Vulvar Disease Research Articles

Surgical margin status and recurrence pattern in invasive vulvar Paget's disease: a Japanese Gynecologic Oncology Group study

<h3>Objectives:</h3> To examine the association between surgical margin status and recurrence pattern in invasive vulvar Paget's disease. <h3>Methods:</h3> This is a preplanned secondary analysis of previously organized nationwide retrospective observational study in Japan (JGOG-1075S). Women with stage I-IV invasive vulvar Paget's disease who received surgical treatment from 2001-2010 were examined (n=139). Multivariable analysis was used to assess local-recurrence, distant-recurrence, and all-cause mortality based on surgical margin status. <h3>Results:</h3> The median age was 70 years. The majority had stage I disease (61.2%), and the median tumor size was 5.0cm. Nodal metastasis was observed in 15.1%. Simple vulvectomy (46.0%) was the most common surgery type followed by radical vulvectomy (28.1%). More than half received vulvar reconstructive surgery (59.0%). Positive surgical margin was observed in 35.3%, and close margin <1cm was observed in 29.5%. Vulvectomy type was not associated with surgical margin status (<i>P</i>=0.424). The median follow-up was 5.8 years, and positive surgical margin was significantly associated with local-recurrent (5-year cumulative rates for positive versus negative margin: 38.0% versus 15.0%, <i>P</i>=0.005) but not distant-recurrence (20.5% versus 16.0%, <i>P</i>=0.388). Positive surgical margin was also associated with all-cause mortality (5-year overall survival rates for positive versus negative margin: 72.6% versus 88.2%, <i>P</i>=0.032). In multivariable analysis, positive surgical margin remained an independent factor associated with increased risk of local-recurrence (hazard ratio 3.32, 95% confidence interval 1.29-8.53) and all-cause mortality (hazard ratio 2.87, 95% confidence interval 1.20-6.83). <h3>Conclusions:</h3> Positive surgical margin appears to be common in invasive vulvar Paget's disease that is associated with increased local-recurrence and all-cause mortality risks. Role of alternative surgical technique (e.g., Mohs micrographic surgery) or adjuvant therapy (e.g., imiquimod) merits further investigation to improve local disease control.

Invasive extramammary Paget's disease of the vulva: incidence, trends and outcomes

<h3>Objectives:</h3> To explore the incidence, trends and survival outcomes of invasive extramammary vulvar Paget's disease compared to squamous and basal cell vulvar cancers. <h3>Methods:</h3> Incidence data were extrapolated from the United States Cancer Statistics (USCS) from 2001 to 2017 by SEER*Stat. Trends analysis was performed by Joinpoint regression program and presented by average annual percent change (AAPC). Clinical data on demographics, disease and treatment were recorded from the National Cancer Database from the same period. Chi-squared test, Kaplan-Meier survival estimates, and Cox proportional hazards model adjusted for covariates were used. <h3>Results:</h3> From 2001-2017, there were 3,715 cases of malignant extramammary Paget's disease of the vulva. Whites comprised 3,172 cases (85.4%), followed by Asian/Pacific Islanders with 227 cases (6.1%), Hispanics with 198 cases (5.3%), and Blacks with 44 cases (1.2%). Most cases had localized disease (73.1%), 10.4% had regional spread and 1.2% had distant disease. The overall incidence was 0.12/100,000 women per year in 2017. The incidence increased with an average percent increase of 0.4% per year from 2001 to 2017 (p<0.01). Of 1,388 patients with invasive vulvar Paget's disease from the NCDB, the median age was 72 (range: 63-80) years. Local excision was performed in 77.4% of cases, and 10.7% underwent radical surgery. The overall five-year survival was 85.9%. Older age (HR=7.95, p<0.001), advanced disease (HR=6.0, P<0.001), positive LVSI (HR=2.81, p<0.001), and Charlson comorbidity index ≥ 1 (HR 2.17, p<0.001) had worse survival. Using the NCDB, we compared the 5 year survival rates of vulvar squamous cell carcinoma (SCC) (n=28,587) and basal cell carcinoma (BCC) (n=1,720) to invasive Paget's disease. The survival of SCC and BCC were 63.5% and 77.9% compared to 85.9% for invasive Paget's disease. More specifically, the survival of early stage I and II were SCC: 73.7% and 59.3%, BCC: 79.5% and 60.5% and Paget's: 83.6% and 81.3%. Survival of advanced stage III and IV were SCC: 45.3% and 24.8%, BCC: 71.4% and 50.0% and Paget's: 52.5% and 41.7%. <h3>Conclusions:</h3> Invasive extramammary Paget's disease of the vulva is uncommon though the incidence is increasing. Older age and advanced stage are associated with poorer survival. Patients with metastatic vulvar Paget's disease and squamous cell carcinoma have a poorer survival compared to metastatic vulvar basal cell carcinoma.

Neoadjuvant chemotherapy followed by radical surgery in locally advanced vulvar carcinoma: a single-institution experience.

Squamous cell carcinoma of the vulva is a rare malignancy that affects elderly women. About one-third of vulvar cancers are diagnosed in an advanced stage, requiring extensive surgery. Neoadjuvant chemotherapy (NACT) has been introduced to reduce local tumor burden. In this retrospective study, we analyze the efficacy and toxicity of NACT followed by radical surgery. Patients with locally advanced vulvar cancer (LAVC) treated at our institution with neoadjuvant platinum and paclitaxel-based chemotherapy ± ifosfamide followed by surgery at our institution were retrospectively identified. Fourteen patients (93%) completed NACT with tolerable toxicities (G3-G4 toxicity: 30%). Thirteen patients (87%) underwent surgery. The overall clinical response rate on vulvar disease was 66% (20% complete response, 46% partial response), confirmed by histopathologic analysis, while on inguinal lymph nodes it was 69% (23% complete response, 46% partial response). At the pathologic examination, all patients had negative surgical margins. Three out of 9 patients (33%) with lesions infiltrating the urethral meatus and 4 patients out of 7 (57%) with anal involvement did not require urethral amputation or colostomy, respectively, after NACT. No severe postoperative complications were described. Overall survival at 5 years was 60%, and median overall survival was 76 months. NACT followed by surgery in locally advanced vulvar cancer is well tolerated and allows surgical modulation.

Dermatographism with vulvar symptoms.

Dermatographism (DG) is characterized by a localized, inducible, wheal-and-flare response along the distribution of mechanical pressure. We report an illustrative case of DG with vulvar symptoms (DG-VS) and review the literature on this rarely recognized but easily treated etiology of vulvar complaints. A 35-year-old woman presented with a 1-year history of vulvar pruritus unresponsive to antifungal, antibacterial, and steroid treatments. A prior punch biopsy was nondiagnostic. Vulvar examination revealed normal architecture and no cutaneous abnormalities. She was markedly dermatographic with a scratch test. DG-VS was diagnosed. The patient achieved complete symptomatic control on low-dose hydroxyzine. She maintains excellent control at 3.5 years. In the literature, a typical patient with DG-VS is of reproductive age, with several years’ history of vulvar symptoms (itching, burning, pain, or swelling) and repeated empiric treatment for infectious/inflammatory etiologies. Exacerbation with sexual activity, menstruation, or wearing tight clothing is characteristic and supports the role of mechanical pressure in inducing focal symptoms. Dermatologic changes to the vulvar skin are rarely noted. DG-VS is diagnosed based on clinical findings, symptom patterns, and a positive scratch test and is treated with antihistamines. DG-VS remains absent from current vulvar disease guidelines. In the complex world of vulvar pain and itch, an etiology so easily screened for and readily treated warrants consideration.

Vulvar Paget's disease and stromal invasion: Clinico-pathological features and survival outcomes

PURPOSETo evaluate clinico-pathological features, treatments and survival outcomes of vulvar Paget's disease (VPD). MethodsWe retrospectively reviewed VPD diagnosed between 1983 and 2018 at the Department of Surgical Sciences, Sant’Anna Hospital, Turin. Clinico-pathological characteristics and surgical treatment outcomes were investigated according to the depth of invasion. ResultsA total of 122 patients were identified. Eighty-seven patients were diagnosed with intraepithelial VPD, 22 with microinvasive (<=1 mm) VPD and 16 with invasive VPD. The median follow-up was 94.6 months (interquartile range 25th-75th, 26–120). Most of patients 95/122 (77%) were treated by surgery. Local recurrence was observed in 69/95 (73%) patients without significant difference between the 3 groups (p = 0.33), however, total vulvectomy showed better local control in microinvasive and invasive VPD than in intraepithelial tumors. At 120 months the cancer-specific survival was 100% for intraepithelial and microinvasive VPD versus 31% for invasive VPD (log-rank p = <0.0001) Age ≥65 years (OR: 4.17 CI 1.12–15.5, p = 0.03) and VPD's area ≥15 cm2 (OR: 5.83 CI 1.75–19.3, p = 0.004) were associated with risk of invasiveness. ConclusionMicroinvasive VPD has an identical prognosis to intraepithelial VPD, suggesting the omission of lymphadenectomy or adjuvant treatments are safe in this subset of patients. We recommend caution to propose medical treatment in patients who are ≥65 years old and with wide tumor area, as they are at the greatest risk of invasiveness.

Four-decade trends in lymph node status of patients with vulvar squamous cell carcinoma in northern Italy

The 4-decade (1980–2017) trends in lymph node status of patients with vulvar squamous cell carcinoma (VSCC) in a province of northern Italy were investigated. Information was collected on lymph node dissection, number of lymph nodes dissected, lymph node involvement, and number of positive lymph nodes from a series of 760 patients admitted to a tertiary referral centre for vulvar disease. The adjusted odds ratios (ORs) for lymph node involvement, for ≥ 2 positive nodes, and for a lymph node ratio ≥ 20% were estimated from multiple logistic regression models. The adjusted OR for lymph node dissection was greater in the 2000s and 2010s versus the 1980s. The adjusted OR for lymph node involvement was 1.36 (95% confidence interval (CI), 0.72–2.60) in the 1990s, 1.31 (95% CI, 0.72–2.38) in the 2000s and 1.32 (95% CI, 0.73–2.41) in the 2010s versus the 1980s. The adjusted OR for ≥ 2 positive nodes was 1.36 (95% CI, 0.68–2.72), 0.86 (95% CI, 0.44–1.65) and 0.67 (95% CI, 0.34–1.31), respectively. The adjusted OR for lymph node ratio ≥ 20% was 1.45 (95% CI, 0.62–3.43), 1.21 (95% CI, 0.54–2.72) and 0.81 (95% CI, 0.35–1.89), respectively. This stagnation indicates the need for a serious rethink of the local model for the care of VSCC.

Maladie de Paget extra-mammaire

Extramammary Paget's disease is a rare malignancy. The underlying cause of VPD remains not well understood. We provide an overview of the histopathology of vulvar Paget's disease, with or without invasion.

Cancer-related cognitive impairment (CRCI), depression and quality of life in gynecological cancer patients: a prospective study.

Cancer-related cognitive impairment (CRCI) has been reported in non-central nervous system neoplasms survivors. The purpose of this study was to evaluate the perception of cognitive decrement in patients undergoing surgical and / or medical therapy for gynecological cancers. All women diagnosed with primary gynecological cancer and undergoing active medical treatment have been enrolled in a prospective study. Before starting treatment (T1) and 6months after the end of treatment (T2), patients were interviewed to evaluate the effects of cancer treatment on perceived cognitive function (using FACT-Cog -version 3), on depression (using Beck Depression Inventory-II test) and on quality of life (using EORTC-QLQC-30). Age, education level, marital status, lifestyle, menopausal state at diagnosis, cancer type, cancer FIGO stage, treatment modality was also recorded. The differences between baseline and post-treatment results have been evaluated with Student's t test. The results have been stratified by the menopausal state at diagnosis, type of tumor (endometrial, cervical, ovarian, vulvar) disease stage and type of treatment (chemotherapy or radiotherapy). Seventy-three patients were included. A significant reduction in perceived cognitive impairments was demonstrated at T2 (CogPCI: 61.35 ± 13.83 vs 55.05 ± 16.56; p < 0.05). On the contrary, a significant improvement was shown in depression state (BDII: 21.14 ± 11.23 vs 12.82 ± 12.33, p < 0.005). The menopausal state at surgery, tumor site, stage and treatment modality seem to influence the variables analyzed. CRCI is a true risk also in gynecological cancer survivors. The cognitive impairment does not seem to be dependent on depression state after treatment or to a menopausal condition. Assessing cognitive decline in cancer survivorship is essential for ensuring the optimum quality of life and functioning.

Vulvar edema: diagnostic clue to Crohn disease

Vulvar lesions are clinically challenging for physicians because the differential diagnosis may include many entities. Vulvar edema is one of the most frequent symptoms and is normally attributed to a local cause. Herein, we present a case report of vulvar Crohn disease (VCD) in a 9-year-old girl, in which skin lesions preceded the systemic gastrointestinal symptoms. Both clinical features and histopathological findings guided us to an early Crohn disease (CD) diagnosis. Dermatologists often have the opportunity to detect systemic diseases at early stages. A good knowledge of the CD skin manifestations could lead to an early CD diagnosis, especially in children. The suspicion of CD in those cases in which cutaneous involvement precedes digestive symptoms is crucial to prevent future psychological and physical consequences.

Efficacy of 3D-pore sanitary napkin on mild-to-moderate irritant contact dermatitis in the female genital area

Background: &nbsp; Women worldwide have their own strategies to cope with menstruation, and unhygienic menstrual practices often cause vaginal diseases. During menstruation, the skin is irritated by the remaining unabsorbed menstrual flow and sweat on sanitary pads. Irritation of vulvar skin by an external agent could cause contact dermatitis, which is an important contributor to vulvar diseases. Various sanitary napkins available today share similar materials. This study compared commonly used sanitary napkin among Indonesian women with 3D-pore sanitary napkin in terms of efficacy. Methods:&nbsp; A randomized, controlled, single blind, crossover study of 72 participants who met the inclusion and exclusion criteria was conducted. Six areas were evaluated by dermatologists using the Grading Scale of Cutaneous Symptoms. The evaluation was performed in five visits. Results: &nbsp;All participants were divided randomly into two groups. Eight of the 72 participants dropped out; thus, 64 participants completed the study. Scores at Visit-2 show a significant difference between group A (3D-pore napkin) and group B (comparator napkin). Group A shows better improvement. The difference in total score at first second visit until end visit from each napkin shows that the 3D-pore napkin reduces the score by 4.77 and the comparator napkin reduces the score by 3.10. The difference between these numbers is statistically significant. The specific area (external genitalia and perianal) of both groups is significantly reduced in visit 1 and visit 2. The 3D-pore napkin reduces wetness better than the comparator napkin. Conclusion: &nbsp; The 3D-pore sanitary napkin significantly improves vulvar skin inflammation compared with the comparator napkin. &nbsp; Keywords : 3D-pore sanitary napkin, commonly used napkin, female genitalia&nbsp;

Инновационные подходы к лечению заболеваний вульвы на основе высокочастотного фокусированного ультразвука

Инновационные подходы к лечению заболеваний вульвы на основе высокочастотного фокусированного ультразвука

The prevalence of self-reported medical comorbidities in patients with vulvar lichen sclerosus: A single-center retrospective study.

To compare the demographics and self-reported medical comorbidities of patients with vulvar lichen sclerosus (VLS) with those of women with other vulvar conditions. Intake questionnaires for patients presenting to the University of Michigan Center for Vulvar Diseases between 1996 and 2019 were entered into a de-identified database (n=1983). Responses to questions about thyroid disease, urinary symptoms and signs, gastrointestinal conditions, and pain conditions were collected. A total of 1983 women, including 865 patients with VLS and 1118 patients without VLS were enrolled. Pearson's χ2 analysis showed that age, hypertension, anorectal fissures, peptic ulcer disease/gastroesophageal reflux disease, urinary incontinence, fibromyalgia, thyroid disease, kidney problems, liver problems, and cancer were significantly associated with VLS when compared between the VLS and non-VLS groups (P<0.01). However, multiple regression analysis demonstrated that only age, thyroid disease, and anorectal fissures were strongly associated with VLS (P<0.01). Increasing age, thyroid disease, and anorectal fissures were significantly associated with VLS. The association between anorectal fissures and VLS likely represents a sequela of the disease rather than a true comorbidity.

Neoplasia intraepitelial vulvar: Cribado en población de riesgo

BackgroundPatients with cervical intraepithelial neoplasia (CIN) are more likely to develop lesions caused by the human papilloma virus (HPV) in other locations of the lower genital tract (including the vulva). Vulvoscopy is not included in the follow-up of women with CIN. It is proposed to study the efficiency of including vulvoscopy in follow-up. An analysis is also performed on incidence of high-grade vulvar dysplasia, as well as the influence of protective and risk factors analysed. Material and methodsThe study included 95 patients with a diagnosis of CIN in the cone biopsy piece. All the information relative to their socio-demographic and clinical characteristics was collected and included, performing of the vulvoscopy as well as the biopsy. Results and conclusionsThe mean age of the patients was 40 years. Just under two-thirds (62.1%) of them were or had been smokers (more than half of those had quit smoking at the time of the study). Only 21.1% said they were not using a barrier method. Although 78.9% of those studied were or had been users of hormonal contraception, only 8 out of the 95 continued using it. Most (88 out of the 95 women) were vaccinated against HPV. No high-grade vulvar dysplasia was diagnosed. The modification in the lifestyle after the diagnosis of the cervical disease, the transience of the HPV infection, and the greater susceptibility of the cervical epithelium to this, are indicated as the most probable causes of the discordance between the expected prevalence of vulvar disease and the effective rate found within the studied population.

Association Between Vulvar Squamous Intraepithelial Lesions and Psychiatric Illness.

The aims of the study were to describe and to compare demographics and the prevalence of psychiatric disorders among patients with low- and high-grade vulvar squamous intraepithelial lesions. A retrospective chart review was performed for patients presenting to a vulvar diseases clinic between 1996 and 2019 (N = 2,462). Intake questionnaire data were entered into a deidentified database. Results were compared between 80 patients with biopsy-confirmed high-grade squamous intraepithelial lesions (HSILs) and 48 patients with biopsy-confirmed low-grade squamous intraepithelial lesions (LSILs). Bivariate analysis was performed to compare demographics and psychiatric treatment and outcomes across HSIL and LSIL groups. Among 128 patients with vulvar disease, 80 (62.5%) had HSILs and 48 (37.5%) had LSILs. Patients with HSILs were significantly older (HSIL median [interquartile range] = 49.0 (39.0-61.0) vs LSIL = 36.0 [29.0-53.0], p = .006). There were no significant differences between groups across race/ethnicity, education, marital status, or self-reported household income categories. Forty percent of HSIL patients reported depression compared with 20.8% of LSIL patients (p = .03), whereas 31.3% of HSIL patients and 8.3% of LSIL patients reported anxiety (p = .002). Bipolar disorder was reported in 3.8% of HSIL patients and no LSIL patients (p = .29). There were no differences in the proportion of patients receiving psychiatric counseling, medications, or hospitalizations between groups. Squamous intraepithelial lesions of the vulva are associated with psychiatric disorders above age-matched national averages; these disorders are more prominent in the HSIL group. Combining mental health services with ongoing disease treatment seem to be part of a comprehensive approach to caring for this patient population.

Geriatric Vulvar Dermatology

The purpose of this review is to provide the diagnosis and management of inflammatory vulvar dermatoses in the geriatric population. The increasing geriatric population in the USA necessitates informing a broad base of healthcare providers on this topic. In the elderly, there are increasing case reports of contact dermatitis due to sanitary napkins, incontinence pads, and over the counter medications. Superimposed vulvovaginal candidiasis and lichen simplex chronicus can occur simultaneously with the primary vulvar disease. The limited research specific to geriatric populations confirms the current state of vulvar dermatosis underdiagnosis. In order to close the gaps in diagnosis and treatment of vulvar dermatoses, providers should carefully review the patient’s medical history and complete a physical examination of the genitoanal area for asymptomatic and symptomatic elderly women. Prompt, consistent treatment can vastly improve the patient’s quality of life and is critical to preventing the advancement of lesions to squamous cell carcinoma in conditions that incur this increased risk such as lichen sclerosus and lichen planus.

National guidelines for management of cervical squamous intraepithelial lesion: A survey of European Federation for colposcopy members

ObjectivesThe management of women with cervical squamous intraepithelial lesions (SIL) is fundamental to prevention of cervical cancer in an organized cervical screening programme. Clinical guidance should improve quality of care and clinical effectiveness if developed and implemented appropriately. This survey provides an update on the current situation of national guidelines for management of cervical SIL amongst member countries of European Federation for Colposcopy (EFC). Study designA questionnaire was sent to representatives of each member country of EFC. The questionnaire contained questions on: guidelines for management of cervical SIL of the National Societies/Associations of Colposcopy or others national societies/associations including the development and the consultation processes, guidelines for management of lower genital tract diseases and the regulations in each country for colposcopy practice. ResultsWe received responses from all 34 member countries. Thirty countries reported a national guideline for management of cervical SIL that were developed by, or in conjunction with, their national societies or associations of colposcopy. In most cases there was adherence to the recommended steps for guideline development: they were developed by a multi-disciplinary group of specialists (29 countries) and society members were consulted before publication (21 countries). A small number of countries (8) reported to have guidelines for the management of lower genital tract dysplasia (e.g. vulval disease) developed by other national societies. In most countries (26) the colposcopists are obliged to follow the guidelines but this is regulated in only 6 and in 12 countries the colposcopists need to be certified by the national society of colposcopy in order to practice. ConclusionThere are advances in the development and provision of country specific guidance on the management of cervical SIL. Most EFC member countries have appropriate national guidelines that were developed using a clear methodology, are updated according to progresses in the field and are accessible online to current practitioners. These guidelines support colposcopists to follow evidence-based practice and provides understanding of best practice in guideline development and access.

Patterns of Care and Outcomes of Vulvar Cancer Treatment in Women With or Without HIV Infection in Botswana

Vulvar cancer is a rare gynecological malignancy. However, the incidence of human papilloma virus (HPV)-associated vulvar disease is increasing, particularly in low- and middle- income countries. Human immunodeficiency virus (HIV) infection is also associated with an increased risk of vulvar cancer. Patterns of care for vulvar cancer in low resource-limited settings with high rates of HPV and HIV co-infection have not been well described. Women with vulvar cancer who presented to an oncology clinic in Botswana from January 2015 through October 2019 were prospectively enrolled in this observational cohort study. Factors associated with survival including age, HIV status, stage, and treatment were evaluated. Analysis of 128 women with vulvar cancer demonstrated a median age of 42 years. At presentation 53.3% of patients were early stage (stage I/II) and 46.6% were late stage (stage III/IV). The majority of patients were living with well-controlled HIV infection (89%, n = 107) with a median CD4 count of 461 cell/ul (IQR 300.5-684.5) and high level of viral suppression (95% with viral copies & <400). Surgery was performed in 25 (20.8%) patients, 29 (24%) patients received chemotherapy, and 81 (67.5%) received radiation therapy. Adjusted analysis controlling for HIV, age, stage, surgery, chemotherapy and radiation demonstrated no differences in survival at 32 months by HIV status (HR, 0.426; 95% CI, 0.112-1.5976). Advanced stage (stage III and IV) (HR, 2.41; (95% CI, 1.03-5.68) and older age (HR, 1.05; (95% CI, 1.00-1.10) were associated with worse survival while receipt of surgery was associated with improved survival (HR 0.09, 95% CI 0.15-0.74). Women in Botswana with vulvar cancer have a high rate of HIV infection. They present at a young age and just under half of patients present at a late stage. While decreased survival was associated with older age and late stage disease, HIV status did not impact survival outcomes. Efforts to identify patients early with limited disease burden may be necessary to improve outcomes in the future.

Photodynamic therapy in the treatment of patients with vulvar premalignant diseases. First experience of its use in Ukraine

Objective of the study was to evaluate the tolerability and effectiveness of photodynamic therapy (PDT) in patients with vulvar premalignant diseases.Materials and methods. Study was performed in 10 patients on the basis of the National Cancer Institute of Ukraine (Kyiv). Age of patients ranged from 31 to 67 years old (mean age 53.3 ± 3.6 years old). Diagnosis was made on the basis of medical history, complaints and clinical examination of patients, vulvoscopy and results of morphological examination of pathologically altered vulvar tissues. A drug of the chlorine series “Photolon” (RUE “Belmedpreparaty”, Republic of Belarus) in doses from 1 to 2.5 mg/kg was used as a photosensitizer (FS). Photoirradiation of pathologically altered foci was performed 3–4 hours after the end of the FS infusion using a laser coagulator universal “Lika-surgeon” (“Photonics Plus”, Ukraine, λ = 660 nm) with a radiation power of 0.4 W in exposure doses of 100 up to 150 J/cm2. PDT tolerability was assessed basing on the frequency and severity of adverse reactions (CTCAE, version 3.0). PDT effectiveness was assessed basing on the presence/absence of complaints, data from visual observation of changes in the area of treated lesions and morphological examination data at 3 and 6 months after treatment (WHO criteria).Results. No serious adverse reactions associated with FS infusion and PDT session were observed: no allergic reactions (Quincke’s edema, urticaria, drop in blood pressure, bronchospasm), no symptoms of skin phototoxicity. There was remission of clinical symptoms (itch in the area of vulva) in the treated pathological centers and high frequency of clinical and morphological regressions in the control observation terms of patients.Conclusion. Obtained results indicate the relevance and prospects of further researches in the field of laser technology and PDT as options for organ-preserving treatment of vulvar premalignant diseases

Czy terapia Recover skutecznie zmniejsza ból u kobiet z wulwodynią?

Introduction: Vulvodynia (Vd) is a form of chronic vulvar pain and other discomfort that persists for more than three months in the absence of any evident vulvovaginal pathology. Provoked Vd is one of the reasons of dyspareunia. Vd is classified as a functional pain syndrome that is mediated by pelvic floor muscles dysfunction (PFMD overactive state) and psychological predisposition. Treatment standards do not exist, although multidisciplinary therapy seems to be the most effective. Material and methods: Retrospective study was performed within 121 women with Vd who undergo Recover therapy. Nineteen therapeutic sessions were included, with manual pelvic therapy, initial general physiotherapy and psychological consultations performed during minimum 5 days. Vd patients with PFMD overactive state were qualified by a gynecologist to the therapy, who also summarizes the treatment. Pain rate and characteristics of vulvar discomfort were assessed before and 2 and 6 months after therapy, recorded in NRS. Results: Vulvar pain and discomfort subjective reduction by 65% was confirmed after therapy, even more, 2/3 of women reported a minimum 50% relief in pain, the improvements were maintained over the time. The best treatment results in dyspareunia women caused by provoked Vd were obtained. The outcome was not dependent on the duration of Vd. Conclusions: In the center when women with vulvar diseases and Vd are treated, interdisciplinary Vd therapeutic program was developed. Recover therapy can lead to clinically meaningful improvement in Vd pain, according to chronic pain therapy assessment criteria. Randomized clinical trial with control group is indicated, when other key parameters of IMMPACT consensus, for Recover therapy assessment, would be taken under consideration.

Diagnosis and Management of Vulvovaginal Lichen Planus.

Genital lichen planus is a debilitating disorder that lacks definitive recommendations regarding diagnosis and treatment. The aim of this study was to present best practices from available evidence for the diagnosis and treatment of genital lichen planus. We conducted a narrative review of the literature on genital lichen planus by searching PubMed using the following search terms: "vulvar lichen planus" OR (vulvar diseases[mesh] OR vulva[mesh]) AND lichen planus[mesh] OR vulvar[ti] AND "lichen planus"[ti]. We included all languages and years in the search. The search resulted in 273 citations that we reviewed for relevancy and selected 60 as the foundation for this review that focuses on genital sites. Diagnosis can be made without biopsy, and when a biopsy is taken, the pathologic findings may be nonspecific. Topical ultrapotent corticosteroids are most commonly used as first-line treatment of genital lichen planus. When patients present with genital lichen planus, a complete review of systems and a thorough physical examination should be performed because of the prevalence of extragenital sites. Treatment of genital disease should start with a topical, ultrapotent steroid, and follow-up visits should occur to ensure improvement and to monitor for adverse drug reactions and malignancy.