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Menopause (New York, N.Y.) Nov 2020Little is known about the role of androgens in the female genital tract, specifically in the vulvovaginal area. The abundance of androgen receptors in this area could... (Review)
Review
IMPORTANCE AND OBJECTIVE
Little is known about the role of androgens in the female genital tract, specifically in the vulvovaginal area. The abundance of androgen receptors in this area could help us to explain their role. The main objective of the present article is to review current data on androgen receptors in the different structures of vulvovaginal tissues.
METHODS
A review of the literature using data from PubMed was carried out on androgen receptors in the vulva, labia majora and minora, vestibule, clitoris, and vagina. The effects of androgens and regulation of androgen receptors both in the embryo and in premenopausal and postmenopausal women were also reviewed. Given the characteristics of this review, we also analyzed animal studies and animal models of human disease. There were no filters or restrictions with respect to the date of publication.
DISCUSSION
Androgen receptors have been detected throughout the genitourinary tract by means of Western blot, immunohistochemistry, ligand binding, and gene expression. They are present in the labia majora and minora, the clitoris, the vestibule, and in the three layers of the vaginal mucosa (epithelium, lamina propria, and muscularis). More specifically, studies on the labia majora have shown that androgen receptors seem to be particularly abundant in epidermal keratinocytes and in dermal fibroblasts. Androgen receptors are also abundant in the epidermis, especially in the keratinocytes, and in the dermis of the labia minora and vestibule, where they are more numerous than in the vagina. Androgen receptors have also been found in the Bartholin glands.
CONCLUSIONS
Estrogens play a major role in the maintenance of vaginal physiology. Although little is known about the role of androgens in the genital apparatus of women, specifically in the vulvovaginal area, the abundance of androgen receptors could enable us to explain their role. Androgens and estrogens play a major role in the maintenance of vaginal physiology. Better knowledge of the role of androgens and their receptors in vulvovaginal tissue would make it possible to discern their effects on female genitalia and help us to understand new therapeutic strategies.
Topics: Androgens; Animals; Estrogens; Female; Humans; Receptors, Androgen; Vagina; Vulva
PubMed: 33110052
DOI: 10.1097/GME.0000000000001587 -
Urology Jul 2023To describe our technique for performing gender affirming graft only vaginoplasty.
OBJECTIVE
To describe our technique for performing gender affirming graft only vaginoplasty.
METHODS
In graft only vaginoplasty, penile skin is used only for the external genitals, and the entire vaginal canal is created from a full thickness skin graft. The inner scrotum is excised and used as a skin graft to line the vaginal canal. The outer scrotum is left in place then moved medially to form the labia majora. The penile skin and Dartos fascia are incised dorsally and ventrally then advanced to the posterior perineum to become the labia minora. The glans clitoris is constructed from a W-shaped dorsally-based portion of the glans penis, and the clitoral hood is constructed from the distal 2-3 cm of penile shaft skin. The posterior wall of the introitus is formed from a posterior perineal flap.
RESULTS
The patient presented here is a 26-year-old transgender woman with marked and sustained gender incongruence. She is circumcised, has typical penile length, scrotal contents are normal, and all hair has been removed on the scrotum and perineum. She underwent graft only vaginoplasty, as shown in the accompanying video.
CONCLUSION
Gender affirming graft only vaginoplasty allows for construction of the vaginal canal from a full thickness skin graft, and construction of external genitals from penile and scrotal skin. Advantages of this approach include availability of more tissue for construction of the external genitals and an external skin to graft anastomosis. The procedure is modified slightly when the patient has a small scrotum, short penis, or is uncircumcised.
Topics: Male; Female; Humans; Adult; Sex Reassignment Surgery; Transsexualism; Surgical Flaps; Vulva; Clitoris; Penis; Vagina
PubMed: 37187273
DOI: 10.1016/j.urology.2023.05.006 -
Aesthetic Surgery Journal May 2022Heightening interest in labiaplasty has driven potential patients to online fora, permitting the dissemination of material by potentially unqualified or inexperienced...
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 < 0.0001). Presenting responders with an educational tool comparing each procedure's indications, risks, and potential benefits did not alter respondent opinions, indicating notions about sexual surgery are relatively fixed. The most common reason respondents persisted in their relative opposition to labia reduction was a perceived deficiency in social acceptance (27.1%), followed by a perceived similarity to female genital mutilation (14.8%).
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.
Topics: Adult; Female; Humans; Plastic Surgery Procedures; Sexual Behavior; Surgeons; Surveys and Questionnaires; Vulva
PubMed: 34498668
DOI: 10.1093/asj/sjab335 -
Women's Health (London, England) 2024Knowledge of female genital anatomy and physiology is often inadequate or incorrect among women. Precise patient-physician conversations can be inhibited by a reluctance... (Review)
Review
Knowledge of female genital anatomy and physiology is often inadequate or incorrect among women. Precise patient-physician conversations can be inhibited by a reluctance or inability to speak accurately about the vulva and vagina, with the terms often being used interchangeably. There is a paucity of scientific evidence and clinical guidelines to support women and physicians in ensuring best practices in feminine hygiene. In this review, the unmet needs in the field are highlighted. Evidence is provided for the complex array of physiological and pathological systems, mechanisms and behaviours that either protect or, if inappropriate, predispose the vulva and vagina to infections, irritation or other conditions. The need for attention to perineal health is recommended, given the interdependence of perineal and vulvar microbiota and the risk of colonic pathogens reaching the vulva and the vagina. Differences in feminine hygiene practices can vary widely across the world and among varying age groups, and suboptimal habits (such as vaginal douching or the use of certain cleansers) can be associated with increased risks of vulvar and vaginal conditions. Critical areas for discussion when advising women on their intimate health include: advice surrounding aesthetic vulvar cosmetic trends (such as depilation and genital cosmetic surgery), bowel health and habits, and protection against sexually transmitted infections. Routine, once-daily (maximum twice-daily) washing of the vulva with a pH-balanced, mild cleanser is optimal, ideally soon after bowel voiding, when feasible. Due to the finely balanced ecosystems of the vulva, the vagina and the perineal area, a scientific and clinical perspective is essential when determining the most appropriate vulvar cleansers based on their components. Correct intimate care may contribute to improved genital and sexual health and overall well-being. An increased awareness of correct practices will empower women to be the advocates of their own intimate health.
Topics: Female; Humans; Ecosystem; Vagina; Vaginal Douching; Vulva; Sexual Behavior
PubMed: 38396383
DOI: 10.1177/17455057231223716 -
Aesthetic Surgery Journal Aug 2023
Topics: Female; Humans; Pubic Bone; Vulva
PubMed: 37314378
DOI: 10.1093/asj/sjad187 -
International Journal of Radiation... Oct 2021
Topics: Cervix Uteri; Female; Humans; Uterine Cervical Neoplasms; Uterus; Vulva
PubMed: 34473967
DOI: 10.1016/j.ijrobp.2021.05.002 -
Aesthetic Surgery Journal May 2023In the last decade labiaplasty procedures have been on the rise in the United States. The trim and the wedge are among the most commonly used techniques. The purpose of...
In the last decade labiaplasty procedures have been on the rise in the United States. The trim and the wedge are among the most commonly used techniques. The purpose of this paper is to provide a trim-wedge algorithm to guide the surgeon based on the qualities of the individual patient. The choice of technique should be based on the reasonable labiaplasty candidate's goals, her nicotine/cocaine usage, and the physical characteristics of her labia, including edge quality, texture, pigmentation, symmetry, morphology of protrusion, and labial length. By considering these individual patient factors, the trim-wedge algorithm may improve labiaplasty outcomes and increase patient satisfaction. Some surgeons perform only the wedge or only the trim, and no algorithm should alter that. After all, the best technique is always the one the surgeon performs comfortably and safely.
Topics: Humans; Female; Plastic Surgery Procedures; Vulva; Patient Satisfaction; Physical Examination; Surgeons
PubMed: 36794378
DOI: 10.1093/asj/sjad033 -
Aesthetic Plastic Surgery Jun 2024Hoodplasties and labia minora reductions are some of the most requested operative procedures by women distressed with the appearance of their vulvar region. In the...
INTRODUCTION
Hoodplasties and labia minora reductions are some of the most requested operative procedures by women distressed with the appearance of their vulvar region. In the majority of cases, a concomitant hoodplasty (HP) is performed to achieve a better aesthetic appearance. Various surgical methods have been described for the removal of excess tissue within the clitoris hood area.
MATERIALS AND METHOD
This study aims to describe a single surgeon's preference and results in her private practise in 630 patients who underwent labiaplasty mainly because of dissatisfaction with the aesthetic appearance.
RESULTS
Of the 630 labiaplasties performed, 303 had clitoris hood excess, 44% of cases with concomitant HP and in 7.9% of cases only a HP was performed. The study was done between September 2009 and December 2021 and the HP technique was longitudinal excision in 97% of patients and horseshoe excision in 4.95% of them. Surgeries lasted between 30 and 60 min. 98% of the patients claimed an improvement in self-esteem and 96% claimed improvement in sex life post-surgery. No major complications occurred.
DISCUSSION
An isolated labiaplasty technique in patients with hood excess results in disharmony in the area. HP can be considered as a subdivision of a labioplasty. Extended central wedge labia minora resection (V-plasty) is a commonly used procedure in LP operations but can limit the excess clitoris hood resection. Edge labia minora resection can easily be combined with longitudinal excision of the clitoral hood, and when also horizontal clitoris hood excess is present can also be addressed by converting the resection from longitudinal into a horse hose resection. Limitations in the study include lack of use of validated assessments for the satisfaction of aesthetic outcomes and that all the procedures were performed by a single senior surgeon, which can be seen as a strength but also a limitation because of the high risk of bias. Moreover, there was no comparative cohort for the study population. Furthermore, we could not find comparative cohorts in previously reported techniques in the literature either.
CONCLUSION
Clitoris hood resections should be treated on an individualized approach and adapted according to the excess present. It is important when a patient requests a labiaplasty to always address the clitoris hood during the consultation to avoid unsatisfied patients afterwards. Many patients come just focussed on their labia minora excess and when corrected, realize the clitoris hood excess was also part of the problem.
LEVEL OF EVIDENCE III
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 .
Topics: Humans; Female; Vulva; Adult; Patient Satisfaction; Middle Aged; Esthetics; Retrospective Studies; Plastic Surgery Procedures; Young Adult; Treatment Outcome
PubMed: 38200125
DOI: 10.1007/s00266-023-03777-2 -
The Urologic Clinics of North America Nov 2019Improvements to vulvar aesthetics, particularly the clitoral complex and labia minora reconstruction, are difficult and remain the challenge of genital reconstructive... (Review)
Review
Improvements to vulvar aesthetics, particularly the clitoral complex and labia minora reconstruction, are difficult and remain the challenge of genital reconstructive surgeons. Various modifications of penile inversion technique have been introduced to improve vulvar aesthetics in recent years. Generally penile inversion vaginoplasty leaves limited penile tissue to reconstruct the natural labia minora. This article describes improvements made to overcome substantial limitations of the widely used traditional penile inversion vaginoplasty technique, with emphasis on creating a realistic vulvar aesthetic appearance in all respects, without compromising sexual sensation or vaginal depth.
Topics: Esthetics; Female; Gender Dysphoria; Humans; Male; Penis; Sex Reassignment Surgery; Transsexualism; Vagina; Vulva
PubMed: 31582028
DOI: 10.1016/j.ucl.2019.07.008 -
Indian Journal of Medical Ethics 2022Cosmetic surgery is defined as any procedure involving a change in the appearance or aesthetics of a normal anatomy where there are no congenital or acquired... (Review)
Review
Cosmetic surgery is defined as any procedure involving a change in the appearance or aesthetics of a normal anatomy where there are no congenital or acquired pathologies. The procedures that can be included under female cosmetic genital surgery are the following: reduction labiaplasty, vaginoplasty, hymenoplasty, "G-Spot amplification", and miscellaneous. Those who support these procedures could argue that women undergo such procedures as a matter of choice, whereas those opposed could argue that this choice is made because of society's fascination with physical appearance and feeling young. Prima facie these procedures appear to contradict the Hippocratic principle of "primum non nocere". There has been an increase in the marketing and conduct of the above mentioned procedures. Practitioners need to be both sceptical and cautious while performing these surgeries. Patients requesting them need to be counseled regarding the lack of data supporting their efficacy, and the potential complications of the procedures.
Topics: Female; Gynecologic Surgical Procedures; Humans; Surgery, Plastic; Vagina; Vulva
PubMed: 34730092
DOI: 10.20529/IJME.2021.046