitalia. Resection of the labia minora has been described in several peer-reviewed reports. We also discuss the procedures and modifications to direct resection, wedge resection, and deepithelialization of the labia minora. Aesthetic surgery of the clitoral hood may involve straight-line resection, extended wedge resection, or inverted V hoodoplasty. The mons pubis may be treated with mons pubis pexy, wedge resection, or lipomodeling. The labia majora can be managed with direct resection or lipomodeling, and hymenoplasty may be performed to correct a wide vaginal opening., (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Background: Nowadays, the demand for female genital rejuvenation procedures especially for labiaplasty is surging. Labia minora reduction has been the most practiced esthetic procedure for the female genitalia in China. Gynecological plastic surgeons have proposed several methods for labia reduction, but there is no consensus on which one is the best choice. Patients often receive re-operations for inadequate resection and asymmetry with existing methods. Here we present a modified method of labiaplasty combined wedge and edge resection and to discuss the appropriate indications of this method., Methods: From January 2009 to March 2014, we performed 524 labia esthetic surgeries. The methods we used mainly include simple edge resection, wedge resection, modified de-epithelialization, and the combined method discussed in this article. Forty-nine patients aged from 25 to 45 years were selected to receive combined wedge-edge labial resection and were retrospectively reviewed. Patients were required to come back for follow-up assessment at 1 and 6 months., Results: Twenty-one of forty-nine (42.9 %) patients underwent unilateral labial reduction. The average time for the procedures was 56 min. The mean follow-up was 4.5 months. All the surgeries were successfully performed and 47 patients experienced an uneventful postoperative period. A minor dehiscence occurred in two patients. One of the patients received a revision surgery correcting a postoperative asymmetry malformation. Finally, all the patients were satisfied with the esthetic appearance., Conclusion: The combined wedge-edge reduction of the labia minora is a simple and safe method associated with high satisfaction and a low complication rate. Therefore, we propose this combined procedure for bi-dimensional and/or unilateral hypertrophied labia minora especially in those who require removal of the dark margin of the labia.

The physical and gynecological examination of a Holstein heifer single-born with a disorder of sexual development showed anatomical abnormalities such as the presence of a scrotum and 2 vulvae and an anal sphincter that was positioned on the right side of the body. Also, an early pregnancy was diagnosed. Cytogenetic and hormone analysis was requested, and the animal showed normal female metaphases (60,XX) and hormonal profiles. However, in gross anatomy and histological examinations, a structure compatible with a penis, the absence of a uterine body, 2 exophytic structures, and a septum in the vagina were detected.

Summary: Vaginal rejuvenation has been on the rise for the past 10 years. Women seem to prefer no pubic hair and minimal if any labia minora dangling beyond the majora. Labiaplasty or labia minora reduction is the most common procedure requested by women concerned with the appearance of their vulvar area. Safe and effective surgical procedures exist to trim the labia minora and the labia majora and clitoral hood as indicated. In this article, patient selection and consent, surgical techniques, avoidance of complications, and adjunctive procedures to further enhance the aesthetics of the region are discussed.

Abstract: Background: Swyer syndrome is associated with absent testicular differentiation in a 46XY phenotypic female. Case: A 17-year-old female presented with primary amenorrhea and 46XY karyotype. Breast and pubic hair development were Tanner 2, and clitoral enlargement was noted. Magnetic resonance imaging revealed a hypoplastic uterus and 2 “normal ovaries.” Serum follicle-stimulating hormone and luteinizing hormone were elevated. Testosterone and androstenedione were in the female range. Dehydroepiandrosterone sulfate was slightly elevated. Laparoscopic bilateral gonadectomy was performed. Pathology reports showed bilateral microscopic benign hilar cell tumors. Summary and Conclusion: The diagnosis was a real puzzle for the clinicians because of the association of clitoral hypertrophy without hirsutism, female internal genitalia, and a 46XY karyotype. Clitoral enlargement can be explained by transient androgen secretion by the hilar cells found in the resected gonads. [Copyright &y& Elsevier]

Summary: In reconstructing a large defect of the vulva, we combined the gluteal fold and the pudendal thigh flaps and made a bilobed flap. Using this gluteal fold pudendal thigh bilobed flap, we reconstructed a vagina with sufficient depth and width. The surrounding skin defect was simultaneously reconstructed. Sensation was intact in all areas of the reconstruction. In addition, the sutured lines of both donor sites are hidden in the gluteal and inguinal folds. Thus, the gluteal fold pudendal thigh bilobed flap seems to be ideal for reconstructing large vulvar defects. [Copyright &y& Elsevier]

The article focuses on the case of a 65 year old woman with a 15 year history who presented to doctors with fever, and a rash on her right thigh, vulva and lower abdominal wall. A discussion of the woman's earlier diagnosis of and treatment for a yeast infection and diagnosis of a necrotizing soft-tissue infection, and treatment with aggressive fluid resuscitation, antibiotics, surgical débridement and reconstructive surgery is presented. The patient's subsequent recovery and prognosis is discussed.

The article describes the first case of congenital vulval abnormalities in alpacas in Europe. Physical examination reveals a swollen vulva and not identifiable vulval opening. Serum biochemistry shows an increased lactate concentration, reduced total protein and increased urea and creatinine concentrations. A diagnosis of labial fusion was made with secondary azotaemia and partial failure of passive transfer.

The author analyzes more than 40 years of his own experience concerning the outcome of pediatric gynecology patients who underwent surgery in the Department of Gynecology and Obstetrics, Debrecen University in Hungary. Traditional surgical interventions were performed, and, some new methods elaborated by the author. The age of patients who underwent surgery ranged from infancy to 18 years. The objective of this publication is to describe general principles to support the work of those who are currently active in this area or have chosen the area for their future activity. Types of surgical interventions, conditions of proper management and insitutional background, together with requirements of qualified personnel and diagnostic performance are analyzed. Possible sources of errors and their prevention are pointed out. Different procedures are discussed in separate groups. The author's own procedure modifications based on the original procedure elaborated by Vecchietti for treatment of vaginal aplasia are described. Concluding from results of more than 60 successful modified Vecchietti procedures the author recommends his own procedure.

Introduction: the perineal groove is a very uncommon anorectal anomaly. It is the result of an unknown embryology anomaly. The perineal groove is a wet sulcus extending from de fourchette to the anus. It is a benign pathology and tends to resolve spontaneously., Objective: We report two cases of girls diagnosed with perineal groove and their follow up., Cases Reports: The first case is an 18 days old baby girl, that during her first clinical examination there was found a painless lineal lesion in the perineum from the fourchette to the anus, which created a big anxiety in her family. She was cared at the Pediatric Gynecology Unit, with local lubrication, doing well with the epithelization of it. The second case is an 8 year-old girl who consulted because, when being a child, she was diagnosed with a perineal lesion, but she didn't receive any special treatment and now she feels some aches in the perineum., Conclusions: The perineal groove is a benign entity pretty unknown by general practitioners or pediatricians. It is important to be up to date with this condition to avoid alarming misinterpretations.

We present a case of a female 46,XX infant with a perineal lipoma within an accessory labioscrotal fold containing a penis-like phallus, associated with contralateral renal agenesis and complete absence of Müllerian/paramesonephric structures. To our knowledge, this is the first report of perineal lipoma and accessory labioscrotal fold associated with urogenital abnormalities in a female. The case also has an exceptional penis-like phallus in the absence of Y chromosome material or evidence of virilization., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)