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International Journal of Impotence... May 2023Cosmetic labiaplasty is a form of Female Genital Cosmetic Surgery (FGCS) that is performed with the deliberate intent to alter the appearance and morphology of the... (Review)
Review
Cosmetic labiaplasty is a form of Female Genital Cosmetic Surgery (FGCS) that is performed with the deliberate intent to alter the appearance and morphology of the external genitalia in the absence of medical concerns. Over the last decade, there is an increasing demand for FGCS and the industry behind it is constantly growing. Adolescents comprise an extremely vulnerable population, with labiaplasties in this particular age group having also increased. However, labiaplasty has been widely contested due to the irrevocable alteration of a psychosexually significant body part on minors too young to consent. Besides, the changes that occur during pubertal development in the genital area can significantly alter pediatric surgical results. Genital anatomy is more diverse than we previously thought and there is evidence to suggest that the labia minora with their rich innervation play an important role in sexual arousal and pleasure. Education regarding the wide range of normal genital appearance suffices in most cases to dissolve concerns regarding body self-image. Mental health issues should always be explored and, if identified, the girl should be referred to an experienced professional for their resolution. Postponing labiaplasty until adulthood is strongly recommended to help adolescents achieve a well-informed decision regarding an irreversible procedure with possible adverse esthetic and functional outcomes.
Topics: Adolescent; Child; Humans; Female; Adult; Minors; Vulva; Gynecologic Surgical Procedures; Body Image; Self Concept
PubMed: 34663925
DOI: 10.1038/s41443-021-00480-1 -
Frontiers in Endocrinology 2023Vulvovaginal atrophy (VVA) is a common condition in post-menopausal women. Symptoms of VVA include dyspareunia, vaginal dryness, vaginal and/or vulvar itching, burning...
INTRODUCTION
Vulvovaginal atrophy (VVA) is a common condition in post-menopausal women. Symptoms of VVA include dyspareunia, vaginal dryness, vaginal and/or vulvar itching, burning and soreness, dysuria and vaginal bleeding accompanying sexual activity. These symptoms are physiological responses to hypoestrogenicity, inducing atrophy of the vagina epithelia and sudden reduction in mucous production. Prevailing therapy for VVA is hormone replacement therapy (HRT), notably estrogen, progesterone or a combination of the two. However, using HRT is associated with an increased incidence of breast and endometrial cancer, venous thromboembolism in the lungs and legs, stroke and cardiovascular complications.
METHODS
This study evaluated Malaysian Gelam honey as a nutraceutical alternative to estrogen HRT (ERT) in alleviating VVA. A total of 24 female 8-weekold Sprague Dawley rats underwent bilateral oophorectomy. A minimum of 14 days elapsed from the time of surgery and administration of the first dose of Gelam honey to allow the female hormones to subside to a stable baseline and complete recovery from surgery. Vaginal tissues were harvested following a 2-week administration of Gelam honey, the harvested vagina tissue underwent immunohistochemistry (IHC) analysis for protein localization and qPCR for mRNA expression analysis.
RESULTS
Results indicated that Gelam honey administration had increased the localization of Aqp1, Aqp5, CFTR and Muc1 proteins in vaginal tissue compared to the menopause group. The effect of Gelam honey on the protein expressions is summarized as Aqp1>CFTR>Aqp5>Muc1.
DISCUSSION
Gene expression analysis reveals Gelam honey had no effect on Aqp1 and CFTR genes. Gelam honey had up-regulated Aqp5 gene expression. However, its expression was lower than in the ERT+Ovx group. Additionally, Gelam honey up-regulated Muc1 in the vagina, with an expression level higher than those observed either in the ERT+Ovx or SC groups. Gelam honey exhibits a weak estrogenic effect on the genes and proteins responsible for regulating water in the vaginal tissue (Aqp1, Aqp5 and CFTR). In contrast, Gelam honey exhibits a strong estrogenic ability in influencing gene and protein expression for the sialic acid Muc1. Muc1 is associated with mucous production at the vaginal epithelial layer. In conclusion, the protein and gene expression changes in the vagina by Gelam honey had reduced the occurrence of vaginal atrophy in surgically-induced menopause models.
Topics: Humans; Female; Rats; Animals; Cystic Fibrosis Transmembrane Conductance Regulator; Honey; Postmenopause; Vulva; Rats, Sprague-Dawley; Vaginal Diseases; Estrogens; Atrophy
PubMed: 36923220
DOI: 10.3389/fendo.2023.1031066 -
Philosophical Transactions of the Royal... Jun 2021Regional variation in pelvic morphology and childbirth has long occurred alongside traditional labour support and an understanding of possible normal courses of... (Review)
Review
Regional variation in pelvic morphology and childbirth has long occurred alongside traditional labour support and an understanding of possible normal courses of childbirth for each population. The process of migration and globalization has broken down these links, while a European model of 'normal' labour has become widespread. The description of 'normal' childbirth provided within obstetrics and midwifery textbooks, in fact, is modelled on a specific pelvic morphology that is common in European women. There is mounting evidence, however, that this model is not representative of women's diversity, especially for women of non-white ethnicities. The human birth canal is very variable in shape, both within and among human populations, and differences in pelvic shapes have been associated with differences in the mechanism of labour. Normalizing a white-centred model of female anatomy and of childbirth can disadvantage women of non-European ancestry. Because they are less likely to fit within this model, pelvic shape and labour pattern in non-white women are more likely to be considered 'abnormal', potentially leading to increased rates of labour intervention. To ensure that maternal care is inclusive and as safe as possible for all women, obstetric and midwifery training need to incorporate women's diversity. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
Topics: Cervix Uteri; Delivery, Obstetric; Female; Humans; Midwifery; Obstetrics; Social Support; Vagina; Vulva
PubMed: 33938285
DOI: 10.1098/rstb.2020.0024 -
JAMA Dermatology Nov 2020Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. It presents as single or multiple asymptomatic macules or patches of...
IMPORTANCE
Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The differential diagnosis of melanocytic lesions includes melanoma, which creates anxiety for patients and the physicians who diagnose the condition and treat the patients.
OBJECTIVE
To evaluate the clinical and dermoscopic features of vulvar melanosis and their changes over time.
DESIGN, SETTING, AND PARTICIPANTS
In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. Data on patient characteristics and on both the clinical and dermoscopic features of the vulvar lesions were collected. Each lesion was photographed clinically and dermoscopically at initial evaluation and at annual follow-up visits.
MAIN OUTCOMES AND MEASURES
The clinical, dermoscopic, and histopathologic features of vulvar melanosis and their changes over time.
RESULTS
This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. A total of 87 patients (67%) with vulvar melanotic lesions were premenopausal, and 84 patients (65%) had received some type of hormone therapy. The most frequent location for vulvar melanosis was the labia minora (55 [43%]), followed by the labia majora (33 [26%]). In 39 of 129 cases (30%), the lesions increased in size and changed color after initial evaluation but ultimately stabilized. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years).
CONCLUSIONS AND RELEVANCE
This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. An association between hormonal status and vulvar melanosis may be hypothesized.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Color; Dermoscopy; Diagnosis, Differential; Disease Progression; Female; Follow-Up Studies; Hormone Replacement Therapy; Humans; Italy; Melanoma; Melanosis; Middle Aged; Mucous Membrane; Photography; Retrospective Studies; Vulva; Vulvar Diseases; Vulvar Neoplasms; Young Adult
PubMed: 32785609
DOI: 10.1001/jamadermatol.2020.2528 -
International Journal of Cancer Jan 2021The risk of vulvar squamous cell carcinoma (VSCC) in patients with high-grade vulvar intraepithelial neoplasia (VIN) is considered lower in high-grade squamous...
The risk of vulvar squamous cell carcinoma (VSCC) in patients with high-grade vulvar intraepithelial neoplasia (VIN) is considered lower in high-grade squamous intraepithelial lesion (HSIL) compared to differentiated VIN (dVIN), but studies are limited. Our study investigated both the incidence of high-grade VIN and the cumulative incidence of VSCC in patients with HSIL and dVIN separately. A database of women diagnosed with high-grade VIN between 1991 and 2011 was constructed with data from the Dutch Pathology Registry (PALGA). The European standardized incidence rate (ESR) and VSCC risk were calculated, stratified for HSIL and dVIN. The effects of type of VIN (HSIL vs dVIN), age and lichen sclerosis (LS) were estimated by Cox regression. In total, 1148 patients were diagnosed with high-grade VIN between 1991 and 2011. Between 1991-1995 and 2006-2011, the ESR of HSIL increased from 2.39 (per 100 000 woman-years) to 3.26 and the ESR of dVIN increased from 0.02 to 0.08. The 10-year cumulative VSCC risk was 10.3%; 9.7% for HSIL and 50.0% for dVIN (log rank P < .001). Type of VIN, age and presence of LS were independent risk factors for progression to VSCC, with hazard ratios of 3.0 (95% confidence interval [CI] 1.3-7.1), 2.3 (95% CI 1.5-3.4) and 3.1 (95% CI 1.8-5.3), respectively. The incidence of high-grade VIN is rising. Because of the high cancer risk in patients with dVIN, better identification and timely recognition are urgently needed.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma in Situ; Carcinoma, Squamous Cell; Disease Progression; Female; Follow-Up Studies; Humans; Incidence; Middle Aged; Netherlands; Precancerous Conditions; Risk Factors; Squamous Intraepithelial Lesions; Vulva; Vulvar Neoplasms; Young Adult
PubMed: 32638382
DOI: 10.1002/ijc.33198 -
Cancer Reports (Hoboken, N.J.) Oct 2022Verrucous vulvar carcinoma (VC) is an uncommon and distinct histologic subtype of squamous cell carcinoma (SCC). The available literature on VC is currently limited to...
BACKGROUND
Verrucous vulvar carcinoma (VC) is an uncommon and distinct histologic subtype of squamous cell carcinoma (SCC). The available literature on VC is currently limited to case reports and small single institution studies.
AIMS
The goals of this study were to analyze data from the National Cancer Database (NCDB) to quantitate the incidence of VC and to investigate the effects of patient demographics, tumor characteristics, and treatment regimens on overall survival (OS) in women with verrucous vulvar carcinoma.
METHODS AND RESULTS
Patients diagnosed with vulvar SCC or VC between the years of 2004 and 2016 were identified in the NCDB. OS was assessed with Kaplan-Meier curves and the log-rank test. Construction of a Cox model compared survival after controlling for confounding variables. The reported incidence of SCC of the vulva has significantly increased since 2004 (p < .0001). In contrast, the incidence of VC has remained stable (p = .344) since 2004. Compared to SCC, VC was significantly more likely to be diagnosed in older women (p < .0001) and treated with surgery alone (p < .0001). However, on propensity score weighted analysis there was a trend toward improved 5-year OS in women with VC compared to those with SCC (63.4% vs. 57.7%, p = .0794). Multivariable Cox survival analysis showed an improvement in OS in VC patients treated with both primary site and regional lymph node surgery compared to primary site surgery alone (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.46-0.97, p = .0357).
CONCLUSION
Verrucous carcinoma is more likely to present in older women. Regional lymph node surgery in addition to primary site surgery significantly improves OS in VC patients.
Topics: Aged; Carcinoma, Squamous Cell; Carcinoma, Verrucous; Female; Humans; Treatment Outcome; Vulva; Vulvar Neoplasms
PubMed: 35075817
DOI: 10.1002/cnr2.1591 -
Lasers in Surgery and Medicine Sep 2016To evaluate the safety, tolerability, and clinical efficacy of transcutaneous temperature controlled radiofrequency (TTCRF) on vulvovaginal tissue for orgasmic... (Clinical Trial)
Clinical Trial
BACKGROUND AND OBJECTIVES
To evaluate the safety, tolerability, and clinical efficacy of transcutaneous temperature controlled radiofrequency (TTCRF) on vulvovaginal tissue for orgasmic dysfunction.
STUDY DESIGN/MATERIALS AND METHODS
Subjects included 25 sexually active women, ages 21-65, with self-reported difficulty in achieving orgasms during sex (anorgasmic or slow-to-orgasm). Each patient received three sessions at intervals of about 1 month. Treatment was performed using a slim S-shaped probe with a stamp-sized metal radiofrequency emitter on one surface of the tip (25 minutes total time on average). External treatments covered the labia majora and minora, lower mons pubis, perineal body, clitoral hood, and clitoris. Full length treatment of the vagina with concentration on the anterior wall was performed. Tissue temperature during therapy was elevated to and maintained between 40°C and 45°C. No anesthesia was required. After treatment, patients immediately resumed normal activities, including sex.
RESULTS
Twenty‐three of 25 patients reported an average reduction in time to orgasm of 33%. Patients also noted significant vaginal tightening effects, increased vaginal moisture, and improved vulvar and clitoral sensitivity. All anorgasmic patients reported the ability to achieve orgasms. Two patients had minimal response.
CONCLUSION
TTCRF is an effective non-hormonal, non-surgical option for women having difficulty achieving orgasm. Treatment also has visible tightening effects on feminine tissues and appears to increase local blood flow, resulting in increased vaginal tightness and moisture. Improved appearance and friction resulted in improved confidence and reduced performance anxiety. Lasers Surg. Med. 48:641-645, 2016. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
Topics: Adult; Aged; Body Temperature; Female; Follow-Up Studies; Humans; Middle Aged; Pilot Projects; Radiofrequency Therapy; Sexual Dysfunction, Physiological; Treatment Outcome; Vagina; Vulva
PubMed: 27197701
DOI: 10.1002/lsm.22537 -
The Journal of Sexual Medicine Feb 2022Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is characterized by sensations of physiological genital sexual arousal (and/or other types of...
BACKGROUND
Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia (PGAD/GPD) is characterized by sensations of physiological genital sexual arousal (and/or other types of genitopelvic dysesthesia) that occur in the absence of subjective feelings of sexual desire.
AIMS
The aim of this study was to compare relationship, sexual, and psychological well-being in partnered individuals with and without distressing symptoms of PGAD/GPD.
METHODS
The sample (N = 65 individuals with vulvas and vaginas, N = 11 individuals with penises) of 152 partnered individuals (N = 76 with and 76 without PGAD/GPD symptoms) participated in a one-time anonymous online survey.
OUTCOMES
The questionnaires assessed relationship satisfaction (Couple Satisfaction Index-Short Form, CSI); sexual satisfaction (Global Measure of Sexual Satisfaction, GMSEX); sexual functioning (Female Sexual Functioning Index, FSFI, or International Index of Erectile Functioning, IIEF); sexual distress (Sexual Distress Scale, SDS); and psychological well-being, as determined by the presence of depression and/or anxiety symptoms (Hospital Anxiety and Depression Scale, HADS).
RESULTS
Among individuals with vulvas and vaginas, those with PGAD/GPD symptoms reported significantly lower relationship and sexual satisfaction, greater sexual distress, and more symptoms of depression and anxiety than their counterparts in the control group. In addition, these individuals with PGAD/GPD symptoms also reported significantly worse sexual functioning (arousal, orgasm, satisfaction, and pain), and they were significantly more distressed about each aspect of their sexual functioning difficulties compared to those in the control group. Among the small sample of individuals with penises (N = 11), descriptive analyses revealed that total sexual functioning scores did not differ across the PGAD/GPD symptom and control groups. In addition, 64.5% of the total sample with PGAD/GPD symptoms managed unwanted genital arousal by avoiding sex with their partner, while 55.3% managed their symptoms by having sex with their partner, and some individuals with PGAD/GPD used both strategies.
CLINICAL IMPLICATIONS
The finding that PGAD/GPD symptoms impact relationships indicates that treatment for PGAD/GPD should include consideration of the well-being of one's intimate relationship(s).
STRENGTHS & LIMITATIONS
This study added to the small literature on experiences of PGAD/GPD in relationships, and it was the first to assess sexual satisfaction. Limitations include the small sample of individuals with penises, and the cross-sectional, correlational design, which does not allow for causal conclusions to be drawn.
CONCLUSION
Results emphasize the importance of continued research of this population (and their partners) in order to improve diagnosis, intervention, and recognition within the medical community. Mooney KM, Poirier É, Pukall CF., Persistent Genital Arousal in Relationships: A Comparison of Relationship, Sexual, and Psychological Well-Being. J Sex Med 2022;19:234-248.
Topics: Arousal; Cross-Sectional Studies; Female; Genitalia; Humans; Male; Sexual Behavior; Sexual Dysfunctions, Psychological; Surveys and Questionnaires
PubMed: 34903472
DOI: 10.1016/j.jsxm.2021.10.009 -
American Journal of Obstetrics and... Jan 2024
Topics: Female; Humans; Epidermolysis Bullosa Acquisita; Vulva
PubMed: 37506750
DOI: 10.1016/j.ajog.2023.07.045 -
African Journal of Paediatric Surgery :... 2022The knowledge that preservation of clitoral sensation is essential for future sexual satisfaction gave rise to sensation-preserving clitoral reduction surgery. We...
BACKGROUND
The knowledge that preservation of clitoral sensation is essential for future sexual satisfaction gave rise to sensation-preserving clitoral reduction surgery. We present our results of sensation-preserving clitoral reduction procedure in the small group of patients.
AIMS AND OBJECTIVES
To show our technique and result of sensation-preserving clitoral reduction surgery.
MATERIALS AND METHODS
This is a retrospective study of cases with clitoromegaly, over a 5-year period, in which sensation-preserving clitoral reduction procedure was done by us at our centre. Demographics, indication for clitoral reduction, operative procedure, operative time, any intraoperative difficulty or problem, anaesthesia type, post-operative stay and outcome were analysed. Pre-operative and post-operative evaluation for clitoral viability done in all the cases, and evaluation for clitoral sensory testing and vibratory sensory testing done in selected cases.
RESULTS
A total of eight cases were operated in the last 5 years. Five were due to congenital adrenal hyperplasia. Immediate post-operative period was uneventful in all. Cosmetic appearance and viability were satisfactory in all the cases. In five cases, clitoral sensory testing and vibratory sensory testing were done, an average degree of sensation of 3.2 at the labia minora and 4.7 at the clitoris and an average values clitoral vibratory sensory testing for the introitus, clitoris, labia and thigh were 3.56, 1.61, 5.08 and 5.83, respectively.
CONCLUSIONS
Clitoral enlargement in girls is a rare problem. Sensation-preserving ventral clitoral reduction surgery leads to preservation of neurovascular bundles leads to acceptable cosmesis and preserved sensation.
Topics: Adrenal Hyperplasia, Congenital; Clitoris; Female; Humans; Retrospective Studies; Sensation; Vulva
PubMed: 34916347
DOI: 10.4103/ajps.AJPS_32_21