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Sexual Development : Genetics,... 2018The clitoris is a highly complex organ whose structure has only been clarified in recent years through the use of modern imaging techniques. Clitoromegaly is an abnormal... (Review)
Review
The clitoris is a highly complex organ whose structure has only been clarified in recent years through the use of modern imaging techniques. Clitoromegaly is an abnormal enlargement of this organ. It may be congenital or acquired and is usually due to an excess of androgens in fetal life, infancy, or adolescence. Obvious clitoromegaly in individuals with ambiguous genitalia is easily identifiable, whereas borderline conditions can pass unnoticed. Case reports of clitoromegaly with or without clinical or biochemical hyperandrogenism are quite numerous. In these subjects, a comprehensive physical examination and an accurate personal and family history are needed to investigate the enlargement. We reviewed the literature on the conditions that may be involved in the development of clitoromegaly in childhood and adolescence.
Topics: Adolescent; Child; Clitoris; Female; Humans; Organ Size
PubMed: 29804109
DOI: 10.1159/000489385 -
International Journal of Gynaecology... May 2015Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C). (Review)
Review
BACKGROUND
Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C).
OBJECTIVES
To review evidence on the safety and efficacy of clitoral reconstruction.
SEARCH STRATEGY
PubMed and Cochrane databases were searched for articles published in any language from database inception until May 2014. Search terms related to FGM/C and clitoral reconstruction were used in various combinations.
SELECTION CRITERIA
Studies of any design that reported on safety or clinical outcomes (e.g. appearance, pain, sexual response, or patient satisfaction) associated with clitoral reconstruction after FGM/C were included.
DATA COLLECTION AND ANALYSIS
Evidence was summarized and systematically assessed via a standard data abstraction form.
MAIN RESULTS
Four of 269 identified articles were included. They were fair to poor in quality. Summary measures could not be computed owing to heterogeneity. The studies reported on immediate surgical complications, clitoral appearance, dyspareunia or chronic pain, and clitoral function postoperatively via non-standardized scales.
CONCLUSIONS
Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit.
Topics: Circumcision, Female; Clitoris; Female; Gynecologic Surgical Procedures; Humans
PubMed: 25638712
DOI: 10.1016/j.ijgo.2014.11.008 -
Scientific Reports Jun 2022Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and...
Purulent vulvar discharges, primarily caused by genito-urinary tract infections, are an important source of economic loss for swine producers due to sow culling and mortality. However, the agents that compose the vaginal microbiota of sows and their changes during infections are not well understood. The first goal of this study was to characterize and compare the vaginal bacterial content of healthy (HE, n = 40) and purulent vulvar discharge sows (VD, n = 270) by a culture-dependent method and MALDI-TOF MS identification. Secondly, we performed 16S rRNA targeted metagenomic approach (n = 72) to compare the vaginal microbiota between these groups. We found a wide variety of bacteria, with Proteobacteria, Firmicutes, and Bacteroidota being the most abundant phyla in both groups, as well as Escherichia-Shigella, Streptococcus, and Bacteroides at the genus level. Most agents identified in the sequencing method also grew in the culture-dependent method, showing the viability of these bacteria. Alpha diversity did not differ between HE and VD sows, regarding sample richness and diversity, but a beta-diversity index showed a different microbiota composition between these groups in two tested herds. ANCOM analysis revealed that Bacteroides pyogenes were more abundant in VD females and can be a marker for this group. Other agents also require attention, such as the Streptococcus dysgalactiae and Staphylococcus hyicus found in remarkably greater relative abundance in VD sows. Network analysis revealed important positive correlations between some potentially pathogenic genera, such as between Escherichia-Shigella, Trueperella, Streptococcus, Corynebacterium, and Prevotella, which did not occur in healthy sows. We conclude that the alteration of the vaginal microbiota between healthy and purulent vulvar discharge sows, although not extreme, could be due to the increase in the relative abundance of specific agents and to associations between potentially pathogenic bacteria.
Topics: Animals; Bacteria; Female; Humans; Microbiota; RNA, Ribosomal, 16S; Swine; Vagina; Vulva
PubMed: 35650232
DOI: 10.1038/s41598-022-13090-8 -
Maturitas Aug 2024Genitourinary syndrome of menopause is a comprehensive term that groups genital, urinary and sexual signs and symptoms mainly due sex hormone deficiency and aging, with... (Review)
Review
Genitourinary syndrome of menopause is a comprehensive term that groups genital, urinary and sexual signs and symptoms mainly due sex hormone deficiency and aging, with a crucial impact on quality of life of midlife women. While this broad definition captures the common underlying physiopathology and the frequent overlap of symptomatology, improving knowledge about different components of genitourinary syndrome of menopause may be relevant for individualized treatment, with possible implications for efficacy, compliance and satisfaction. This narrative review focuses on the vulvar component of genitourinary syndrome of menopause, highlighting anatomical and functional peculiarities of the vulva that are responsible for some of the self-reported symptoms, as well as specific signs at physical examination. Increasing evidence points towards a pivotal role of vulvar vestibular health in the occurrence of sexual pain, one of the most common and distressing symptoms of genitourinary syndrome of menopause, which should be evaluated with validated scales taking a biopsychosocial perspective. This is an essential step in the recognition of different phenotypes of genitourinary syndrome of menopause and in the assessment of the most effective diagnostic and therapeutic algorithm. Menopausal vulvar health deserves more research into tailored non-hormonal and hormonal treatment options.
Topics: Humans; Female; Menopause; Vulva; Syndrome; Female Urogenital Diseases; Sexual Dysfunction, Physiological; Quality of Life; Vulvar Diseases
PubMed: 38704313
DOI: 10.1016/j.maturitas.2024.108006 -
Scientific Reports Mar 2022In this study, a prospective study was conducted by using optical coherence tomography (OCT) in the in vivo detection of vulvar diseases. The clinical efficacy of the...
In this study, a prospective study was conducted by using optical coherence tomography (OCT) in the in vivo detection of vulvar diseases. The clinical efficacy of the OCT we investigated in the detection of vulvar diseases, and the characteristics of the OCT images were defined. Overall, this study recruited 63 patients undergoing the colposcopy for vulvar lesions in three Chinese hospitals from December 20th, 2018 and September 24th, 2019. The colposcopy and the OCT examination were performed successively, and the OCT images were compared with the relevant tissue sections to characterize different lesions. The OCT diagnoses where categorized into 7 types, including normal and inflammatory vulva, condyloma acuminata, papilloma, lichen sclerosus, atrophic sclerosing lichen, fibrous epithelial polyp as well as cysts. The structural characteristics of the vulva tissue can be clearly observed in the OCT image, which are consistent with the characteristics of the tissue section. Compared with the pathological results, the sensitivity, specificity and accuracy of the OCT examination reached 83.82% (95% confidence interval, CI 72.5%-91.3%), 57.89% (95% CI 34.0%-78.9%) and 78.16%, respectively. The OCT is found with the advantages of being noninvasive, real-time and sensitive and with high resolution. It is of high significance to screening vulva diseases, and it is expected as one of the methods to clinically diagnose vulva diseases.
Topics: Colposcopy; Female; Humans; Pregnancy; Prospective Studies; Tomography, Optical Coherence; Vulva; Vulvar Diseases
PubMed: 35256649
DOI: 10.1038/s41598-022-07634-1 -
Journal of the American Academy of... May 2023
Topics: Female; Humans; Vulva; Vulvar Lichen Sclerosus; Laser Therapy; Vulvar Neoplasms; Carcinoma in Situ; Precancerous Conditions; Lichen Sclerosus et Atrophicus
PubMed: 36639033
DOI: 10.1016/j.jaad.2023.01.003 -
International Journal of Molecular... Nov 2022Lichen sclerosus (LS) is defined as a chronic mucocutaneous inflammatory disease with a localization predominantly to the anus and genitals (vulvar sclerosus (VLS)).... (Review)
Review
Lichen sclerosus (LS) is defined as a chronic mucocutaneous inflammatory disease with a localization predominantly to the anus and genitals (vulvar sclerosus (VLS)). Pediatric lichen sclerosus (LS) is a chronic inflammatory skin condition with predilection for the anogenital area that if untreated can lead to scarring. Vulvar LS is characterized by two peaks in incidence: it occurs in prepubertal girls and in postmenopausal women. To date, several mechanisms and risk factors have been proposed in the pathogenesis of pediatric vulvar LS; however, the etiology of this condition is still not fully understood and constitutes a challenge for scientists and clinicians. The presented research aimed to systematically review the existing literature on the pathogenesis of pediatric LS and to identify possible underlying autoimmune mechanisms and molecular networks. The clinical presentation of pediatric lichen sclerosus and available treatment modalities are also presented to acquaint a broader audience with this underdiagnosed and undertreated condition. As a result of our review, we discuss several potential mechanisms, molecules, and pathways that have been recognized in this disease. The purpose of our review was also to summarize what we can induce in further studies, which will ultimately help to identify the mechanism responsible for the disease and aid in the development of new, more effective treatment strategies for diagnosis and treatment by clinicians and researchers.
Topics: Humans; Female; Child; Lichen Sclerosus et Atrophicus; Vulva; Immune System Diseases; Genitalia; Treatment Outcome
PubMed: 36430687
DOI: 10.3390/ijms232214212 -
Journal of Plastic, Reconstructive &... Sep 2022Multiple handheld three-dimensional (3D) systems are available on the market, but data regarding their use in detecting small volumes are limited. The aim of this study...
Multiple handheld three-dimensional (3D) systems are available on the market, but data regarding their use in detecting small volumes are limited. The aim of this study was to compare different portable 3D technologies in detecting small volumetric enhancement on a mannequin model and a series of patients. Five portable 3D systems (Artec Eva, Crisalix, Go!Scan, LifeViz Mini, and Vectra H1) were tested in a controlled environment with standardised volumes and in a clinical setting with patients undergoing small volume fat grafting to face, vulva, and hand. Accuracy was assessed with absolute and relative technical error measurement (TEM and rTEM); precision with intra- and inter-observer reliability (r and ICC); and usability in clinical practice with the following parameters: portability, suitability of use in operating theatre/clinic, ease of use of hardware and software, speed of capture, image quality, patient comfort, and cost. All tested devices presented overall good accuracy in detecting small volumetric changes ranging from 0.5 to 4 cc. Structured-light laser scanners (Artec Eva and Go!Scan) showed high accuracy, but their use in clinical practice was limited by longer capture time, multiple wiring, and complex software for analysis. Crisalix was considered the most user-friendly, less bothering for patients, and truly portable, but its use was limited to the face because the software does not include vulva and hand. Three-dimensional technologies exploiting the principle of passive stereophotogrammetry such as LifeViz Mini and Vectra H1 were the most versatile for assessing accurately multiple body areas, representing overall the best long-term value for money. Therefore, 3D portable technology is a non-invasive, accurate, and reproducible method to assess the volumetric outcome after facial, vulval, and hand injectables. The choice of the 3D system should be based on the clinical need and resources available.
Topics: Face; Female; Humans; Imaging, Three-Dimensional; Photogrammetry; Reproducibility of Results; Vulva
PubMed: 35659734
DOI: 10.1016/j.bjps.2022.04.042 -
Acta Obstetricia Et Gynecologica... Jan 2024Vulva squamous cell carcinoma (VSCC) develops through two separate molecular pathways-one involving high-risk human papilloma virus infection (HPV-associated), and the...
INTRODUCTION
Vulva squamous cell carcinoma (VSCC) develops through two separate molecular pathways-one involving high-risk human papilloma virus infection (HPV-associated), and the other without HPV infection (HPV-independent) often involving TP53 mutation. HPV-associated VSCC generally has a better progression-free survival than HPV-independent VSCC. The aim of this study was to determine TP53 mutation status using immunohistochemistry, compare different methods of HPV detection and correlate both with survival in a retrospective cohort of 123 patients with VSCC.
MATERIAL AND METHODS
Immunohistochemistry for p53, Ki67 and p16 (a surrogate marker for HPV infection) was performed on formalin-fixed paraffin-embedded tissues from a cohort of surgically treated VSCC patients to identify molecular subtypes of VSCC. Presence of HPV infection was detected by HPV DNA PCR and HPV mRNA in situ hybridization (ISH). The Pearson chi-square test and multivariable Cox regression model were used to investigate the association of different parameters with progression-free survival and disease-specific survival (DSS), and Kaplan-Meier curves were used to show the association of different parameters with survival.
RESULTS
The results of p53 and p16 immunohistochemistry confirmed three VSCC subtypes associated with different prognosis. The TP53 mutation status was identified as an independent prognostic factor of worse progression-free survival (p = 0.024) after adjustment for FIGO stage. p16 immunohistochemistry, mRNA ISH, and DNA PCR had excellent concordance in terms of HPV detection. According to the multivariable Cox regression model, the presence of hrHPV mRNA correlated significantly with increased progression-free survival (p = 0.040) and DSS (p = 0.045), after adjustment for other confounders.
CONCLUSIONS
p53 and p16 immunohistochemistry stratify VSCC cohort into three subtypes with TP53mutated patients having the worst prognosis. The detection of hrHPV mRNA by ISH was an independent predictor of increased survival. Thus, the combined detection of p53 and HPV mRNA might improve risk stratification in VSCC.
Topics: Female; Humans; Prognosis; Human Papillomavirus Viruses; Papillomavirus Infections; Retrospective Studies; Cyclin-Dependent Kinase Inhibitor p16; Tumor Suppressor Protein p53; Carcinoma, Squamous Cell; Vulvar Neoplasms; DNA; RNA, Messenger; Vulva; Papillomaviridae
PubMed: 37840151
DOI: 10.1111/aogs.14689 -
Acta Medica Portuguesa Jan 2022Sebaceous carcinoma of the vulva is a rare malignancy of the sebaceous glands, with potentially aggressive behaviour, that is usually found in the peri-ocular area.... (Review)
Review
Sebaceous carcinoma of the vulva is a rare malignancy of the sebaceous glands, with potentially aggressive behaviour, that is usually found in the peri-ocular area. Nonetheless, there are sebaceous glands in the vulva and this diagnosis is especially rare, with only ten cases described in the literature. We report a case of 78-year-old female patient who presented with vulvar pruritus, previously treated with topical steroid and antifungal treatments, without improvement. The vulvar examination showed a visible yellow papule, 12 x 10 mm on the right major labia, which was biopsied and the microscopic examination revealed an invasive sebaceous carcinoma of the vulva, with an in situ component. We performed an uneventful excisional biopsy, followed by a subsequent margin widening. Three months after the diagnosis, she presented with the first recurrence. Two and half years after the diagnosis, she recurred with a larger lesion (13 mm) in the upper half of small right lip, more than 10 mm away from the midline. In a multidisciplinary meeting it was decided that the patient should undergo partial right vulvectomy with homolateral inguino-femoral sentinel node biopsy (one negative node). There was no evidence of recurrence one-year post-surgery.
Topics: Aged; Biopsy; Carcinoma; Female; Humans; Vulva; Vulvar Neoplasms
PubMed: 35225764
DOI: 10.20344/amp.13551