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Introduction Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affecting the vulva. Studies have shown high rates of sexual dysfunction in patients with LS; however, the sexual effects of the condition are poorly acknowledged. Objectives We sought to identify sexual health consequences among women with vulvar LS through systematic review of available literature. Methods A systematic review of the literature was conducted to find reports on sexual health consequences among women with LS. PubMed, MEDLINE, and Scopus were queried. Included articles were observational studies evaluating women with LS and their sexual health and randomized controlled trials or comparative studies utilizing a validated sexual health measure before intervention among the same population. Articles must have been written in English and published from January 1991 to April 2022. Results The search produced 683 references, including 32 articles that met criteria for full-text review and 20 reported studies that met inclusion criteria. Two studies investigated the impact of LS on interpersonal relationships, 6 studies evaluated sexual symptoms, 16%-60% reported sexual dysfunction, and 22%-56.7% reported dyspareunia. Also described were decreased sexual frequency and satisfaction, negative impact on sexual relationships, and feelings of inadequacy. Eight publications evaluated the Female Sexual Function Index (FSFI); all described studies that demonstrated a central tendency less than 26.55. Four publications evaluated the Female Sexual Distress Scale (FSDS); all demonstrated average scores greater than 12. Two publications evaluated the Female Genital Self-Image Scale (FGSIS), both found decreased scores compared to controls. Four publications evaluated the Dermatology Life Quality Index (DLQI); impact on quality of life was small to very large, with sexual difficulties affecting most study patients. One publication evaluated the Vulvar Quality of Life Index (VQLI); sexuality was the second highest-scoring subgroup. Conclusions Sexual health consequences of LS include sexual pain, dysfunction, and distress; negative genital self-image; and negative impact on sexual relationships. Women with LS experience a negative impact on quality of life, particularly related to sexual functioning.

Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short- and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2021;XX:XXX-XXX.

OBJECTIVE This systematic review aimed to present the available literature on plasma cell vulvitis (PCV), a relatively uncommon form of inflammatory vulvovaginal dermatitis. MATERIALS AND METHODS A literature search was performed in PubMed, Science Direct, and Google Scholar using the following key words: "plasma cell vulvitis," "Zoon vulvitis," and "vulvitis circumscripta plasmacellularis." Specific variables were assessed in each article, including patient age, menopausal status, comorbidities, presenting symptoms, symptom duration, histological description, treatment, and treatment response. RESULTS Thirty-nine articles met inclusion criteria, including 38 case reports and 1 observational study, with a total of 96 cases of PCV reported. The mean age of diagnosis was 52.9 years, with an age range of 8-76 years. Most common presenting symptoms included pruritis and vaginal discomfort, with average duration of symptoms 28.2 months (range = 2 months to 10 years). All reports demonstrated subepithelial plasma cell infiltrate on histology. Five percent of PCV cases reported concomitant autoimmune conditions and 6% sexually transmitted infections. Most common treatment modalities included topical corticosteroids (n = 41), tacrolimus (n = 6), and imiquimod (n = 6). In 53 reported outcomes, 88.7% of patients had resolution of symptoms with treatment. CONCLUSIONS Clinical research is needed to better determine the diagnostic criteria and to assess the efficacy of treatment options for PCV.

To evaluate the frequency and severity of post-concussive symptoms in youth with a history of concussion relative to youth without concussion who had another medical diagnosis, as well as compare the correlations between post-concussive and depressive symptoms between groups. We hypothesized comparable symptom reporting and correlations in each group.A total of 564 youth ages 8-18 years were assessed regarding post-concussive symptoms. A subset of youth (Youth with concussion reported a comparable number of post-concussive and depressive symptoms as youth with another medical condition without concussion. However, those with concussion reported greater post-concussive symptom severity (but small effect sizes). Relationships between post-concussive and depressive symptoms were comparable for both groups, but for those who sustained a concussion, the correlation was significantly stronger for females than males.This study further demonstrates that post-concussive symptoms are nonspecific and provide little functional utility. Post-concussive and depressive symptoms are strongly correlated, particularly in females with concussion. Psychiatric comorbidities and other medical diagnoses should be assessed pre-injury because both affect interpretation of post-concussive symptom reports.

Presenting symptoms of vulvar lichen sclerosus (LS) specific to premenopausal women are not well reported in the literature and may differ from those in postmenopausal women. This study aimed to characterize the presentation of vulvar LS among premenopausal women.An observational web-based study was conducted in premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50 years. Participants completed a 28-question survey evaluating characteristics of symptoms, timing of diagnosis, alternate diagnoses, and presence of concomitant autoimmune conditions.Of the 956 responses received, 503 met inclusion criteria of biopsy-confirmed LS and premenopausal status. Average age of symptom onset was 27 years, and average age of diagnosis was 32 years, with a 4-year delay in diagnosis. Symptoms most present were dyspareunia (68%) and tearing with intercourse or vaginal insertion (63%). Symptoms that affect the individual most were also dyspareunia (44%) and tearing with intercourse or vaginal insertion (39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%) and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulvar fissures (72%), and labial resorption (60%), with fissures affecting the individual the most (48%). Sixty-six percent of the respondents initially received an alternative diagnosis, most commonly vulvovaginal yeast infection (49%). Hypothyroidism was the most common concurrent autoimmune condition (10%).Vulvar LS affects premenopausal women, commonly presenting with dyspareunia and tearing with intercourse. This condition should be considered and evaluated in premenopausal women presenting with vulvar symptoms and sexual pain.

PURPOSE: Determine baseline clinical skills of medical students entering the Obstetrics and Gynecology (OB/GYN) clerkship with prior clinical curricular exposure. BACKGROUND: Students are introduced to clinical correlates sooner in the preclinical curriculum to facilitate adult learning. There are few studies determining clerkship-specific clinical skills readiness in OB/GYN, a specialty with historically limited previous exposure. METHODS: An anonymous 15-question clinical readiness survey (1–5 Likert scale) was administered to medical students during their OB/GYN Orientation at the University of Texas Health Science Center San Antonio over four academic years, 2014–2018, to determine baseline OB/GYN clinical skill knowledge and confidence. Statistical analysis included Spearman rank correlation and Kruskal-Wallis tests, with significance defined as p < 0.05. RESULTS: The survey was completed by 346 students (77% participation). Overall, students felt most confident in knot tying skills (17%) and closed gloving technique (7%) and least confident in knowledge of labor curve (86%), Leopold’s maneuvers (88%), and Montevideo units (MVU) (90%). Confidence in performing closed gloving (4% vs. 11%, p < 0.01) and tying knots (8% vs. 27%, p < 0.01) was significantly higher during rotations later in the academic year. Students who expressed a higher level of interest felt more prepared for the clerkship (rs = 0.21, p < 0.01). DISCUSSION: Results indicate that confidence in obstetric-specific clinical skills is relatively low throughout the academic year; however, baseline surgical skills show improvement. It is important for teaching faculty to know baseline clinical skills of the medical student with earlier clinical exposure to enhance adult learning and optimize clinical competency. In medical students receiving earlier clinical exposure, confidence in baseline obstetric-specific clinical skill is relatively low throughout the academic year. Confidence in general surgical skills demonstrates improvement over the academic year.

Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO2 laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.

Lichen sclerosus (LS) is a chronic inflammatory skin disorder with unknown pathogenesis. The aberrant expression of microRNAs (miRNAs) is considered to exert a crucial role in LS. We used the next-generation sequencing technology (RNASeq) for miRNA profiling and Ingenuity Pathway Analysis (IPA) for molecular network analysis. We performed qRT-PCR, miRNA transfection and Matrigel assays for functional studies. We identified a total of 170 differentially expressed miRNAs between female LS and matched adjacent normal tissue using RNASeq, with 119 upregulated and 51 downregulated. Bioinformatics analysis revealed molecular networks that may shed light on the pathogenesis of LS. We verified the expression of a set of miRNAs that are related to autoimmunity, such as upregulated miR-326, miR-142-5p, miR-155 and downregulated miR-664a-3p and miR-181a-3p in LS tissue compared to the matched adjacent normal tissue. The differentially expressed miRNAs were also verified in blood samples from LS patients compared to healthy female volunteers. Functional studies demonstrated that a forced expression of miR-142-5p in human dermal fibroblast PCS-201-010 cells resulted in decreased cell proliferation and migration. These findings suggest that differentially expressed miRNAs may play an important role in LS pathogenesis, therefore, they could serve as biomarkers for LS management.

Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet’s syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.

Study Objective To evaluate the effect of stress on laparoscopic skills between obstetrics and gynecology residents. Design Observational prospective cohort study. Design Classification Prospective cohort. Setting Urban teaching university hospital. Participants (Patients) Thirty-one obstetrics and gynecology residents, postgraduate years 1 to 4. Intervention We assessed 4 basic laparoscopic skills at 2 sessions. The first session was the baseline; 6 months later the same skills were assessed under audiovisual stressors. We compared the effect of stress on accuracy and efficiency between the 2 sessions. Measurements and Main Results A linear model was used to analyze time. Under stress, residents were more efficient in 3 of the 4 modules. Ring transfer (hand-eye coordination and bimanual dexterity), p = 0.0304. Ring of fire (bimanual dexterity and measure of depth perception), p = 0.0024 and dissection glove (respect of delicate tissue planes), p = 0.0002. Poisson regression was used to analyze the total number of penalties. Residents were more likely to acquire penalties under stress. Ring transfer, p = 0.0184 and cobra (hand-to-hand coordination), p = 0.0487 yielded a statistically significant increase in penalties in the presence of stressors. Dissection glove p = 0.0605 yielded a nonsignificant increase in penalties. Conclusion Our work confirmed that while under stress residents were more efficient, this translated into their ability to complete tasks faster in all the tested skills. Efficiency, however, came at the expense of accuracy.

Vulvar lichen sclerosus (LS) is a chronic, inflammatory dermatosis that may lead to scarring of the vulva and sexual dysfunction. LS affects women of all ages and often goes unrecognized and underreported. Uncertainty continues to exist around its pathogenesis, histologic diagnosis, and treatment. However, there have been great advances in our understanding of autoimmunogenic targets in disease formation and progression. In addition, there has been recent investigation of potential non-steroid-based treatments, including platelet-rich plasma therapy and energy-based modalities such as the fractional CO2 laser, photodynamic therapy, and high intensity focused ultrasound. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. This review summarizes current perspectives on the pathogenesis, symptomatology, diagnosis, and treatment for vulvar lichen sclerosus.

BackgroundRisk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. ObjectiveThe primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. MethodsThis controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. ResultsA total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. ConclusionsThe use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction. Trial RegistrationClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517)

Physicians often feel challenged in the diagnosis and management of vulvar diseases and their effects on psychosexual health. Vulvar dermatoses must be considered in the differential diagnosis of women experiencing female sexual dysfunction or vulvovaginal pain. This review will focus on the diagnosis and treatment of common vulvar dermatoses, including vulvar contact dermatitis, lichen simplex chronicus, vulvar psoriasis, lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia. The impact of these disorders on sexual well-being will be emphasized. A detailed history and physical examination, backed by confident knowledge of vulvar dermatoses, will aid in diagnosis and management of these diseases. Current gold-standard treatments will be discussed as well as innovative therapeutic approaches currently being developed. With increased clinician awareness and further research, vulvar dermatoses and resulting sexual dysfunction can be appropriately managed.

Introduction Lichen sclerosus (LS) is a chronic inflammatory dermatosis, usually affecting the anogenital skin in women. This chronic inflammation can cause scarring of genitalia including narrowing of the introitus and phimosis of the clitoris. These architectural changes can lead to recurrent tearing during intercourse (vulvar granuloma fissuratum) and decreased clitoral sensation. Surgical correction of vulvar granuloma fissuratum (VGF) and clitoral phimosis can be performed, but there is little data on the patient satisfaction and complications following these surgical procedures. Aim To evaluate patient experience and outcomes in women undergoing surgical correction of scarring caused by anogenital LS. Methods A retrospective chart review of patients at a vulvar disorders clinic was performed to identify women who had undergone surgical correction of clitoral phimosis or lysis of vulvar adhesions for VGF due to LS. Twenty-eight women were contacted via telephone between 4 and 130 months postoperatively. An eight-question survey was used to determine patient experience and outcomes. Main Outcome Measures All participants completed an eight-question survey to evaluate patient satisfaction with the surgery, effects on clitoral sensation, orgasm and pain with intercourse, postoperative symptoms or complications, and the presence of recurrent vulvar scarring. Results Participants reported that they were either very satisfied (44%) or satisfied (40%) with the procedure. Of the women who experienced decreased clitoral sensation prior to surgery, 75% endorsed increased clitoral sensitivity postoperatively. Of the women who had dyspareunia prior to surgery, the majority of women reported having pain-free sex (33%) or improved but not completely pain-free sex (58%) after surgery. There were no complications or symptoms made worse by the surgical procedures. Conclusions This study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS.

Deficits in retention of anatomy knowledge from the preclinical years to clinical application on the wards have been well documented in the medical education literature. We developed and evaluated a web and laboratory-based curriculum to address deficits in anatomy knowledge retention and to increase anatomy knowledge recall through repetition and application of clinical concepts during the obstetrics and gynecology (Ob/Gyn) core clinical clerkship. Using principles of adult learning and instructional design, a curriculum was designed consisting of (1) interactive, case-based e-modules reviewing clinically relevant anatomical topics and (2) a hands-on laboratory session reinforcing the content of the e-modules, with the practice of clinical techniques using anatomical cadaveric dissections. The curriculum's effectiveness was evaluated by using multiple choice testing and comparing baseline and final test scores. For questions testing content directly covered in this curriculum, mean final scores increased by 14.3% (P

International audience; New developments in nanosciences and nanotechnologies are strongly dependent on our ability to synthesize well-controlled nanobuilding units, with specific properties. We report in this paper the first synthesis of hybrid single-walled imogolite nanotubes (OH)3Al2O3SixGe1?xCH3 with diameter-controlled hydrophobic nanopores varying from 1.8 to 2.4 nm. Methylation and nanotube dimensions are studied by combining infrared spectroscopy, cryo-TEM observations, and X-ray scattering measurements. We show that, in solution, the water density inside methylated nanotubes is decreased by a factor of 3 compared to the bulk value. Spontaneous confinement of bromopropanol molecules inside the nanotubes, when added to the solution, is demonstrated. These newly synthesized nanotubes may open up possibilities for water filtration or water decontamination.

In order to improve outcomes, identification of the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genes has become crucial in advanced non-small-cell lung cancer (NSCLC). The aim of the present study is to analyse time trends and frequency of testing, factors affecting testing as well as prevalence of mutations in the Swiss population. We analysed EGFR and ALK testing in a cohort of patients with newly diagnosed metastasised non-squamous NSCLC in the catchment area of the cancer registry Eastern Switzerland in the years 2008-2014. We analysed prevalence of mutations and studied clinicopathological characteristics and survival of tested and non-tested patients and of patients with and without mutations. Among 718 patients identified, 11% (51/447) harboured an EGFR mutation in the exons 18, 19 or 21 and further 12% (31/265) showed a positive test result for ALK rearrangements. In non-smokers the proportions of mutations were 31% and 23% respectively. Testing rates increased over time and reached 79% in 2014. We observed significantly lower testing rates and poorer survival in elderly, patients with limited life expectancy and patients treated at hospitals not involved in clinical research. Outcomes can be further improved in a considerable proportion of patients with advanced non-squamous NSCLC.

Testosterone treatment increases sexual desire and well-being in women with hypoactive sexual desire disorder; however, many studies have shown only modest benefits limited to moderate doses. Unlike men, available data indicate women show a bell-shaped dose-response curve for testosterone, wherein a threshold dosage of testosterone leads to desirable sexual function effects, but exceeding this threshold results in a lack of further positive sexual effects or may have a negative impact. Emotional and physical side-effects of excess testosterone, including aggression and virilization, may counteract the modest benefits on sexual interaction, providing a possible explanation for a threshold dose of testosterone in women. In this commentary, we will review and critically analyze data supporting a curvilinear dose-response relationship between testosterone treatment and sexual activity in women with low libido, and also explore possible explanations for this observed relationship. Understanding optimal dosing of testosterone unique to women may bring us one step closer to overcoming regulatory barriers in treating female sexual dysfunction.

There is growing recognition of female sexual dysfunction (FSD) as an important women's health concern. Despite an increased awareness of the pathophysiologic components to FSD, currently, there are no drugs approved for the most common sexual complaint in women-decreased sexual desire. In response to an overwhelming demand for therapy for FSD, several drugs are undergoing development and testing.The aim of this paper is to provide the latest data on pharmacological treatments for FSD currently in Phase I and II clinical trials. These include topical alprostadil, bremelanotide (BMT), intranasal testosterone (TBS-2), intravaginal dehydroepiandrosterone (DHEA), sublingual testosterone with sildenafil, apomorphine (APO), bupropprion and trazodone. It should be noted that the definitions of FSD have recently been revised in the diagnostic and statistical manual for mental disorders (DSM) 5, with merging of hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD) into female sexual interest/arousal disorder (FSIAD). However, it is noted that the majority of clinical trials discussed in this paper use the DSM IV-R diagnoses of HSDD and FSAD.Medications in early phase trials show promise for the treatment of FSD. These therapies focus on treating many possible causes of FSD. Concerns over gender bias within the FDA need to be resolved given the need for new treatment options for FSD.

Surgical anatomy is taught early in medical school training. The literature shows that many physicians, especially surgical specialists, think that anatomical knowledge of medical students is inadequate and nesting of anatomical sciences later in the clinical curriculum may be necessary. Quantitative data concerning this perception of an anatomical knowledge deficit are lacking, as are specifics as to what content should be reinforced. This study identifies baseline areas of strength and weakness in the surgical anatomy knowledge of medical students entering surgical rotations. Third-year medical students completed a 20–25-question test at the beginning of the General Surgery and Obstetrics and Gynecology rotations. Knowledge of inguinal anatomy (45.3%), orientation in abdominal cavity (38.8%), colon (27.7%), and esophageal varices (12.8%) was poor. The numbers in parentheses are the percentage of questions answered correctly per topic. In comparing those scores to matched test items from this cohort as first-year students in the anatomy course, the drop in retention overall was very significant (P = 0.009) from 86.9 to 51.5%. Students also scored lower in questions relating to pelvic organs (46.7%), urogenital development (54.0%), pulmonary development (17.8%), and pregnancy (17.8%). These data showed that indeed, knowledge of surgical anatomy is poor for medical students entering surgical clerkships. These data collected will be utilized to create interactive learning modules, aimed at improving clinically relevant anatomical knowledge retention. These modules, which will be available to students during their inpatient surgical rotations, connect basic anatomy principles to clinical cases, with the ultimate goal of closing the anatomical knowledge gap. Anat Sci Educ 7: 461–468. © 2014 American Association of Anatomists.

Introduction Hypermobility-type Ehlers–Danlos syndrome (EDS), an often-missed diagnosis with the potential for serious sequelae, may have a variety of uncommon presentations, some of which may be gynecologic. Aim The aim of this case report is to present two cases of profound labial edema associated with intercourse as a presenting symptom of hypermobility-type EDS. Methods A 25-year-old female presented with severe labia minora swelling and bladder pressure associated with intercourse, in addition to persistent genital arousal. History revealed easy bruising, joint pain, and family history of aneurysm. A 22-year-old female presented with intermittent profound labial swelling for 6 years, associated with sensitivity and pain with intercourse. The patient has a history of joint pain and easy bruising, as well a sister with joint hypermobility and unexplained lymphedema. The presenting symptom of profound labial edema led to the diagnosis of hypermobility-type EDS. Results Patients with hypermobility syndrome exhibit an increased ratio of type III collagen to type I collagen, causing tissue laxity and venous insufficiency. Abnormal collagen may lead to gynecologic manifestations, including unexplained profound labial edema, pelvic organ prolapse in the absence of risk factors, and possibly persistent genital arousal. Conclusions This case report highlights the need for further research to determine incidence of labial edema in hypermobility-type EDS and to further elucidate a potential correlation between profound labial edema and collagen disorders. Krapf JM and Goldstein AT. Two case presentations of profound labial edema as a presenting symptom of hypermobility-type Ehlers–Danlos syndrome. J Sex Med 2013;10:2347–2350.

Vulvovaginal atrophy is a frequently neglected symptom of menopause. While an estimated 10–40% of women are affected by the progressive symptoms of vaginal dryness, irritation, itching, dysuria and dyspareunia, only a quarter of symptomatic women are believed to seek medical attention. Until recently, treatments for vulvovaginal atrophy were limited to often insufficient or inappropriate oral estrogen therapies and over-the-counter lubricants and moisturizers. Currently, a broader range of treatments, which address symptom reduction and estrogen restoration to affected tissue, are being developed. Among these treatments are local estrogen, selective estrogen receptor modulators, tissue-selective estrogen complexes, local androgens, dehydroepiandrosterone, oxytocin, phytoestrogens and nonhormonal options. The aim of this article is to discuss current treatments for vulvovaginal atrophy. In addition, we will discuss alternative therapies and explore emerging strategies for care.

Since its adoption in 1948, the Universal Declaration of Human Rights has lost none of its relevance. Nevertheless, a lacuna in the Declaration documents a legacy that has become anachronistic in the twenty-first century: in tune with the zeitgeist of the nineteen-forties, an unquestioning and unreserved faith in economic growth, devoid of any awareness of the complex ecological implications of exploiting all natural resources without ever contemplating restraint, was considered the way forward. Likewise with the benefit of hindsight, more space for cultural rights could have enhanced the relevance of the Declaration. None of this can detract from the significance of the Declaration’s historical achievement: to identify, in the context of the incipient Cold War, that both economic and social rights on the one hand, and civil and political rights on the other, are inseparable, and that this would need to guide the agenda of future international human rights law. In a situation when the values of mankind had been ruined by global warfare, genocide, and totalitarianism, the authors of the Declaration had the courage to spell out the values by which the world of tomorrow would have to live. Regarding the future of the planet and its inhabitants in the twenty-first century, Hessel was convinced that sensitivity to poetry—a paradigm for limitless creativity—was indispensible to any progress that might facilitate the survival of mankind. * Thomas M. Krapf, M.A., Ph.D. (Religious Studies), LL.M. (University of Essex), has served with the OSCE as Adviser on Freedom of Religion or Belief (2005–2007) and as Rule of Law Adviser to the EU Police Mission in Afghanistan (2011–2012). He has worked in the Middle East for many years as a media correspondent and is presently based in Berlin as a human rights consultant. Vol. 35 754 HUMAN RIGHTS QUARTERLY

Liquid crystals have found wide applications in many fields ranging from detergents to information displays and they are also increasingly being used in the ‘bottom-up' self-assembly approach of material nano-structuration. Moreover, liquid-crystalline organizations are frequently observed by biologists. Here we show that one of the four major lyotropic liquid-crystal phases, the columnar one, is much more stable on dilution than reported so far in literature. Indeed, aqueous suspensions of imogolite nanotubes, at low ionic strength, display the columnar liquid-crystal phase at volume fractions as low as ∼0.2%. Consequently, due to its low visco-elasticity, this columnar phase is easily aligned in an alternating current electric field, in contrast with usual columnar liquid-crystal phases. These findings should have important implications for the statistical physics of the suspensions of charged rods and could also be exploited in materials science to prepare ordered nanocomposites and in biophysics to better understand solutions of rod-like biopolymers., Liquid crystals are grouped into four main classes—nematic, lamellar, cubic and columnar—depending on their symmetries. Here, the authors show for the first time that a columnar phase can form in suspensions of imogolite nanotubes at very low concentrations.

Dyspareunia can be one of the most challenging complaints that providers encounter in the office setting. Ensuring adequate time and a comfortable setting to address a woman’s concerns is essential to evaluation and treatment. Understanding the broad differential diagnosis of painful intercourse guides history taking. A thorough, yet focused, pelvic examination is necessary to determine the cause of the sexual pain. Identifying the location of the pain is the first step in determining the diagnosis. Although specific conditions may be associated with dyspareunia, sexual pain often falls into the category of vulvodynia or more specifically provoked vestibulodynia. Sexual pain can significantly affect a woman’s well-being and quality of life. Restoration of lasting and satisfying sexual function often requires a multidimensional understanding of the condition. Providers should feel empowered to treat this condition with the information reviewed in this chapter.

Female sexual interest/arousal disorder (FSIAD), formerly known as hypoactive sexual desire disorder (HSDD), is characterized by reduced sexual interest, receptivity, pleasure, response, and sensation leading to personal distress and not related to a psychological disorder, medication, or medical condition. Low desire can be linked to situational circumstances, such as dysfunctional interpersonal relationships, or may have a physiologic cause related to chronic disease, certain medications, or hormonal factors. There is abundant research demonstrating that testosterone increases sexual desire and well-being in postmenopausal women with HSDD. Based upon this evidence, the transdermal testosterone patch is approved for treatment of women with HSDD in Europe and Australia. However, in the United States, the FDA has yet to approve a testosterone product for treating HSDD in women. There are many androgen and testosterone products under investigation, compounded preparations, and FDA-approved medications for men, which are commonly prescribed off label for women. This chapter will discuss medical management of HSDD, focusing on testosterone therapies in development.

Clay/polymer nanocomposites have recently raised much interest because of their widespread industrial applications. Nevertheless, controlling both clay platelet exfoliation and orientation during polymerization still remains challenging. Herein, we report the elaboration of clay/polymer nanocomposite hydrogels from aqueous suspensions of natural swelling clays submitted to high-frequency a.c. electric fields. X-ray scattering experiments have confirmed the complete exfoliation of the clay sheets in the polymer matrix, even after polymerization. Moreover, polarized light microscopy shows that the clay platelets were perfectly oriented by the electric field and that this field-induced alignment was frozen in by in situ photopolymerization. This procedure allowed us to not only produce uniformly aligned samples but also pattern platelet orientation, at length scales down to 20 μm. This straightforward and cheap nanocomposite patterning technique can be easily extended to a wide range of natural or synthetic inorganic anisotropic particles.

At least 16 million women over the age of 50 currently experience low sexual desire, with approximately 4 million women exhibiting hypoactive sexual desire disorder (HSDD). Although early research established that testosterone therapy improves sexual desire in postmenopausal women, safer and more efficacious administration routes were explored. Large randomized, double-blinded placebo-controlled studies demonstrate that transdermal testosterone improves sexual function and activity in postmenopausal women with HSDD. Large multi-center Phase III trials further confirm the positive effects of the testosterone patch in the treatment of HSDD. More recent studies are exploring the utility of testosterone gels. Based upon data from two recent clinical relevance studies, physicians can be reassured that postmenopausal women with HSDD report a meaningful benefit with testosterone therapy, and further, women will only continue therapy if they experience a meaningful benefit. Although most trials combined testosterone with estrogen/progesterone therapy, the recent APHRODITE trial examined testosterone alone, showing increased sexual desire with mild adverse events. Concerns regarding the long-term safety profile of transdermal testosterone must be addressed before the FDA will approve a testosterone product for women. Although some fear an increased risk of breast cancer with exogenous testosterone administration, recent studies support the idea that androgens can play a role in suppressing the proliferative effects of estrogen and progesterone. Long-term safety data is now being collected and analyzed and Phase III trials focusing on long-term risks are underway. In the meantime, transdermal testosterone appears to be a safe and effective therapy for postmenopausal women with HSDD [Swanson S, DeRogatis L, Snabes M, Simes S, Zborowski J. Treatment of HSDD in surgically menopausal women: a newly initiated Phase III, randomized, double-blind, placebo-controlled, multi-center study of the safety and efficacy of LibiGel. Presented at the Annual Meeting of the International Society for the Study of Women's Sexual Health, February 22-25, Orlando, FL; 2007].

Deficits in retention of anatomy knowledge from the preclinical years to clinical application on the wards have been well documented in the medical education literature. We developed and evaluated a web and laboratory-based curriculum to address deficits in anatomy knowledge retention and to increase anatomy knowledge recall through repetition and application of clinical concepts during the obstetrics and gynecology (Ob/Gyn) core clinical clerkship. Using principles of adult learning and instructional design, a curriculum was designed consisting of (1) interactive, case-based e-modules reviewing clinically relevant anatomical topics and (2) a hands-on laboratory session reinforcing the content of the e-modules, with the practice of clinical techniques using anatomical cadaveric dissections. The curriculum's effectiveness was evaluated by using multiple choice testing and comparing baseline and final test scores. For questions testing content directly covered in this curriculum, mean final scores increased by 14.3% (P 0.001). In contrast, for questions not directly addressed in this curriculum, mean final scores did not increase significantly, only by 6.0% (P = 0.31). Questions related to the uterus showed the greatest gains in final scores (30.3% improvement, P = 0.002). A curriculum with web-based preparatory material and a hands-on gross anatomy laboratory session effectively addresses deficits in anatomy retention and improves anatomical knowledge recall for medical students on a clinical clerkship. In the future, the authors plan to conduct a multicenter study to further evaluate the ability of this curriculum to improve clinically relevant anatomical knowledge. Anat Sci Educ 9: 337-343. © 2015 American Association of Anatomists.

International audience; Aggregation tests between bacteria and Polyethyleneimine (PEI) of low (600 g/mol) and high (750,000 g/mol) molecular weight were performed in order to address the physico-chemical mechanisms underlying the interactions between cationic polymer and bacterial membranes. The selected strain, Schewanella oneidensis MR-1, produces a lipopolysaccharide (LPS) of various lengths depending on the growth conditions. Optical density, bioaggregate size, electrophoretic mobility measurements, TEM and AFM observations, and cell lysis tests (crystal violet release), were collected to describe the PEI-mediated aggregation of LPS-O-antigen-free and LPS-O-antigen-decorated bacteria. The results show that PEI of low molecular weight (600 g/mol) fails to aggregate bacteria, whereas PEIs of higher molecular weight (60,000 and 750,000 g/mol) lead to flocculation at low polymer concentrations. In addition, the LPS-O antigen bacterial superstructure is shown to act as a protective barrier, thus delaying the harmful effects of the cationic polymer. Despite this protection, the interaction of bacterial membranes with increasing concentrations of PEI leads to a series of deleterious processes including biosurface modification (peeling, membrane permeabilization and/or lysis), aggregation of bacterial cells, and complexation of PEI with both released biosurface fragments and cytoplasmic residues issued from lysis.

Introduction Identification of incoming residents' unique strengths and weaknesses in a clinical setting is important for developing an individualized educational curriculum and addressing specific needs. This resource presents and describes materials for a clinical development program for first-year residents. Methods The program is structured around three educational elements: an entrance objective structured clinical examination (OSCE), an individualized learning plan (ILP), and peer clinical coaching. The included files that describe these three elements serve as a resource for residency directors and/or graduate medical education faculty interested in constructing a similar program. In the program, first-year OB-GYN residents participated in an entrance OSCE as a component of their orientation to residency. Their performance was evaluated through faculty and self-assessment tools and scored on a 9-point scale in accordance with the Accreditation Council for Graduate Medical Education's core competency scoring evaluation system. These evaluations were utilized in the creation of ILPs. Stated goals were translated into discrete learning objectives and then developed further through a learning strategy and time line using the SMART model. As a component of a research study, first-year residents were randomized into one of two groups: clinical coaching group or individual implementation group. Senior resident volunteers served as peer clinical coaches after participating in a 2-hour interactive workshop. The peer clinical coaches met with first-year residents on a monthly basis for 4 months to develop the resident's ILP. Exit questionnaires were completed at the conclusion of the yearlong program. Results Residents in both groups felt very positive about developing their ILPs, emphasizing that the program helped to map out their goals in preparation for midyear reviews. First-year residents in the clinical coaching group reported that the intervention improved their clinical experience. First-year residents who implemented the ILP alone indicated that their clinical experience was somewhat worse. Discussion The OSCE is a well-utilized tool for ensuring direct observation, evaluating clinical performance in a simulated environment, and providing timely feedback. Another potential application of the OSCE is to provide a baseline evaluation of clinical performance that may be used in determining a starting point for clinical competencies. Utilizing the feedback from the OSCE to create an ILP can translate valuable feedback into measurable objectives and competencies, while also providing a model for reassessment and follow-up.