Female Perineum Research Articles

Philibert Joseph Roux (1780–1854)

Philibert Joseph Roux (1780-1854), a French surgeon, was a student and friend of Marie Xavier François Bichat, the father of modern pathology and histology. He was assigned as a surgeon to the Hôpital Beaujon (1806), the Hôpital de la Charité (1810) and to Hôtel-Dieu de Paris (1835), where he succeeded to Guillaume Dupuyrten, a French anatomist, as a Chief Surgeon. Roux is best known for having performed the surgical repair of a cleft palate and for having been the first surgeon to stitch a ruptured female perineum. His contribution to surgery has also included the publication of Quarante années de pratique chirurgicale. Roux was awarded the grade of Chevalier of the National Order of the legion of Honor and that of Officer. He also served as a President of the Academy of Sciences. He died of a stroke on 3 March 1854.

Female pelvic actinomycosis and intrauterine contraceptive devices

Female genital Actinomyces infection is relatively rare, although strongly related to long-lasting intrauterine contraceptive device (IUD) application. An infective pathway has been postulated extending upward from the female perineum to the vagina and cervix. The traumatic effect of the device and a prior infection may contribute to the Actinomyces infection in the female genitalia. This disease is characterized by local swelling, suppura- tion, abscess formation, tissue fibrosis, tubal-ovarian mass and fistula formation. The infec - tion spreads by contiguity often mimicking the characteristics of a malignant neoplastic process. Currently there is no consensus regarding diagnosis and screening tests, although there seems to be agreement in relation to IUD type, duration, and sexual behavior as major risk factors.

Aggressive Angiomyxoma: An Unusual Female Pelvic Tumour. Report of Three Cases and Review of the Literature

Aggressive angiomyxoma was first described in 1983 by Steeper and Rosai, and fewer than 150 cases have been reported in the world medical literature. It is a soft-tissue tumour of the pelvis and perineum. The recurrence rate is high, and often extensive resections are performed with considerable morbidity. These tumours are benign, locally infiltrative mesenchymal neoplasms with a predilection for the female pelvis and perineum and they usually tend to recur. Furthermore, these tumours often reach too large dimensions before becoming clinically symptomatic; their incidence is higher in women of the reproductive age group; however a few cases of its occurrence outside the pelvis have also been reported. In this study, we reported three cases with aggressive pelvic angiomyxoma treated with surgical methods and used an approach that described by Kraske in order to get access to lower rectal cancers. Accurate preoperative diagnosis should alert the surgeon to the need for wide excision, which is essential for prevention of local recurrence.

A new study method: the perineal scan in obstetrics and gynecology

For gynecological/obstetrical ultrasound examination the abdominal wall constituted the first and for a long time the only acoustical window that could be used to visualize the female reproductive organs. Only recently transvaginal/transrectal endosonography has opened new approaches in this diagnostic field. Apart from the above-mentioned procedures, the female perineum can be regarded as a useful window to demonstrate the cervix uteri, the bladder and the urethra. At the Universitäts-Frauenklinik Heidelberg this examination procedure was used since June, 1985, to evaluate its clinical reliability in obstetrics and gynecology.

Ultrasound imaging of the pelvic floor: ‘What name shall be given to this Child?’

Ultrasound imaging of the pelvic floor: ‘What name shall be given to this Child?’

Huge Aggressive Angiomyxoma: A Case Report and Literature Review

Angiomyxoma occurs mostly in 30- to 40-year-old females and is described histologically as a mesenchymal tumor, composed of fibroblasts within a strong myxoid background. It occurs mainly in the female pelvis, vulva or perineum, and grows slowly. Treatment is surgical excision. Unfortunately, there is a relatively high rate of recurrence because the exact extent of the tumor is difficult for the surgeon to determine. We report a case of aggressive angiomyxoma combined with uterine myoma, and discuss the characteristics of its images. Surgical excision of the tumor was performed, and adjuvant treatment was given for local recurrence.

Ultrasound Imaging of the Female Perineum

Ultrasound Quarterly: June 2006 - Volume 22 - Issue 2 - p 115-116 doi: 10.1097/01.ruq.0000224576.43737.f2

Ultrasound imaging of the female perineum: the effect of vaginal delivery on pelvic floor dynamics

To assess the use of perineal ultrasound in the evaluation of the influence of vaginal delivery on urethral mobility and on the contraction strength of the levator ani muscles. This was a prospective observational study of 70 nulliparous women. Each woman underwent perineal ultrasound assessment at 36-38 weeks' gestation and at 1 week and 3 months following delivery. During each examination we assessed: the posterior urethrovesical angle at rest, urethral mobility during Valsalva maneuver and movement of the anorectal angle and levator sling angle during contraction of the levator ani. The urethrovesical angle and the urethral mobility increased significantly after delivery (P < 0.0001). The levator sling excursion decreased proportionally. The anorectal excursion had decreased significantly by the examination 3 months after birth. Perineal sonography provides objective assessment criteria for urethral mobility and for contraction strength of the levator ani muscles and detects changes in the anatomy and function of the pelvic floor after vaginal delivery.

Identification of human papillomavirus DNA gene sequences in human breast cancer

Human papilloma viruses (HPVs) are accepted as being carcinogenic in human cervical and anogenital cancers. The suspicion that HPVs may also have a role in human breast cancer is based on the identification of HPVs in human breast tumours and the immortalisation of normal human breast cells by HPV types 16 and 18. For this investigation, DNA that had been previously extracted and fresh frozen at −70°C from 50 unselected invasive ductal breast cancer specimens were screened by polymerase chain reaction (PCR) for HPV type 16, 18 and 33 gene sequences. We show that HPV 18 gene sequences are present in DNA extracted from breast tumours in Australian women. Overall, 24 (48%) of the 50 samples were HPV positive. Overall no correlations with tumour grade, patient survival, steroid receptor status, ERB-2, p53 expression and mutation were observed. Human papilloma viruses may have a role in human breast cancer. We speculate that HPVs may be transmitted by hand from the female perineum to the breast.

Placement of a Word catheter: A resident training model

The present study developed and evaluated a practical teaching model and training protocol for Word catheter placement in the treatment of a Bartholin gland cyst. Residents were asked to treat a model of the female perineum, fashioned from harvested porcine tissue, with a simulated Bartholin cyst via Word catheter placement and drainage. Each resident was evaluated for procedural competence. They were retested after the viewing of a continuous 59-second video demonstrating catheter placement. The model's resemblance to female genitalia was confirmed by 68% of residents. Correct diagnosis and treatment of a Bartholin gland cyst was made by 61%. The mean pretraining score was 5.5 +/- 1.46, while the post-training average was 8.2 +/- 1.20, indicating an approximate 58% increase in resident proficiency (P < .05). A model of the female perineum fashioned from harvested porcine tissue is a suitable instructional aid in the recognition and treatment of a Bartholin cyst. Proficiency in Word catheter placement is improved through the use of the model and instructional video.

Aggressive angiomyxoma in a child with chronic renal failure

Aggressive angiomyxoma (AAM) is a rare and nonmetastasizing soft-tissue tumor predominantly found in the female pelvis and perineum. It has a high risk of local recurrence. We report the unusual case of a 15-year-old boy with an AAM presenting as a slowly enlarging scrotal mass. The patient had had chronic renal failure since 1997 and had needed hemodialysis for the previous 11 months. He presented with a 12-month history of a nontender soft mass in the right scrotum. Ultrasound examination revealed a solid mass in the scrotum. After surgical resection, pathological analysis disclosed spindle-shaped neoplastic cells widely separated by a myxoid stroma rich in collagen fibers and prominent irregularly shaped blood vessels; the histological examination confirmed an AAM.

Aggressive Angiomyxoma of the Female Genital Tract

Aggressive angiomyxoma (AAM), a distinctive neoplasm occurring in the female perineum and pelvis, was initially described in 1983. Subsequently reported to occur in the inguinoscrotal region in men, this uncommon specialized genital stromal tumor is characterized by a paucicellular spindle cell proliferation separated by loose myxoid stroma with a prominent thick-walled, hyalinized vascular component. Despite the bland histologic appearance, AAM is an infiltrative tumor with a propensity for aggressive local and regional recurrences, especially when incompletely excised. Due to involvement of the deep pelvic soft tissues and retroperitoneal regions, these tumors often attain a large size and may not be amenable to complete surgical excision. While AAM can be very difficult to distinguish histologically from other myxoid soft tissue lesions of the vulvovaginal region, especially from the so-called benign angiomyofibroblastoma, differences in the clinical behavior between these various neoplasms require accurate diagnosis to ensure proper treatment. A variety of immunohistologic strategies have been proposed to be of value in differentiating these various tumors, but in many instances their relative contribution is overemphasized. In problematic cases, careful evaluation of a few key histologic features, in concert with attention to a series of practical considerations, including patient age, determination of adequacy of biopsy and tumor sectioning, tumor size, borders, and location (superficial versus deep), should permit accurate classification.

Procedural proficiency in the placement of a word catheter: a resident training model

Study objectives: Residency involves on-the-job training and may present a risk when the least-experienced personnel perform critical procedures requiring a degree of surgical skill and dexterity. We develop a training tool for the evaluation and treatment of a Bartholin's cyst or abscess. We assess resident procedural proficiency in the placement of a Word catheter. Methods: This was a prospective before-and-after model. Postmortem porcine tissue was fashioned to simulate the female perineum with Bartholin cyst or abscess. A Foley catheter placed at the vestibule was inflated with Maalox to simulate a Bartholin cyst or abscess. Residents completed a survey to validate the model's clinical fidelity. With an array of equipment used in treatment, including a Word catheter, residents were asked to treat this model as they would a patient. Each resident was individually and critically evaluated and scored using a standardized critical points sheet for procedural competence before and after viewing an instructional video on the placement of a Word catheter. Results: Equal numbers of obstetrics and gynecology (OBGYN) and emergency medicine residents participated (N=34). Sixty-eight percent stated that the model resembled female genitalia. Sixty-one percent correctly diagnosed a Bartholin cyst or abscess. Emergency medicine residents' responses were comparable to those of the OBGYN residents. Mean pretraining score was 5.5±1.46 (range 3 to 9). Mean posttraining score was 8.2±1.20 (range 4 to 9 points). There was a 58% increase in procedural proficiency (<i>P</i><.05). Conclusion: A model female perineum fashioned from porcine tissue can be used to instruct residents in the recognition of a Bartholin cyst or abscess. Residents' procedural proficiency in the placement of a Word catheter may be improved through the use of tissue model perineum and instructional video.

A case of Aggressive Angiomyxoma of the Perineum

Aggressive angiomyxoma is a rare neoplasm of undetermined etiology that occurs mainly in the female perineum and pelvis. It has an infiltrative margin and tends to recur but does not metastasis. We report a 42-year-old woman who presented with a mass arising at perineum. The mass was excised and there is no evidence of recurrence 10 months after surgery.

Aggressive angiomyxoma of the female perineum in pregnancy

Aggressive angiomyxoma of the female perineum in pregnancy

Perineal reconstruction of female conjoined twins

Background/Purpose: Conjoined twins are some of the most challenging patients faced by surgeons. Pygopagus and ischiopagus twins present particular gastrointestinal and genitourinary reconstructive challenges. This study reviews the authors' experience with the perineal reconstruction of these types of conjoined twins. Methods: Retrospective analysis was performed for 3 sets of female conjoined twins undergoing separation between 1999 and 2001. Particular attention was given to the separation and reconstruction of the distal gastrointestinal and urogenital structures. Results: Three sets of female conjoined twins underwent successful separation 2 pygopagus, one ischiopagus tripus) with 5 surviving infants. The sixth infant died of congenital anomalies incompatible with life. Four of the 5 surviving infants had diverting enterostomies. Two of these enterostomies have been closed. Perineal reconstruction consisted of anoplasty (5 of 5), vaginoplasty (4 of 5), and urethroplasty (4 of 5). Although fecal and urinary continence are not completely measurable at this age (<3 years), all 5 survivors void spontaneously. Three infants with intestinal continuity have apparently normal defecation without the need of a bowel regimen. Conclusions: With careful preoperative planning and a multidisciplinary team of pediatric surgeons and urologists, satisfactory reconstruction and functional outcome of the female perineum can be achieved in conjoined twins. J Pediatr Surg 37:1740-1743. Copyright 2002, Elsevier Science (USA). All rights reserved.

Anterolateral Thigh Vastus Lateralis Myocutaneous Flap for Vulvar Reconstruction after Radical Vulvectomy: A Preliminary Experience

Background. There are many myocutaneous flap methods which have been reported for the immediate reconstruction of large vulvar defects created by deforming radical cancer surgery in the female perineum except for the anterolateral thigh vastus lateralis myocutaneous flap. The present report describes our preliminary experience with the use of this flap in a patient who underwent radical vulvectomy for locally advanced squamous cell carcinoma of the vulva.Case. A 75-year-old woman underwent radical vulvectomy with bilateral inguinal lymphadenectomy due to right vulvar squamous cell carcinoma. The large vulvar defect was immediately reconstructed by using anterolateral thigh vastus lateralis myocutaneous flap. The postoperative course was uneventful. In addition to the expected primary healing, the neovulva had a relatively normal appearance with satisfactory sensation and function and the donor defect was found to be minimal both functionally and aesthetically.Conclusion. This technique can be used as an alternative method for vulvar reconstruction after radical vulvectomy. Further studies are warranted to prove the efficacy of this myocutaneous flap in reconstructing large vulvar defects.

Prenatal diagnosis of congenital imperforate hymen

Congenital imperforate hymen is an external urogenital anomaly that has a small differential diagnosis. With careful antenatal sonographic evaluation of the female perineum, identification of a thin protruding membrane consistent with imperforate hymen can be made. We report a case in which an imperforate hymen was diagnosed in a fetus at 25 weeks' gestation. It appeared as a thin membrane that distended the vagina and spread the labia majora because of retained secretions. An associated renal abnormality was present, representing either a right multicystic dysplastic kidney or cystic dysplasia. Imperforate hymen and hydrocolpos can be diagnosed as early as the second trimester. Because of the additional renal anomaly in this case, it is suggested that the presence of prenatally diagnosed imperforate hymen warrants a careful survey of the remaining fetal anatomy to rule out associated abnormalities. The possibility of a familial occurrence should be considered, and the appropriate history should be obtained.

Sculpturing the Neoclitoris in Vaginoplasty for Male-to-Female Transsexuals

One of the goals of vaginoplasty for transsexuals is the construction of an aesthetically appealing female perineum. Cosmetic considerations imply the creation of a clitoris-like structure ventral to the urethral orifice. A review of the scarce references on neoclitoroplasty in the literature on vaginoplasty is given. In our hospital, the neoclitoris is usually sculptured to its final appearance during the actual vaginoplasty, employing a free composite graft of the tip of the penile glans to cover the shortened dorsal neurovascular bundle. From the review of the literature and from our experience one may conclude that our technique presents hardly any complications and leads to acceptable results, both functionally and cosmetically. We consider transpositioning of the glans on its long dorsal neurovascular pedicle a technique with too high a risk.

Contribution of imaging to the understanding of the female pelvic fasciae.

According to the ultrasound and MRI findings, supported by planned dissections, the female perineum is organised around the musculofascial system converging towards the fibrous structure of the central perineal tendon (CPT). Behind the CPT the fascial layers form part of a fibrous assembly extending from the ventral surface of the sacrum to the anal complex, prolonging the direction of the sacral concavity downwards and forwards. On the other hand, in front of the CPT the fasciae fuse to form two aponeurotic bands circumscribing the urogenital fossa. The fascial system is reinforced cranially by the structures of the hypogastric sheath and the uterosacral ligaments. The weak point of the urogenital fossa is partly filled by the urethral-clitoridal-vulvar complex. The perineum so formed plays a cardinal role in stabilising the pelvic viscera. Stress is placed on the firmness of the posterior perineum, a key element in pelvic stability. The posterior perineum is often involved in pathological conditions and a good acquaintance with these structures is essential in defining therapeutic indications.