-
Translational Andrology and Urology Feb 2024The vulva is the external portion of a gender-affirming vaginoplasty or vulvoplasty procedure-the "visible" result of surgery. The vulvar appearance can play a major... (Review)
Review
BACKGROUND AND OBJECTIVE
The vulva is the external portion of a gender-affirming vaginoplasty or vulvoplasty procedure-the "visible" result of surgery. The vulvar appearance can play a major role in how individuals feel about their surgical results and new genital anatomy. Therefore, optimizing the aesthetics of the vulva is an important component of surgical care. Although there is no one "ideal" vulvar appearance, aesthetics are optimal when each major sub-unit of the vulva is reconstructed to create a proportional and cohesive vulvar unit. In this article we perform a narrative review of the literature and discuss clinical approaches to improve aesthetic satisfaction such as patient education, re-defining the "ideal" vulva, aesthetic surgery tenets and technical strategies based on our collective experience of over 630 gender-affirming vulvar constructions.
METHODS
A narrative review of the literature was completed accessing PubMed, EMBASE, Google Scholar using search terms "Vaginoplasty OR Vulvoplasty". Articles were removed if not pertaining to gender affirmation surgery, were not in English language, were not accessible or did not discuss aesthetics in the body of the text.
KEY CONTENT AND FINDINGS
A total of 1,042 articles were identified from initial search criteria. Of those, 905 were excluded as they did not involve gender affirmation as an indication. An additional 112 papers were excluded as they were not accessible, not in English, focused on non-vulvar outcomes or did not comment on vulvar aesthetics. Ultimately 25 articles were included for narrative review; 21 of these included technical descriptions of vulva and 13 had direct aesthetic discussion. The anatomy and aesthetics of the transfeminine vulva are reviewed according to the previously described principle of anatomic vulvar sub-units: the labia majora, labia minora, clitoris, urethra and the introitus.
CONCLUSIONS
Ultimately, creating the optimal vulva for each individual patient will demand flexible surgical decisions based on individual anatomy and available tissues. This narrative review provides an overview of current approaches to aesthetics in gender-affirming vulvar construction and technical insights based on our institutional experience of performing over 630 gender-affirming vaginoplasty and vulvoplasty procedures.
PubMed: 38481864
DOI: 10.21037/tau-22-681 -
Animals : An Open Access Journal From... Mar 2024The fertility rate and litter size of female pigs are critically affected by the expression of estrus. The objective of this study was to elucidate the regulatory...
The fertility rate and litter size of female pigs are critically affected by the expression of estrus. The objective of this study was to elucidate the regulatory mechanisms of estrus expression by analyzing the differential expression of genes and long intergenic non-coding RNAs (lincRNA), as well as the utilization of alternative polyadenylation (APA) sites, in the vulva and vagina during the estrus and diestrus stages of Large White and indigenous Chinese Mi gilts. Our study revealed that the number of differentially expressed genes (DEG) in the vulva was less than that in the vagina, and the DEGs in the vulva were enriched in pathways such as "neural" pathways and steroid hormone responses, including the "Calcium signaling pathway" and "Oxytocin signaling pathway". The DEGs in the vagina were enriched in the "Metabolic pathways" and "VEGF signaling pathway". Furthermore, 27 and 21 differentially expressed lincRNAs (DEL), whose target genes were enriched in the "Endocrine resistance" pathway, were identified in the vulva and vagina, respectively. Additionally, we observed that 63 and 618 transcripts of the 3'-untranslated region (3'-UTR) were lengthened during estrus in the vulva and vagina, respectively. Interestingly, the genes undergoing APA events in the vulva exhibited species-specific enrichment in neural or steroid-related pathways, whereas those in the vagina were enriched in apoptosis or autophagy-related pathways. Further bioinformatic analysis of these lengthened 3'-UTRs revealed the presence of multiple miRNAs binding sites and cytoplasmic polyadenylation element (CPE) regulatory aspects. In particular, we identified more than 10 CPEs in the validated lengthened 3'-UTRs of the , , and genes using RT-qPCR. These findings demonstrated the involvement of APA and lincRNAs in the regulation of estrus expression in female pigs, providing new insights into the molecular mechanisms underlying estrus expression in pigs.
PubMed: 38473176
DOI: 10.3390/ani14050791 -
Cureus Feb 2024Vulval fibroadenoma is an uncommon, benign tumor that originates from ectopic breast tissue or mammary-like glands in the anogenital region. Only a limited number of...
Vulval fibroadenoma is an uncommon, benign tumor that originates from ectopic breast tissue or mammary-like glands in the anogenital region. Only a limited number of cases have been documented in medical literature. Typically occurring in young and middle-aged women, this condition, when surgically removed, generally exhibits a favorable prognosis with a low recurrence rate. We report a case of vulvar fibroadenoma wherein the patient exhibited a groin region mass. The mass was then excised and examined histologically. Histological examination of the polypoidal tissue section unveiled a clearly defined lesion comprising both epithelial and stromal components.
PubMed: 38465085
DOI: 10.7759/cureus.53834 -
ZooKeys 2024Two new marine nematode species belonging to the order Monhysterida are described from the sea of China. is characterized by its relatively small body size; short...
Two new marine nematode species belonging to the order Monhysterida are described from the sea of China. is characterized by its relatively small body size; short anterior sensory setae; small, circular amphidial fovea located at the level of buccal cavity base; funnel-shaped buccal cavity; an excretory-secretory system with a large ventral gland and opening as a very narrow canal just posterior to the level of cephalic setae; slightly curved slender spicules with cephalated proximal end and tapered distal end; rod-like gubernaculum without apophysis; two papilliform precloacal supplements just in front of the cloaca; conico-cylindrical tail with two ventral papillae, each with a seta; and distance between the vulva and anus slightly longer than the tail length. This is the first new species of epiphytic nematode reported in China. The second new species, , has a relatively shorter body and longer tail; striated cuticle; The anterior sensilla arranged in two circles, the first circle consisting of six inner labial setiform papillae (3-4 µm) and the second circle consisting of 16 long setae (12-19 µm); a transversely oval amphideal fovea; a well-developed muscle around the funnel-shaped buccal cavity; short spicules and a gubernaculum composed of a single piece; and precloacal supplements absent. An updated key to all species of and pictorial key to all species of are also given.
PubMed: 38463755
DOI: 10.3897/zookeys.1193.110188 -
Clinical Medicine Insights. Case Reports 2024Lichen planus (LP) is an inflammatory disease that affects the skin, hair, nails and mucous membranes. Erosive LP is a chronic and difficult-to-treat subtype of lichen... (Review)
Review
Lichen planus (LP) is an inflammatory disease that affects the skin, hair, nails and mucous membranes. Erosive LP is a chronic and difficult-to-treat subtype of lichen planus, characterized by lesions on mucosal surfaces, particularly in the oral and genital areas. The prevalence of erosive LP has not been determined. To date, treatment has consisted of surgical intervention, photodynamic therapy, laser therapy, and systemic or topical drugs, including steroids and immunomodulatory agents. LP usually need longer periods of treatment and are known as precancerous lesions with a 0.4% to 12% conversion rate. In addition, nearly 25% of patients who develop erosive LP of the vulva are resistant to topical corticosteroids, which are the first choice of treatment. This study reports 6 cases with a mean age of 3.33 years, who were diagnosed with erosive LP lesions and previously failed in treatment with local, intralesional, and systemic steroids, and hydroxychloroquine. These patients were then treated with 10 mg of tofacitinib per day. Interestingly, with the new treatment, the patients' mean overall satisfaction score was 9.16 out of 10 (range: 8-10), the mean pain relief score was 9.16 out of 10 (range: 9-10) and patients' symptom improvement also began an average of 1.33 months after starting treatment (range: 1-2.5 months).
PubMed: 38463136
DOI: 10.1177/11795476241237350 -
Maturitas May 2024To assess clinical characteristics of postmenopausal women with moderate/severe vulvovaginal atrophy, as well as its impact on sexual function, well-being, and quality... (Observational Study)
Observational Study
OBJECTIVES
To assess clinical characteristics of postmenopausal women with moderate/severe vulvovaginal atrophy, as well as its impact on sexual function, well-being, and quality of life, and to provide an overview of most used treatments.
STUDY DESIGN
Ongoing longitudinal, observational study conducted in 17 Italian gynecology centers, involving women already treated or initiating a local vaginal estrogen therapy or ospemifene. We report baseline data for women with and without a history of breast cancer. Participants filled in self-reported questionnaires at study entry.
MAIN OUTCOME MEASURES
Severity of vulvovaginal atrophy; ongoing treatments; patient-reported outcomes, including severity of symptoms, Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and SF-12® Health Survey.
RESULTS
Overall, 334 women (20.4 % with a history of breast cancer) started or continued local therapy (61.1 %) or ospemifene (38.8 %) at study entry. Vulvovaginal atrophy was severe in 28.6 %, and was responsible for severe symptoms, particularly vulvar dryness with burning or irritation and pain during sexual intercourse. Both sexual dysfunction (FSFI≤26) (81.5 %) and sexual distress (FSDS-R ≥ 11) (74.4 %) were common. A reduction in the SF-12 mental component score was documented. Women with breast cancer more often had severe vulvovaginal atrophy (41.2 %), had more severe symptoms, and the impact of vaginal symptoms on emotional well-being, sexual functioning and self-concept/body image was greater. The majority of them (83.8 %) received ospemifene as a treatment.
CONCLUSIONS
Moderate/severe vulvovaginal atrophy is a common, often neglected condition with an impact on QoL and sexuality, particularly in women with a history of breast cancer. It is important to alleviate the burden associated with the disease.
Topics: Female; Humans; Atrophy; Breast Neoplasms; Patient Satisfaction; Quality of Life; Tamoxifen; Vagina; Vaginal Diseases; Vulva
PubMed: 38462385
DOI: 10.1016/j.maturitas.2024.107950 -
Frontiers in Medicine 2024Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern...
INTRODUCTION
Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit.
METHODS
A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion.
RESULTS
The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score ( = 0.151).
CONCLUSION
Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.
PubMed: 38449880
DOI: 10.3389/fmed.2024.1289418 -
Asian Journal of Surgery May 2024Labiaplasty is one of the top cosmetic procedures patients are seeking in the past two years. However, treatment of disease in posterior fourchette caused by various...
BACKGROUND
Labiaplasty is one of the top cosmetic procedures patients are seeking in the past two years. However, treatment of disease in posterior fourchette caused by various etiological factors was less investigated and neglected.
METHODS
Three types of posterior fourchette deformity were proposed: (1) Redundant posterior fourchette, (2) Relaxed posterior fourchette, and (3) Constricted posterior fourchette. Local flap transfer technique was applied. Y-V-plasty and 5-Z-Flap-plasty were used to treat web type and tight type of the constricted posterior fourchette, respectively. Follow-ups were arranged on the Internet or at the outpatient clinic. Visual analogue scale (VAS) was utilized to evaluate sexual discomfort in the satisfaction questionnaires during follow-up.
RESULTS
A total of 48 patients with constricted posterior fourchette deformity from May 2022 to May 2023 were reviewed in the study. Y-V-plasty could decrease VAS in patients with web-type deformity by 4.13 ± 1.46 (p<0.001). 5-Z-Flap-plasty could decrease VAS in patients with tight-type deformity by 3.76 ± 1.53 (p<0.05). Satisfaction rates of the web type and tight type were 93.1% (27/29) and 86.7% (13/15) respectively. Complications include two cases of hematoma, one case of persistent pain and two cases of dehiscence.
CONCLUSION
Constricted posterior fourchette seriously affects the quality of life. Y-V-plasty and 5-Z-Flap-plasty can be utilized to treat the two subtypes of constricted posterior fourchette, which can effectively reduce the pain score of patients with high satisfaction and few long-term complications.
Topics: Humans; Female; Adult; Patient Satisfaction; Vulva; Plastic Surgery Procedures; Surgical Flaps; Treatment Outcome; Middle Aged; Follow-Up Studies; Young Adult; Gynecologic Surgical Procedures
PubMed: 38443253
DOI: 10.1016/j.asjsur.2024.02.114 -
Frontiers in Oncology 2024Vulvar cancer carries a favourable prognosis in early stages. However, therapeutic options for advanced or recurrent cases are limited despite a variety of therapeutic...
INTRODUCTION
Vulvar cancer carries a favourable prognosis in early stages. However, therapeutic options for advanced or recurrent cases are limited despite a variety of therapeutic modalities, such as extensive surgical resection, chemotherapy, and radiotherapy. The most important emerging treatment modalities are immune checkpoint inhibitors. This systematic review and meta-analysis aims to assess the efficacy and safety of pembrolizumab, an immune checkpoint inhibitor, in women with advanced vulvar cancer.
MATERIALS AND METHODS
Following a comprehensive search, review, and appraisal, two relevant single-arm studies were included. Meta-analysis was conducted using R4.3.0 software and RStudio 2023.03.0, presenting the overall effect size with a 95% confidence interval. Heterogeneity was assessed using I and the Cochrane Q χ2 statistics.
RESULTS
Out of 154 studies screened for eligibility, two single-arm studies involving 119 patients receiving pembrolizumab for advanced vulvar cancer were included. The pooled objective response rate (ORR) was overall 10% (95% CI: 0.00-0.84) and 9% (95% CI: 0.00-0.89) in the PD-L1 positive subgroup. In the intention-to-treat (ITT) population, 31% (95% CI: 0.04-0.85) exhibited any clinical benefit (complete response, partial response, or stable disease). In the ITT population at six months, progression-free survival (PFS) was 19% (95% CI: 0.01-0.82), and overall survival (OS) was 48% (95% CI: 0.08-0.90). At 12 months, PFS decreased to 9% (95% CI: 0.00-0.85), and OS was 33% (95% CI: 0.04-0.85). No statistically significant heterogeneity was observed in PFS and OS analyses.
DISCUSSION AND CONCLUSION
This study suggests that one-third of women with advanced or recurrent vulvar cancer may, without the influence of PD-L1 status, benefit from pembrolizumab treatment despite a decline in both PFS and OS at 12 months. These findings provide support for considering pembrolizumab in the treatment paradigm for this specific subset of cancer patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42023391888.
PubMed: 38440225
DOI: 10.3389/fonc.2024.1352975 -
BMC Women's Health Mar 2024Vulvar migration is a rare complication of filler injection for breast augmentation, generally presenting as repeated pain and fever. We will report a case of woman with... (Review)
Review
BACKGROUND
Vulvar migration is a rare complication of filler injection for breast augmentation, generally presenting as repeated pain and fever. We will report a case of woman with polyacrylamide hydrogel breast injection develops vulvar abscess.
CASE PRESENTATION
A woman with a history of polyacrylamide hydrogel breast injection was noted to have vulvar abscess due to migration of filler materials. Filler removal surgery and vacuum sealing drainage was performed for this patient. The patient was discharged from the hospital with no further complications. After a review of pertinent literature, only four previous case reports are found. Local inflammatory response, infection, large volume injections, inframammary fold destruction, hematogenous or lymphatic migrate, trauma, gravity and external pressure could play essential parts in the migration of injected filler.
CONCLUSION
Polyacrylamide hydrogel migration poses a worldwide challenge, necessitating personalized solutions. Our case study underscores the importance of comprehensive examinations for individuals with a history of filler breast injection when suspecting vulvar filler migration.
Topics: Female; Humans; Abscess; Mammaplasty; Breast; Acrylic Resins
PubMed: 38431590
DOI: 10.1186/s12905-024-02998-0