Labia Majora Research Articles

Carcinoma vulva: Ten years experience in a teaching institution of North India.

Vulvar carcinoma is primarily a disease of post-menopausal women. Surgery is a primary treatment strategy. Chemotherapy and radiotherapy are a part of multimodal therapy. Presently, there is a shift towards neoadjuvant chemotherapy or radiotherapy so as to decrease the surgical morbidities. To study the surgical outcome and prognostic factors in Ca vulva patients. A retrospective analysis of 19 vulvar cancer patients, surgically treated at a teaching institution of Punjab (2009-2019). Mean age of the patients was 60.95 years. Ulcerative swelling (89.5%) over labia majora (73.7%) was the main presenting symptom. Radical vulvectomy-bilateral IFLN dissection was performed in 74% patients, hemivulvectomy-unilateral IFLN dissection in 21% patients and wide local excision in one patient. Squamous cell carcinoma was detected in all, and one had verrucous carcinoma. Thirty-seven per cent patients had FIGO stage III disease, 31.5% - stage II and 31.5% - stage I. On HPE, 78.57% (11/14) patients had positive nodes and two had ECS. Only 5/9 (55.5%) cases could receive PORT. Seven patients defaulted follow-up. Two developed nodal metastasis, and seven women developed recurrence. One patient with regional recurrence faced demise during RT course. In 10/19 regular follow-up patients, four are alive and disease free, five patients are on palliative chemoradiation, and one is undergoing adjuvant radiotherapy for regional recurrence. Estimated 5-year overall survival is 83.33%. Tumour stage, nodal positivity and nodal ECS were poor prognostic factors. Radical surgery-extensive groin node dissection causes significant morbidity; hence, studies evaluating the role of neoadjuvant treatment are needed so as to modify current treatment practices. HPV vaccination as a preventive measure and a thorough and extensive evaluation of patients with suspicious signs in vulvar disease is needed.

Vulvar cancer in young woman—case report

Vulvar cancer is rare with incidence of 45,240 new cases globally which account for 4% of all genitourinary tract neoplasma. It is considered as a postmenopausal disease, however incidence age has decreased over the years because of high prevalence of persistent high-risk human papillomavirus (hrHPV) infection. Vulvar cancer diagnosis in young women is challenging. Prompt and adequate diagnosis, and treatment can ensure the life quality. A 23 years old patient was admitted to Department of Operative Gynecology for treating malignant vulvar neoplasma. She was reffered to our clinic for electrocauterization after being diagnosed of condylomata accuminata. Physical examination revealed vulva atrophy with smooth discolored skin patches on both sides. A 2 cm exophytic lesion was noted ~10 mm from clitoris on right labia majora. Multifocal biopsy was performed for suspect finding which proved invasive vulvar squamous keratinizing cancer. Positron emission tomography-computed tomography (PET/CT) scan showed individual lymph nodes on right inguinofemoral region which were moderately metabolically active. Wide excision of cancer was performed with unilateral inguinofemoral lymphadenectomy. Macroscopic evaluation of entire specimen depicted 2.4 × 2.2 × 0.5 cm HPV associated invasive vulvar squamous keratinizing cancer, vulvar high grade squamous intraepithelial lesion (vHSIL) or usual type vulvar intraepithelial neoplasia (uVIN3) and lichen sclerosus. Healthcare professionals in primary care centers should be adequately trained, aware of and familiar with vulvar malignancies in younger women despite their rarity. Early diagnosis can improve outcomes in vulvar cancer via reducing morbidity and mortality. The individualized surgical treatment is the preferred strategy for patients at present.

ANGIOLIPOMA OF LABIA MAJORA: A RARE CASE REPORT

Angiolipoma is a benign, soft tissue tumor. It is a variant of lipoma with a prominent vascular component consisting of only 6-7% of all lipomas. Though conventional lipomas are commonly found over the neck and upper back, shoulders, abdomen, buttocks, and proximal portions of the extremities, vulval lipomas are very rare and fewer than 70 cases have been reported in world literature. Herein, we report a case of angiolipoma in a 35 years old female in labia majora on account of its rarity with a review of literature. A clinical diagnosis of lipoma was provided to usby the surgeon and on the basis of histopathological examination of the excised mass, a diagnosis of angiolipoma was conferred upon. Our case report describes a rare variant of lipoma, at an uncommon location and also highlights the importance of histopathological examination in arriving at the final diagnosis.

Spontaneous vaginal wall rupture with subsequent paravaginal and labial delivery.

SynopsisSpontaneous vaginal wall rupture with subsequent paravaginal delivery through the labia majora is extremely rare.

Treatment of a Cyst of the Canal of Nuck with an Inguinal Hernia by Laparoscopic Surgery.

A cyst of the canal of Nuck is a rare cystic structure along the inguinal canal extending to the labium majus, which forms due to non-obliterated processus vaginalis. In female patients presenting with painless swelling in the groin or labium, in addition to strangulated hernia, a cyst of the canal of Nuck should be considered. This paper presents a case of a 38-year woman with a right-sided cyst of the canal of Nuck and right inguinal hernia and its clinical and diagnostic features, differential diagnosis, and treatment. Laparoscopic diagnosis and total extraperitoneal hernioplasty (TEP) offer a useful alternative in patients with a superimposed inguinal hernia on top of the cyst of the canal of Nuck. Key Words: Cyst, Laparoscopic surgery, Inguinal hernia, Canal of Nuck.

Revision Labiaplasty After Penile Inversion Vaginoplasty Using Costal Cartilage Allograft.

Gender-affirming surgery leads to high satisfaction for patients; however, patients often require revision surgery. Revision labiaplasty is one of the most common surgeries following vaginoplasty. The labia minora commonly become incorporated into the labia majora and lose definition even after revision leading to patient dissatisfaction. We propose a technique of incorporating cadaveric costal cartilage allograft into the revised labia minora to increase the definition. The procedure was demonstrated in a 38-year-old MTF patient who had previously undergone inversion vaginoplasty. The cartilage allograft was incorporated within the labia minora flaps dur ing labiaplasty. The patient had lasting definition of her labia minora post-operatively at 6 weeks without adverse effects. We believe that this technique may be effective and safe in patients requesting more defined labia minora after vaginoplasty.

Secondary syphilis of the vulva: the great imitator

A 15-year-old patient reported painless vulvar lesions for 30 days, with progressive enlargement. She denied comorbidities or use of medications and reported being sexually active for 1 year. There was no abnormality on general physical examination, but genital examination revealed a nodule in the right labia majora and 2 circular plaques with well-defined borders and central ulceration in the left intergluteal region (Figure, A and B). Serology tests for sexually transmitted infections were requested, and biopsies of both lesions were performed.

Aggressive angiomyxoma of vulva: a rare and interesting entity

We report a case of a 44-year-old female with aggressive angiomyxoma arising from right labia majora. The patient presented with a gradually enlarging vulvar mass and was treatment included wide local excision of the mass with R0 resection. Pre operative and final histopathology was consistent with features of aggressive angiomyxoma. Angiomyxoma is a rare, benign, locally infiltrative mesenchymal tumor that occurs in females at reproductive age. Repeated recurrence and locally invasive characteristics of the tumor makes it important to be considered as a part of the differential diagnosis especially in cases of pelvic mass in females.

Unidentified Branches of the Posterior Femoral Cutaneous Nerve and Persistent Neuropathy.

The posterior femoral cutaneous nerve (PFCN) is an extensive nerve with numerous collateral branches which provide cutaneous innervation to 2/3rds of the posterior thigh, the infragluteal fold, as well as the lateral anal region, scrotum, and labia majora through its inferior cluneal and pudendal nerve branches. It has been noted in multiple studies that patients can experience persistent PFCN neuropathy after surgery for decompression of known collateral branches. In this study, we used 17 formaldehyde (7 male and 10 female) perfused cadavers obtained from Hershey Medical Center’s donor program to study the branching patterns of the PFCN. As a result, we found that 41% of individuals have an unidentified proximal branch of PFCN that recurs over the inferolateral border of the gluteus maximus, suggesting other areas of potential compression or nerve entrapment that could lead to persistent PFCN neuropathy that’s not improved after treatment for sciatic, pudendal, or inferior cluneal neuralgia. We hope these findings allow clinicians to modify current surgical techniques and improve patients’ post-operative quality of life.

Condilomata Lata as Clinical Manifestation of Secondary Syphillis In Pregnancy: Study Case Report

The bacterium Treponema pallidum, which causes the infectious disease syphilis, assaults people. Syphilis is a chronic, systemic disease that can affect all regions of the body, can remain dormant for years, is communicable, and can be treated. One of the symptoms of secondary syphilis is condyloma lata. The most typical location is in warm, muggy climates. We describe case G1P0A0, a 29-year-old woman who is 28 weeks pregnant. The patient's main complaint upon arrival was that he had been developing larger and more frequent warts on his genitalia for the past month. The patient, who has only ever been married once, denies having had any previous relationships with men other than her husband. The patient's husband allegedly had sex with prostitutes without wearing a condom in 2021 and admitted to having previously experienced genital injuries in November of that same year but choosing not to seek medical attention.
 Her vital signs and overall status were within normal ranges, and she appeared to be in good health. Multiple 2 cm grey circular plaques with a localized status were found on the labia majora. A VDRL serological examination was performed as a follow-up examination on June 16; the results were reactive.
 At 28 weeks of gestation, the patient was diagnosed with secondary syphilis in the form of condyloma lata based on the history, physical examination, and supportive examination. Erythromycin 500 mg 4x1, paracetamol 500 mg for pain, and a 0.9% NaCl compress were administered to the patient as treatment. Reevaluated after the first month. The VDRL test yielded a titer of 1: 16 and the complaints of lumps in the genitalia had vanished. The patient is advised to have the exam redone in three, six, twelve, and twenty-four months.

Inflammatory vulvar dermatoses following immune checkpoint inhibitor therapy

Immune checkpoint inhibitors (ICIs) are associated with dermatologic adverse effects. We present 2 patients who developed inflammatory vulvar dermatoses after ICI therapy. The first patient—an 81-year-old with rectosigmoid adenocarcinoma—was treated initially with chemotherapy and radiation followed by pembrolizumab for local tumor regrowth. After her second dosage, she experienced vulvar pruritus with skin sloughing. An exam demonstrated bilateral hyperkeratotic white plaques on the labia majora (Figure, A).

An initial lack of knowledge of the perineal anatomy does not influence the learning of intermittent self-catheterization in women

To evaluate the impact of female perineal anatomy knowledge on the success of a first learning of intermittent self-catheterization (ISC). Thirty subjects benefited from educational diagnosis, training and follow-up during 2 visits in a neuro-urology department. Three knowledge anatomical tests were carried out: a freehand drawing, then a diagram to be annotated and a self-location of the following 6 structures (labia majora, labia minora, clitoris, urethral meatus, vaginal orifice, anus) as well as a physiological knowledge test. A correction was made after annotating the diagram to perfect the learning process before performing the procedure. Of the women studied, 83.3% had a neurological pathology and 77.7% had a gyneco-obstetrical history. Half of them had undergone perineal rehabilitation. Our study shows a lack of knowledge of the perineum prior to learning self-catheterization: 43.3% thought they knew it partially and 46.7% reported that they did not know it. Fifty-three percent of the subjects did not indicate the urethral meatus and 43.3% did not annotate the vaginal orifice on the diagram. Difficulties in anatomical transposition were observed: the urethral meatus was self-located in only 43.3% of subjects and 30% did not locate the vaginal orifice. Previous perineal rehabilitation was not benefical in the self-recognition of anatomical structures. However, all the patients, including those who did not initially locate the urethral meatus, acquired the technique of ISC. Intial perineal anatomy ignorance in women was frequent but was not an obstacle to learning ISC. 4.

Vulval Lymphangiectasia Post-radiotherapy in Cervical Cancer

Cutaneous lymphangiectasia is a benign cutaneous disorder of dilatation of the dermal and subcutaneous lymphatic channels, which occurs rarely on the vulva. It can be congenital or acquired developing secondary to tuberculosis, surgery, and radiotherapy. We report the case of a 58-year-old female patient who gives a history of cervical cancer, for which she underwent hysterectomy and postsurgery radiotherapy 3 years back, now presenting with multiple lumps over the vulva, which discharged clear fluid for 1 year. Acquired vulval lymphangiectasia develops 7–15 years postradiotherapy or surgery commonly, while in our case, it developed earlier. On local examination, there were multiple shiny translucent and hyperpigmented “frog-spawn like” vesicles and papules present over the lower midabdomen, mons pubis, and labia majora. Diagnosis of vulval lymphangiectasia was made on the clinical findings and biopsy. Biopsy revealed dilated lymphatic channels in the superficial and deep dermis. CO2 laser treatment was done for the patient.

What is a vulva?

What exactly is a vulva? The question remains unresolved. Some sources consider the clitoris, labia, mons pubis, perineum, or vagina to be components of the vulva, while other sources do not. Indeed, disagreement exists among international anatomical and clinical societies with regard to what precise structures form the human vulva. The obfuscation regarding the anatomy of the vulva and, likewise, inconsistencies in vulva-related anatomical terminology have adversely affected communication, research, and healthcare. Therefore, this review was undertaken to provide a comprehensive and critical analysis regarding the past, present, and potential future of vulvar anatomy and vulva-related anatomical terminology. The review reveals that confusion regarding the specific gross anatomical structures that form the vulva has persisted for thousands of years. The review provides novel information regarding the etymology of vulva, contributes important historical context regarding vulva, and gives details regarding related anatomical terminology including clitoris, hymen, labia majora, labia minora, mons pubis, pudendum, pudendum femininum/muliebre, uterus, vagina, et cetera. The review highlights disagreement regarding what specific structures comprise a vulva, identifies sexual bias in anatomical terminology and among noteworthy anatomical resources, and offers novel perspectives regarding anatomical terminology-especially anatomical terminology that relates to the external genitalia. What specific anatomical structures comprise the vulva? This review provides a comprehensive and critical analysis regarding the past, present, and potential future of vulvar anatomy and vulva-related anatomical terminology.

Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.

Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques.

Correcting gender dysphoria –the anatomical changes with male to female gender reassignment surgery

ABSTRACT Introduction & Objectives Increased Global acceptance of transgender communities, gender-affirming genital reconstructive surgery is becoming more prominent. Formalised education and training however has not quite entered the curriculum of many surgical training programs yet it remains imperative we have an understanding of modified anatomy in out patients. We demonstrate anatomical reconstruction during the transition between male to female anatomy. Methods Patient consent was obtained to take a series of photographs during gender affirming surgery from male to female. Results Contemporary patients receive both spinal and general anaesthesia prior to positioning in standard lithotomy. A perineal incision of approximately 10cm in the midline raphae exposes the corpora and spongiosum. A simple bilateral orchidectomy was performed at the level of the external inguinal ring. A neovaginal cavity was created by firstly dividing the bulbospongiosus attachments to the perineal body and the space is both blunt and sharply dissected. Further dissection is carried out in the avascular perirectal fat plant anterior to the Denonvilliers fascia. During this dissection a 18-22Fr urethral sound is used to apply downward traction on the rectum. A sterile ultrasound sleeve is placed in the rectum to allow bimanual palpation to confirm intact rectal mucosa. A circumferential incision proximal to the glans is performed to aide degloving of the penis. Bucks fasica is left intact and distal penile skin will later be used to form the clitoral hood. The dorsal neurvascular bundle is raised off the corporal bodies but an attachment to the glans remains. A triangular section of dorsal glans is preserved and dissected off the tips of corpora. The penile tissue is then disassembled separating the corpus spongiosum from the corporal bodies. The corpora are amputated at the level of the pubis, remaining erectile tissue destroyed and oversewn for haemostasis. The Urethra is shortened to an appropriate length to allow the dorsal aspect to align between the neoclitoris and neomeatus. The ventral aspect is spatulated to expose the neomeatus. The penile skin flap is invaginated within the neovaginal space and the skin incised to expose the neoclitoris and neomeatus. The penile skin is then anastomosed to the neoclitoris and neomeatus The distal end of the penile skin flaps is oversewn to create a blind ending tube and thus creating the neovagina. Labia Majora are formed by excising excess scrotal skin to create an appropriate contour. This form of neovagina is compared to methods that involve intestinal and peritoneal lining transfer. Conclusions We have outline the stepwise transition of male to female anatomy with a conventional contemporary technique. Creation of a neovagina with penile inversion has become common practice in gender affirming surgery. However there are other means of creating genitalia with alternative tissues, which subspecialised practitioners should be aware. Disclosure Work supported by industry: no.

Vaginal Swelling After Intercourse: A Case Report

Introduction: A vulvar hematoma is a hemorrhagic fluid collection in the female external genitalia. The majority occur as an obstetrical complication, especially during labor. Non-obstetrical vulvar hematomas are usually the result of trauma, with coitus being the most common etiology. Case Report: We present the case of a 25-year-old woman with significant vaginal pain and swelling after vigorous sexual intercourse. She exhibited tenderness and swelling of the left labia majora and minora. The differential diagnosis included bleeding, abscess, and deep venous thrombosis. Laboratory studies were normal and computed tomography of the pelvis indicated the swelling was most likely due to blood. The patient was taken to the operating room, and approximately 150 cubic centimeters of clot was evacuated. The patient had an uneventful recovery and was discharged home the next day. Conclusion: This case illustrates the unique presentation and challenges in making the diagnosis of vulvar hematoma.

Incarcerated Hematosalpinx in the Canal of Nuck

The canal of Nuck is an abnormal pouch of parietal peritoneum extending from the round ligament through the inguinal canal into the labia majora. The incidence of inguinal hernia in the pediatric population is 0.8% to 4.4% [ 1 Chan D Kwon JK Lagomarsino EM Veltkamp JG Yang MS Pfeifer CM. Canal of Nuck hernias. Acta Radiol Open. 2019; 82058460119889867 PubMed Google Scholar , 2 Thomas AK Teague CT Jancelewicz T. Canal of Nuck hernia containing pelvic structures presenting as a labial mass. Radiol Case Rep. 2018; 13: 534-536 Crossref PubMed Scopus (9) Google Scholar ].

An Unusual Case of Large Vulvar Soft Fibroma In An Adult Patient: A Case Report

A 25-year-old female patient applied to our clinic with a complaint of a growing mass in external genitalia. Patient’s complaint began 10 years ago as a small papillomatous lesion in the right labia majora, which increased in size progressively reaching to present size of 20-30 cm in 2-3 years after the first symptom. The mass was prediagnosed as vulvar soft fibroma, and surgical excision was decided. The histopathological findings were compatible with fibroepithelial polyp .The patient had no postoperative complication, and there was no residue or recurrence at the last assessment on postoperative 3rd month.

Multifocal Infantile Hemangiomas Treated by Oral Itraconazole: A Case Report

We describe a case of a 2-month-old girl presented with more than 60 papules and nodules of hemangiomas involving the skin of the sclera, endocanthion, lower lip, and labium majus pudenda without visceral hemangiomas and laboratory abnormality. A skin biopsy showed numerous scattered, clearly limited, irregular cellular lobules in the dermis circumvoluted into capillaries comprising incomplete vessel walls, which was consistent with a diagnosis of multifocal cutaneous infantile hemangioma. Oral treatment with itraconazole (5mg/kg/day) for 26 weeks resulted in predominantly involution of the skin hemangiomas. We would like to report a rare case of multifocal cutaneous infantile hemangioma, successfully treated with oral itraconazole.