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Objective: To compare the effects of the use and non-use of a disinfectant on the outcomes of separation of the labia minora in infants. Methods: The patients were randomly divided into an experimental group with 24 cases and a control group with 25 cases. In the control group, 1% iodophor was used to clean and disinfect the large and small labia and the surrounding skin, while normal saline was used in the experimental group. Other procedures such as the surgery and nursing method were the same in both groups. Results: There were no symptoms of urinary tract infection such as redness of the vulva, swelling, pain, and abnormal urination in the test group and control group after three days of follow-up, and no recurrence was seen at one month of follow-up. There was no statistically significant difference between the two groups (P > 0.05). Conclusion: Use or non-use of a disinfectant to clean the urethral opening before separation of the labia minora has no significant effect on the outcomes, and does not cause postoperative urinary tract infection symptoms. Moreover, non-use of a disinfectant can prevent local irritation and reduce the economic burden on the patients.

BACKGROUND Extramammary Paget's disease (EMPD) is a rare neoplasm that commonly affects post-menopausal women. It usually presents in the anogenital area where apocrine sweat glands are abundant, most commonly in the vulva. The disease is characterised by slow growth and high local recurrence rates. Clinically, EMPD presents as well-demarcated erythematous lesions or plaques that may be ulcerated. Microscopically, it shows a group of atypical cells with abundant clear cytoplasm and nuclear pleomorphism. METHODS We present the case of a 58-year-old female with a history of poorly differentiated squamous cell carcinoma of the cervix, status post-radical-hysterectomy with bilateral salpingo-oophorectomy, and chemoradiation in 2016. The patient also had a long-standing history of vulvar pain, skin changes on her left labia, and itching. RESULTS Punch biopsies of the vulva revealed acanthosis and acantholysis of the epidermis with an intraepidermal scattering of single, or clusters of, large cells with round/oval nuclei and abundant clear cytoplasm. The cells were positive for p16, CK19, CK7, and PAX8, supporting the diagnosis of EMPD without evidence of dysplasia. The concurrent Papanicolaou smear showed a hypercellular specimen composed of hyperchromatic tissue fragments with high nuclear-to-cytoplasmic ratios and apoptotic bodies. The presence of intracytoplasmic mucin and the tridimensionality of the fragments supported the diagnosis of adenocarcinoma. CONCLUSIONS This study compares the histological and cytomorphological features of EMPD with high-grade squamous intraepithelial lesions, since the pathogenesis, precursor lesions, etiological associations, staging, clinical treatment, and prognosis differ substantially and may have a significant clinical impact on the patient's treatment.

Background Heightening interest in labiaplasty has driven potential patients to online fora, permitting the dissemination of material by potentially unqualified or inexperienced individuals. The discourse surrounding this procedure has been injected with strong opinions that are not entirely consistent with medical best-practice or evidence-based knowledge. Objectives The aim of this study was to explore the rationale for ongoing public opposition to labiaplasty and to investigate if awareness of the similarities between labiaplasty and breast reduction can alter an individual’s perception. Methods Four hundred and forty-eight adult women were surveyed concerning their opinion of a surgical procedure to reduce the size of an unspecified organ related to a woman’s sexuality, breast reduction, and labia reduction. Results Reduction of an unspecified organ and breasts was met with significantly greater acceptance than labia reduction (P Conclusions Attitudes towards labiaplasty seem firmly based on emotion or correlation to other unacceptable practices. Informational resources do not sway these biases; thus, there is a limited role for surgeon-led education in the normalization of labiaplasty because it requires a societal shift in acceptance. Labiaplasty is a procedure whose time for popular acceptance has not yet come.

This study was designed to evaluate utility of transferring autologous adipose-derived mesenchymal stem cells with high regenerative capacity and adipose tissue derived‐stromal vascular fraction, so-called 360 Vaginal Beautification technique, in labia majora augmentation and vaginal tightening operation. A total of 97 female patients who underwent labia majora augmentation and vaginal tightening operation with 360 Vaginal Beautification technique were included. Post-discharge early (3rd and 7th postoperative day) and late (1st and 3rd postoperative month) surgical complications were assessed , while the Female Genital Self-Image Scale (FGSIS) was applied before surgery and also during postoperative 6–12 months. All complications noted on postoperative 3rd day (ecchymosis of labia majus, ecchymosis of clitoral hood, tenderness in the pubic area and pain at the vaginal entrance points) regressed on postoperative 7th day with no infection, edema, lipoma or granuloma formation in any patient. Total mean FGSIS score was 17.7 ± 1.6 in the pre-operative period, and increased significantly to 20.9 ± 1.4 and 22.2 ± 1.8 in the postoperative 6th month (p

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

We present a case and discuss the management of a posterior cloacal variant not as yet described in the literature. A 5-week-old infant presented to our institution with a posterior cloacal variant and transposition of the clitoris and labia. After initial radiological investigations, staged operative intervention was performed over a 1-year period. This included an initial laparotomy (with drainage of hydrocolpos and formation of a colostomy), a left ureteric reimplantation and a posterior sagittal anorectoplasty due to a rectoperineal fistula. The child is under continued long-term follow-up by our specialist pediatric surgical team.

Objective To report and compare presentation and management of Fournier's Gangrene (FG) in female vs male patients at a single tertiary care center. Methods Patient demographics, clinical characteristics, treatments and outcomes were summarized and compared between males and females who were treated for FG from 2011 to 2018 at a single institution. Results Of the 143 patients treated for FG at our institution, 33 (23%) were female. Female patients were predominantly white (82%), with a median (IQR) age of 55 (46, 59). Median female boby mass index (BMI) was 42.1 (32, 50.4). Female patients’ wound cultures were polymicrobial mix of gram positive and gram negative organisms. Median number of debridements for females was 2 ( 1 , 3 ). The most common anatomic region of gangrene involvement in females was labia (76%) followed by perineum (55%) and gluteus/buttocks (42%). Mortality rate during initial admission was 6% for females. Female patients had a higher median BMI than males (42.1 vs 33.7 respectively; P = .003). FG severity index, length of hospital stay, number of debridements, and wound cultures were comparable to males. The surgical team managing initial debridements differed with females managed primarily by general surgery and males primarily by urology. Mortality rate was comparable to men (6% vs 7%, P >.05). Conclusion Female patients with FG have greater BMI but similar clinical presentation, microbiologic characteristics and mortality rate compared to men. Urologists have little involvement during initial management for females at our institution.

Background Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. Methods A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized. Results Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. Conclusions In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.

Background Despite controversy surrounding labiaplasty in adolescent girls, labiaplasty might be indicated in the case of recurrent labial hair thread tourniquet syndrome (HTTS). Case We describe a case of an 11-year-old girl with recurrent labial HTTS who underwent labiaplasty. Summary and Conclusion Recurrent labial HTTS can lead to disfigurement and partial loss of labium. Labiaplasty can restore normal anatomy of the labia and prevent further recurrence in select cases.

Facial lymphedema secondary to treatment by a neoplastic process is a rare and disabling pathology, causing functional and aesthetic alterations. A case report of facial and labial lymphedema describing the functional repercussion and aesthetic defect. We present a 61-years-old female patient suffered a tongue neoplasia and bilateral cervical lymphadenectomy in 2015. After several treatments, including diverse surgical interventions and adjuvant radiotherapy, developed facial and labial lymphedema. The patient was sent to our Rehabilitation Department complaining about swelling of the face and lips, dysphagia, sialorrhea, xerostomia, dysarthria and decubitus in lower lip by labia protusion. Due to the functional repercussion that it caused in the patient, rehabilitating physical treatment was planned with manual lymph drainage, facial silicone orthosis and lymphatic taping. The patient improved both subjectively as well as objectively in terms of hardness, volume and slight improvement of lip lymphedema.

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

Lichen simplex chronicus (LSC) of the vulva is an acquired, persistent, severely itchy dermatosis usually located in easily reachable areas of the body like the extremities, nape of the neck, and genitalia. It also has a strong association with atopy and is said to be initiated and perpetuated by the itch-scratch-itch cycle. Two cases of rugose labia as the sole presentation of LSC of vulva are being presented.

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

Physical changes during pregnancy cause stretching of the pubic symphysis. Pubic symphysis rupture occurs when the joint widening is more than 10 mm which is confirmed by radiologic. The conservative and surgical are required to management of rupture of the symphysis. 25-year-old women with a postpartum birth canal tear using a vacuum. The patient felt severe pain and a lump in the pubic area. On examination, the uterus was 2 fingers below the navel, swelling in symphysis area, and pressure pain, and there were the labia and urethra lacerated without active bleeding. in laboratory tests, hemoglobin 7.3 g/dL, leukocytes 15,300/mm3, and platelets 255,000/mm3. The results of the pelvic x-ray examination are symphisiolysis. The patient underwent surgery with open reduction internal fixation (ORIF) and suturing the lacerated urethra by the surgical department. During the treatment, light mobilization and education on self and baby care were carried out. The wound was cleaned in 3 days and the urinary catheter was maintained for up to 14 days. The patient was discharged and carried out control every month for 6 months. Pubic symphysis rupture is one of the rare complications of labor due to multiparity, macrosomia, use of forceps, difficult labor, malpresentation, and trauma. The diagnosis is made when the intrapubic distance is greater than 10 mm on pelvic radiography. An MRI examination is preferred to assess for tissue tears. Operative internal fixation is performed when conservative therapy fails, soft tissue damage, and intrapubic distance of more than 25 mm. Pubic symphysis rupture is a labor complication due to the stretching of the symphysis. Surgical treatment is performed when conservative therapy fails.

Mid-urethral sling (MUS) surgery for stress urinary incontinence (SUI) has relatively low complication rates. However, although rare, complications such as bladder wall, prepubic and thigh abscess occur. We present an unusual case of MUS vaginal mesh exposure followed by mons pubis abscess formation occurring 18 years postoperatively because of inadvertent prepubic insertion of the right arm. Our objectives were to raise awareness about such a rare complication and to describe the approach for sling removal. A 75-year-old woman presented with gradual swelling on the mons pubis followed by pain with a past history of MUS insertion. Examination revealed a palpable, tender, non-fluctuant mass, extending about 10–15 cm from mons pubis to the right labia. There was a 2 × 2-cm vaginal mesh exposure. Following imaging, an examination under anaesthesia was performed with vaginal exploration and complete removal of the right arm of the MUS and closure of the vagina. Six months postoperatively, all surgical sites had healed well, and there was no recurrent SUI or persistent mesh exposure. Unusual long-term complications of MUS should be considered and recognized. Thorough evaluation is crucial for informed decision-making related to treatment strategies. The vaginal approach to mesh removal is safe and should be practised by experienced surgeons. Patients should be informed regarding the possibility of incontinence after sling removal.

BACKGROUND Labiaplasty has grown in popularity, but it remains controversial. Few studies have quantified the change in specific symptomatology from before to after labiaplasty to establish its effectiveness in improving quality of life. METHODS In a prospective study, 62 patients undergoing labiaplasty completed written surveys privately in an examination room preoperatively and postoperatively about the presence of 11 physical and appearance-related symptoms. RESULTS Mean patient age was 33.5 years (range, 17 to 61 years). Two patients were of minority age. All patients presented with at least one symptom, averaging 6.5 (range, one to 11). Most (82.2 percent) had a trim labiaplasty, and the rest (17.7 percent) had a wedge. After labiaplasty, 93.5 percent of patients were symptom-free, with the average dropping to 0.23 of 11 symptoms. Symptom-prevalence changes from preoperatively to postoperatively included self-consciousness, dropping from 93 percent to 6.5 percent; tugging (from 66.1 percent to 0 percent); feeling less attractive (from 66.1 percent to 0 percent); negative impact on self-esteem (from 64.5 percent to 1.6 percent); negative impact on intimacy (from 62.5 percent to 0 percent); twisting (from 58.1 percent to 3.2 percent); being uncomfortable (from 56.5 percent to 4.8 percent); clothing restriction (from 54.8 percent to 3.2 percent); visible outline (from 46.8 percent to 1.6 percent); pain (from 43.5 percent to 1.6 percent); and exposure in swimsuits (from 38.7 percent to 1.6 percent). No major complications occurred. Two patients felt their labia were still too long and revision was offered. Average follow-up was 13.3 months (range, 6 to 24 months). CONCLUSIONS Patients with elongated labia have a high incidence of functional and appearance-related symptoms. Labiaplasty is a safe procedure that yields significant improvement in quality of life. CLINICAL QUESTIONS/LEVEL OF EVIDENCE Therapeutic, IV.

OBJECTIVE The aim of the study was to determine outcome measures that women with vulvar lichen sclerosus (LS) rate as important in assessing disease severity with the ultimate goal of including these items in a disease severity rating tool. METHODS An online survey of women older than 18 years with a diagnosis of vulvar LS was performed. The survey was posted in Facebook LS support groups. Participants rated items on a scale from 1 to 5 (not important to include to essential to include) in a disease severity scale. Participants also rated how often they were affected by various symptoms on a scale from 1 to 5 (never to daily). Mean rating of importance and mean rating of frequency for each sign and symptom were calculated. T tests were used to compare patients with biopsy-proven disease with those with a clinical diagnosis of LS. RESULTS Nine hundred fifty-eight participants completed the survey (86% completion rate). Patients felt that the most important items to assess disease severity were irritation (4.39), fusion of the labia (4.38), soreness (4.37), itch (4.34), change in vulvar skin (4.34), and decrease in quality of life (4.33). The most frequently experienced items by those with LS were irritation (3.92), changes in appearance of vulvar skin (3.92), and discomfort (3.89). There were no differences between patients with biopsy-proven LS versus those diagnosed on clinical examination. CONCLUSIONS Future LS severity assessment tools will need to include a combination of patient-rated symptoms, clinical rated signs and anatomical changes, and quality of life measures.

How sound is generated in the hummingbird syrinx is largely unknown despite their complex vocal behavior. To fill this gap, syrinx anatomy of four North American hummingbird species were investigated by histological dissection and contrast-enhanced microCT imaging, as well as measurement of vocalizations in a heliox atmosphere. The placement of the hummingbird syrinx is uniquely located in the neck rather than inside the thorax as in other birds, while the internal structure is bipartite with songbird-like anatomical features, including multiple pairs of intrinsic muscles, a robust tympanum and several accessory cartilages. Lateral labia and medial tympaniform membranes consist of an extracellular matrix containing hyaluronic acid, collagen fibers, but few elastic fibers. Their upper vocal tract, including the trachea, is shorter than predicted for their body size. There are between-species differences in syrinx measurements, despite similar overall morphology. In heliox, fundamental frequency is unchanged while upper-harmonic spectral content decrease in amplitude, indicating that syringeal sounds are produced by airflow-induced labia and membrane vibration. Our findings predict that hummingbirds have fine control of labia and membrane position in the syrinx; adaptations that set them apart from closely related swifts, yet shows convergence in their vocal organs with those of oscines.

Background A significant proportion of patients seeking labiaplasty are nulliparous and may experience later changes to their labia following vaginal delivery. Objectives In the present study, the authors reported the long-term outcomes of a single surgeon’s patient cohort who had vaginal delivery after labiaplasty. Methods A retrospective chart review of the senior author’s database was conducted. All patients who underwent in-office labiaplasty from 2007 to 2018 were surveyed. The resulting cohort was stratified into patients who had delivered children prior to labiaplasty and those who delivered after labiaplasty. Results A total of 204 patients responded to a phone survey. Seventy patients had children prior to undergoing labiaplasty, and 33 had children after labiaplasty. The rate of vaginal delivery was lower in the women who had children before labiaplasty (82.6% vs 91.8%, P = 0.015). The tear/episiotomy rate for vaginal deliveries was lower in women who had children prior to labiaplasty compared with after labiaplasty (3.1% vs 17.8%, P Conclusion Patients in our cohort had over 90% success with vaginal deliveries after labiaplasty. For nulliparous patients contemplating the procedure, the data we present suggest the risk of episiotomy or vaginal tear risk with vaginal birth after labiaplasty is comparable with or lower than the general population, further supporting the safety of this procedure. For patients with previous delivery, the data are more limited but suggest no increased risk in this small cohort. Level of Evidence: 4

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

After the simple resection of genital acquired lymphangiectasia, a high recurrence rate is reported, as lymphatic fluid from the legs to the genital region continues. Here we report a case in which we treated and prevented recurrence of recurrent genital acquired lymphangiectasia with genital lymphaticovenous anastomosis (LVA). A 48-year-old woman underwent hysterectomy and pelvic lymph node dissection for uterine cervical cancer at 30 years of age. The patient consulted our department for lymphedema in bilateral legs and acquired lymphangiectasia in the major labia. Despite nine attempted genital acquired lymphangiectasia resections and LVA in the lower limbs, which was aimed to prevent the recurrence, it recurred within 1-2 months postoperatively. Then we injected indocyanine green (ICG) to the bilateral edge of the anus before 10th LVA. ICG flowed from the anus to the genital area and we performed acquired lymphangiectasia resection and genital LVA on this lymphatic vessel (one anastomosis). After 6 months postoperatively, no recurrence of acquired lymphangiectasia, lymphatic leakage, or cellulitis had occurred. We found that a lymphatic flow from the anus into genital acquired lymphangiectasia occurred in one of the patients and the genital LVA, anastomosis of that responsible lymphatic vessel to the vein, might prevent genital acquired lymphangiectasia recurrence after resectional treatment.

Vulvar hematoma is an extremely rare complication outside obstetric practice. Owing to the vulvar structure and its rich blood supply, hematoma can reach an enormous size over a short period. Although direct trauma is the anesthetic 31-year-old nullipara admitted for acute massive vulvar swelling as a complication of labiaplasty. She scored 10 on the pain scale. Upon admission to the emergency department, she had normal vital signs and was immediately started on intravenous acetaminophen and prophylactic antibiotics. The patient was subsequently transferred to the operating theater for examination and drainage of the hematoma under anesthesia. Reconstruction of the labia was performed. The patient had a smooth postoperative course and was discharged on the 3rd postoperative day. We concluded that Anesthetic gynecological procedures, although categorized as minor, can result in grave sequelae, and must therefore be performed in a hospital set-up.

Cervical insufficiency is one of the most frequent reasons for late miscarriage and preterm birth. Its rate is increased in women who conceived after the use of additional reproductive technologies. The objective: to assess the parameters of cervical elastography in women with cervical insufficiency and anovulatory infertility in a history. Materials and methods. 40 pregnant women with cervical insufficiency who conceived after treatment of infertility associated with anovulation were examined in the term of 16–20 weeks: in the I group (20 persons) pregnancy conceived after conservative treatment of infertility, in the II (20 patients) – after in vitro fertilization. 20 women with the physiological course of pregnancy without cervical insufficiency and with spontaneous gestation were controls. Cervical elastography index was used to assess the strain of cervical tissue. Results. According to the results of compression elastography all patients in the I and II groups had red or yellow color of the internal cervical os and cervical canal. In the persons without cervical insufficiency the cervical tissue was firm (purple and blue color). The number of women with purple color of the anterior labia of the cervix in the I and II groups was in 4.67 (р=0.001) and 2.33 (р=0.03) times less compared to the controls, of the posterior labia – in 3,2 times (р=0.001) in both groups. Conclusion. In women with cervical insufficiency and a history of anovulatory infertility there are considerable changes of strain in internal os and cervical canal of the cervix.

Cutaneous leiomyomas, also known as pilar leiomyomas, arise from the arrectores pilorum muscles and are made up of a poorly circumscribed proliferation of haphazardly arranged smooth muscle fibers located in the dermis that appears to infiltrate the surrounding tissue and may extend into the subcutis. Cutaneous leiomyomas are rare, benign, smooth muscle tumors. The most common type of cutaneous leiomyoma, angioleiomyoma arise from the tunica media of blood vessels. The other subtypes, piloleiomyomas and genital leiomyomas arise from the arrector pili musculature of the hair follicle and from the smooth muscle found in the scrotum, labia, or nipple, respectively. Here, we presented a case of cutaneous leiomyoma, in a young male presenting with a swelling in the arm.

A 40-year-old woman presented with a huge right labial swelling that had been enlarging gradually for the last four years. A 10-cm labial swelling was revealed on clinical examination. Preoperative magnetic resonance imaging (MRI) was used to rule out other possible diagnoses, such as hernias, vulvar cysts and tumours. When it came to assessing and diagnosing soft tissue swelling, MRI was the method of choice. It determined that the swelling had a bright T1 and T2 signal intensity similar to that of subcutaneous fat, with a decline in signal in fat-saturated sequences, indicating a diagnosis of vulvar lipoma. The mass was surgically excised, and histopathology confirmed the diagnosis of a benign lipoma. Lipomas are considered the most common soft tissue tumours accounting for a prevalence of 1% in the population. Their occurrence in the vulva in premenopausal women is considered rare and only a few cases of vulvar lipomas have been reported in the literature. Herein, we report a rare case of a patient with vulvar lipoma and review the available literature.

Background The literature regarding the route of the dorsal nerve of the clitoris is sparse and lacks surgical focus. With an increasing number of procedures being performed on the labia, it is important to elucidate the route and note any variation from normal of the nerve. Methods Fifty-one cadavers were dissected to yield 97 dorsal nerve of the clitoris samples. Measurements were taken from (1) the dorsal nerve of the clitoris penetration point of the perineal membrane to the urethra, (2) the nerve's penetration point of the perineal membrane to the pubic bone, (3) the angle of the clitoris to the branch point of the dorsal nerve of the clitoris, and (4) the branch point of the nerve to the distalmost point of the glans clitoris. Any anomalous branching patterns of the dorsal nerve of the clitoris were recorded and classified. Results The means and standard deviations of each measurement were used to create a surgical danger zone. The mean of each measurement was (1) 34.63 mm, (2) 5.74 mm, (3) -3.07 mm, and (4) 30.40 mm, respectively. In addition, six distinct branching patterns were observed, organized, and classified based on the location and number of branches observed. Conclusions The dorsal nerve of the clitoris has multiple branching patterns and typically travels along the same course in most women. Further investigation of the course and three-dimensional position of the dorsal nerve of the clitoris is warranted to preserve sexual sensation as the frequency of procedures involving the female pudendum increases.

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

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

OBJECTIVE To measure the anatomical dimensions of the vulva in adult Indian women. To analyze their correlations with age, body mass index (BMI), parity, and mode of delivery. METHODS This cross-sectional study was conducted in a tertiary care university hospital in India, among 400 women aged 18 years and above. Various vulval measurements were taken, and Pearson's correction was applied to variables like age, BMI, parity, and mode of delivery. RESULTS Mean length of glans of clitoris was 5.2 ± 1.43 mm, the labia minora width was 2.6 ± 0.74 cm, length of introitus was 1.3 ± 0.59 cm, and perineal body length was 2.3 ± 0.60 cm. The range of some measurements was extensive, for example labia minora width ranged from 0.7 to 4.9 cm. Normal centile curves were constructed for vulval measurements according to age groups. Statistically significant positive correlations of age, BMI, and obstetrical history were seen with labia minora width (r = 0.165, P = 0.001; r = 0.284, P

Indirect inguinal hernias of the canal of Nuck containing the uterus and the ovary is rare entity in girls presenting as labia major masses at infancy and early childhood. Authors present a case of the canal of Nuck hernia in a 5-month-old girl presented as palpable lump in the right labia majora which was diagnosed by ultrasonography. Ultrasound is the noninvasive diagnostic modality of choice in for evaluation of palpable external genital masses in children.

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

Background: Syphilis is one of the most serious sexually transmitted diseases worldwide, and has tremendous consequences for the mother and her developing fetus if left untreated. The burden of morbidity and mortality due to congenital syphilis is high. Purpose: Screening and prompt to know the importance of treatment of syphilis during pregnancy. Case: A 32-year-old multigravida in 5 months of pregnancy presented with multiple raised lesions over her labia. It was accompanied by fluor and smelly fishy odor. There was no history of genital ulcers in either spouse and no history of sexual promiscuity. History of antenatal care in public health showed non-reactive status of HIV, syphilis and hepatitis B. Clinical examination revealed multiple flat, moist warts over her labia mayora and minora, and multiple roseola syphilitica on the plantar pedis sinistra. Darkfield microscopic examination presence spirochete, venereal disease research laboratory (VDRL) titer was 1:16 and T. pallidum particle agglutination assay (TPHA) titer was 1:2560. Obstetric ultrasonography examination was suggestive no mayor congenital abnormalities. Both of serology VDRL and TPHA were non-reactive in her husband. Significant of lesion improvement and decrease a fourfold titer serologic in VDRL (1:4) and TPHA (1:320) as follow-up 3 months after being treated with single intra-muscular injections of benzathine penicillin 2.4 million units. Discussion: Coordinated prenatal care and treatment are vital. It’s implemented before the fourth month of pregnancy to reduce vertical transmission and all associated side effects of congenital syphilis. Penicillin is highly efficacious in maternal syphilis and prevention of congenital syphilis. Conclusion: Universal screening and adequate pregnancy care must be a priority.

Highlights • Turner Syndrome is a chromosomal condition that affects development in females, occurring in approximately 1/2500 live female births. • Labial Synechiae usually noted in female with numerous UTIs and vaginal infections. • Synechiae is probably the result of multiple recurrent infections that could cause a chronic inflammation, denudating epithelial cells forming an agglutination of both labia. • There is no literature to suggest any link between TS and LS directly., Introduction Turner syndrome (TS) is a chromosomal condition that affects development in females, resulted from a complete or partial absence of the second X chromosome or from structural anomalies (mosaicism) of one X chromosome. TS is one of the most common sex chromosome disorders among live-born female births. Case presentation We presented with a 63 y.o. Female, who admitted to our Hospital with a chief complaint of pain when urinating and frequent haematuria. She has a history of Turner Syndrome (45 XO). Local examination in the lithotomy position revealed labial agglutination involving the labia majora. We did a Cystoscopy to evaluate the bladder and urethra, and then biopsied the tissues. Vaginal Reconstruction was performed to repair the Labial Synechiae. The biopsy showed that this histological finding is consistent with Follicular Cystitis that could cause by chronic UTIs. Discussion Labial Synechiae (LS), or Labial agglutination is a disorder of the female genitalia characterized by thin, membranous adherence of the labia. LS usually noted in female with numerous UTIs and vaginal infections. Goel et al confirmed that LS is not a congenital disorder. In a retrospective study, they found out that LS is probably caused by multiple numerous UTIs that may cause a membrane to formed around the labia. The negligence and chronicity of this condition may have thickened the synechiae, making it persist for a long time, and can actually cause a symptom to appear. Conclusion There is no literature to suggest any link between TS and LS directly.

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