Vulvar Disorders Research Articles

Vulvovaginal Disease Education in Canadian and American Gynecology Residency Programs: A Survey of Program Directors.

The aims of the study were to assess and describe the current vulvovaginal curriculum in gynecology residency training programs in Canada and the United States and to compare this with national training objectives. A 22-question electronic survey was sent to 252 gynecology program directors in Canada and the United States between September 2015 and July 2016 using the platform SurveyMonkey.com. Survey responses were entered into SPSS Version 23, and analysis was performed using descriptive statistics. Overall, 58 (23%) of 252 programs directors responded. Nearly all of the sites provided formal teaching on pain disorders (54/58, 93%), vulvar dermatoses (54/58, 93%), and vulvovaginal infections (57/58, 98%). Exposure to vulvovaginal clinics varied widely. On average, program directors estimated that residents spend a median of 10 hours (0-200) in vulvar pain clinics, 9 hours (0-200) in dermatology clinics, and 50 hours (0-480) in colposcopy clinics during residency training. Most program directors (53/57, 93%) believed that all general gynecologists should be able to manage vulvar disorders in practice. Reported obstacles to treating vulvar disorders included lack of training (41/58, 71%) and lack of interest (35/58, 60%). While most residency programs provided formal education on vulvovaginal diseases, clinical exposure is extremely variable between sites. When it is not possible to increase clinical exposure to vulvovaginal disorders, traditional training methods (lectures, textbooks) should be supplemented with online modules and other means of learning to improve resident knowledge of vulvovaginal diseases.

Retrospective Study of Remission and Recurrence of Vulvar Lichen Sclerosus in Different Racial/Ethnic Pediatric Groups

Lichen Sclerosus (LS) is an inflammatory disease of unknown etiology that often affects anogenital skin and associated with high recurrence rates after achieving first remission. In the past, lichen sclerosus among kids was thought to be a rare condition, but recent surveys suggest it is one of the most frequently seen pediatric vulvar disorders. There is very little published information regarding the ethnic or racial epidemiology, presentation and natural history of prepubertal LS.

Diagnosis and Treatment of Vulvar Dermatoses.

Vulvar symptoms of pain, dyspareunia, and pruritus are common and may significantly affect a woman's sense of well-being and sexual function. Despite this, vulvar symptoms are often underreported by women. When identified, however, vulvovaginal symptoms should be addressed by health care providers to optimize care. The evaluation of patients with vulvovaginal complaints begins with a thorough history and physical examination. Biopsy is indicated when concern exists for malignancy or the diagnosis is uncertain. Treatment, if possible, should be evidence-based, although for many vulvar disorders including vulvar dermatoses, treatment is based on limited evidence and anecdotal experience. Although many vulvar dermatoses represent chronic conditions and thus cannot be simply cured, control is possible for the majority of women. Patient education regarding vulvar hygiene and skin care is the foundation for optimal management of inflammatory vulvar dermatoses. These conditions may be triggered or worsened by aggressive hygiene. Additionally, patients should be counseled regarding the need for individually tailored long-term maintenance to achieve optimal outcomes.

Vulvar Vestibulectomy for Neuroproliferative-Associated Provoked Vestibulodynia: A Retrospective Analysis

Objective: This study was conducted to determine if women with neuroproliferative-associated vestibulodynia who had vulvar vestibulectomy had less vulvar pain and sexual distress than women with neuroproliferative-associated vestibulodynia who chose not to have this surgery. Materials and Methods: This was a retrospective analysis study of a vulvar disorders clinic database. A database review was used to identify 227 women diagnosed with neuroproliferative-associated vestibulodynia for whom conservative treatment failed and who were advised to have vulvar vestibulectomy. Of the 227 women, 101 elected to undergo vestibulectomy and 126 declined the procedure. Ninety-eight of the 101 women who had surgery and 40 of the 126 who declined surgery answered an online questionnaire. Results: Compared to women who had vestibulectomy, women who declined this surgery were more likely to report significant persistent vulvar burning (29.58% versus 80%; p < 0.001), vulvar rawness (23.450% versus 67.5%; p < 0.0001), vulvar cutting (9.18% versus 30%; p < 0.002), and sexual distress, as measured by the Female Sexual Distress Scale (18.88 versus 25.925; p = 0.005). In addition, 97% of surgical pathology specimens met the histopathologic criteria for neuroproliferative-associated vestibulodynia. Conclusions: This study demonstrated the importance of the 2015 International Society for the Study of Vulvovaginal Disease/International Society for the Study of Women's Sexual Health/International Pelvic Pain Society vulvodynia nomenclature emphasizing that treatment should be chosen according to possible associated factors rather than using a “shotgun” approach. The correlation between the presumptive preoperative diagnoses and the confirmatory postoperative histology validates the vulvar-pain diagnostic algorithm previously published by King and colleagues. Finally, this study provides further evidence that vulvar vestibulectomy can be an appropriate first-line treatment for women with neuroproliferative-associated vestibulodynia. (J GYNECOL SURG 34:58)

Development and Psychometric Testing of an Electronic Patient-Reported Outcome Tool for Vulval Disorders (ePAQ-Vulva).

Development of an electronic patient-reported outcome measure (PROM) specifically designed for vulval disorders. Psychometric testing of the components of the questionnaire, which assess vulval symptoms, sexual function, and quality of life (QoL). Development and programming of the instrument (ePAQ-Vulva) was informed by national guidelines for the assessment of vulval disorders, an expert panel, and a survey of 61 vulval clinic patients. The PROM assesses frequency and impact of vulval symptoms, sexual function, and QoL. It also records conditions and behaviors related to vulval disorders and patient concerns/goals.Scale generation and psychometric testing were undertaken for the vulval symptoms, sexual function, and QoL components of the PROM with 91 participants; descriptive statistics, factor analysis and internal reliability of identified domains, and agreement between free-text and multiple-choice items to assess convergent validity and interrater reliability of picture items were assessed. Descriptive statistics showed high floor effects for seven questionnaire items. Factor analysis identified 5 principal components. These were reviewed and amended to provide a putative domain structure of 6 domains. Internal reliability of these domains was assessed using Cronbach α, producing values of 0.715 to 0.917. Interrater reliability of the picture items produced a κ statistic of 0.405. Spearman rank showed moderate correlation between multiple-choice answers and free-text concerns (r = 0.364-0.462) in 3 of the 6 domains (pain, sex, and dyspareunia). ePAQ-Vulva offers the first patient-reported outcome tool, specifically designed for vulval disorders. The instrument requires further validation and testing, including evaluation of the stability, responsiveness, and reliability.

Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage.

Women use various feminine hygiene products, often as part of their daily cleansing routine; however, there is a paucity of published medical literature related to the external vulva and how personal hygiene practices can affect it. This review article provides background information on the physiological changes that occur during women’s lives and reviews the relevance of transient and resident microbiota as they relate to common vaginal and vulvar disorders. It also discusses the need for female intimate hygiene, common practices of feminine hygiene from a global perspective, and the potential benefits of using suitable external, topical feminine vulvar washes to minimize the risk of vulvovaginal disorders and to improve overall intimate health in women around the world. Supported by international guidelines, daily gentle cleansing of the vulva is an important aspect of feminine hygiene and overall intimate health. Women should be encouraged to choose a carefully formulated and clinically tested external wash that provides targeted antimicrobial and other health benefits without negatively impacting on the natural vulvovaginal microbiota.

Who Should Manage Vulvar Disorders? A National Survey of Gynecology and Dermatology Residents [16H

INTRODUCTION: Vulvar disorders are unique, and it is unclear which specialty is responsible for screening the vulva. We sought to survey behaviors, knowledge and comfort of residents in obstetrics/gynecology (OB/Gyn) and dermatology regarding vulvar disease and evaluate differences among programs. METHODS: This was a cross-sectional, web-based, national survey of OB/Gyn and dermatology residents. Program coordinator email addresses were obtained from FREIDA Online®. Two separate emails requested coordinators forward the author-designed survey to current residents. RESULTS: Two hundred five surveys were completed: 67% OB/Gyn and 33% dermatology. The majority of both OB/Gyn (84%) and dermatology (77%) residents believed OB/Gyns are responsible for screening the vulva. Most OB/Gyn and dermatology residents reported thoroughly inspecting the vulvar area for lesions (62%), though 19% of dermatology residents reported never examining the vulva. Concerning comfort with managing vulvar lesions, only 2% of the total sample felt “very comfortable”. Regarding training, 53% overall reported this as “adequate”, whereas 4% believed they had “very good” training. One-fifth of OB/Gyn residents were “dissatisfied” with their vulvar disorders training. Most residents correctly identified images of vulvar melanoma (80%), squamous cell carcinoma (68%), and lichen sclerosus (98%). Ob/Gyn residents were more likely to correctly respond to items regarding vulvar melanomas (p=.032), biopsy performance (p &lt; .001), and lichen sclerosus diagnosis (p &lt; .001). CONCLUSION: Both cohorts believed OB/Gyns were the appropriate group to screen the vulva. Nevertheless, dermatologists should be able to and offer to perform this exam if not completed recently. A standardized curriculum regarding vulvar disorders could improve training in both specialties.

P133 Inter-speciality working to provide competencies in genital dermatology for GUM trainees: Abstract P133 Table 1

Background The Health and Social Care Act (2012) led to decommissioning of genital dermatology services in our sexual health clinic, creating a training deficiency in this aspect of the GUM curriculum. Objective To develop a service for patients with vulval pathology whilst also providing competencies in genital dermatology for GUM trainees. Methods Training concerns were discussed with the local Health Education England board. A dermatology consultant with considerable experience in vulval disorders agreed to supervise a weekly vulval clinic, held within the dermatology department, to which GUM trainees would be seconded. Women were seen by a GUM trainee under the supervision of the dermatology consultant. Details of patient outcomes were prospectively recorded. Results Over 10 months 84 women were seen in a total of 165 visits. The patients had a median age of 57 (range 19–94) years. 34 (40.5%) were follow-up dermatology patients. Of the 50 remaining patients, 10 (20%) were referred from other dermatology consultants, 3 (6%) from gynaecology, 8 (16%) from genitourinary medicine, and 29 (58%) from general practice. Diagnoses are tabulated below. Discussion Inter-speciality working has allowed GUM trainees to develop expertise in genital dermatology whilst the presence of a GUM doctor facilitates exploration of psychosexual issues in these patients. We recommend that other centres consider this model for training and service provision.

Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus.

IntroductionLichen sclerosus (LS) is a chronic inflammatory dermatosis, usually affecting the anogenital skin in women. This chronic inflammation can cause scarring of genitalia including narrowing of the introitus and phimosis of the clitoris. These architectural changes can lead to recurrent tearing during intercourse (vulvar granuloma fissuratum) and decreased clitoral sensation. Surgical correction of vulvar granuloma fissuratum (VGF) and clitoral phimosis can be performed, but there is little data on the patient satisfaction and complications following these surgical procedures.AimTo evaluate patient experience and outcomes in women undergoing surgical correction of scarring caused by anogenital LS.MethodsA retrospective chart review of patients at a vulvar disorders clinic was performed to identify women who had undergone surgical correction of clitoral phimosis or lysis of vulvar adhesions for VGF due to LS. Twenty‐eight women were contacted via telephone between 4 and 130 months postoperatively. An eight‐question survey was used to determine patient experience and outcomes.Main Outcome MeasuresAll participants completed an eight‐question survey to evaluate patient satisfaction with the surgery, effects on clitoral sensation, orgasm and pain with intercourse, postoperative symptoms or complications, and the presence of recurrent vulvar scarring.ResultsParticipants reported that they were either very satisfied (44%) or satisfied (40%) with the procedure. Of the women who experienced decreased clitoral sensation prior to surgery, 75% endorsed increased clitoral sensitivity postoperatively. Of the women who had dyspareunia prior to surgery, the majority of women reported having pain‐free sex (33%) or improved but not completely pain‐free sex (58%) after surgery. There were no complications or symptoms made worse by the surgical procedures.ConclusionsThis study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS. Flynn AN, King M, Rieff M, Krapf J, and Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med 2015;3:251–255.

History of Abuse in Women With Vulvar Pruritus, Vulvodynia, and Asymptomatic Controls.

Chronic vulvar pruritus and vulvodynia are common vulvar diseases. The aim of this study was to compare gynecologic and sexual and physical abuse histories from patients with these diagnoses and from healthy controls. Questionnaires were self-completed by patients diagnosed with vulvar itch-scratch (n = 93), patients diagnosed with vulvodynia (n = 232), and patients presenting for annual gynecologic examinations (n = 104) at the University of Michigan Hospitals, Ann Arbor, MI. Patients who came for annual examinations were less likely to report past gynecologic infections (p < .05) and indicated higher interest in and more frequent sexual activity than the other 2 groups (p = .003). Vulvodynia patients had the highest scores on the McGill Pain Questionnaire (p < .001). Subjects with either vulvar disorder were more likely to self-report a history of gynecologic infections than annual examination controls. Rates of sexual (p = .78) and physical abuse (p = .12) were similar for all 3 groups. Patients with vulvar pruritus and vulvodynia report similar rates of sexual and physical abuse.

Common vaginal and vulvar disorders.

Vaginal and vulvar disorders are among the leading causes for women to visit a health care professional. Therefore, it is important to have a basic understanding of these diseases. Although rarely life threatening, these disorders can impact significantly a woman's sexual function and sense of well-being.

Dyspareunia and its comorbidities among Taiwanese women: analysis of the 2004-2010 Nationwide Health Insurance Database.

Most of the existing studies on dyspareunia only focus on qualitative observations. These measurement tools may not reflect the actual situation of dyspareunia in Taiwan. This study aimed to estimate the incidence of dyspareunia in Taiwan and investigate dyspareunia-associated comorbidities using the National Health Insurance Research Database (NHIRD). This study is a population-based retrospective cohort investigation. We analyzed the 2004-2010 claims data on dyspareunia from the NHIRD. Dyspareunia was identified by outpatient visits using International Classification of Diseases, Ninth Revision, Clinical Modification (diagnosis code 6250). Patients who visited as outpatients with dyspareunia after the index date were considered to have comorbidities associated with dyspareunia medical conditions. The index events included vaginal disorders, vulvar disorders, uterine and ovarian factors, female genital organ and menstrual cycle disorders, menopause, and relative abdominopelvic organ disorders. The incidence of dyspareunia among different age groups was determined. The location and areas significantly related to the physical gynecology or relative pelvic organ causing the disease were also analyzed. A total of 978 females of different ages had experienced dyspareunia. The incidence of dyspareunia was higher among individuals aged 30-34 years. The findings of this study indicated that dyspareunia was comorbid with menopause, pelvic floor dysfunction, and most gynecological infections. In particular, the more common physical causes of dyspareunia were introitus and vaginal infections (19.95%), menopause (16.80%), female genital organ and menstrual cycle disorders (15.22%), and female pelvic organ infections (13.65%). This study posits that women of all ages (20-70 years) experience painful sexual intercourse. This large-scale nationwide claims-based study showed that menopause and pelvic infection disorder were dyspareunia-related comorbidities. Moreover, gynecological infections and pelvic floor dysfunctions were associated with dyspareunia.

Primary Classic Kaposi's Sarcoma Confined to the Vulva in an HIV-Negative Patient.

Dear Editor: Kaposi's sarcoma (KS) is a vascular neoplasm associated with human herpesvirus-8 (HHV-8) infection that is primarily categorized into 4 different types: endemic (African), iatrogenic (associated with immuno-suppressive therapy), AIDS-associated (rapidly progressive form in HIV-infected patients), and classic. The classic type is frequently observed in elderly male patients of Mediterranean origin and Ashkenazi Jews, presenting as an indolent disease with bluish-red (hematoma-like) cutaneous macules that tend to progress only slowly both horizontally and vertically and develop into firm angiomatous plaques and nodules. The most frequently affected sites are the lower limbs and feet; extracutaneous involvement is uncommon1. The lesions of KS are rarely localized exclusively in unusual mucocutaneous areas, thus leading to frequent diagnostic errors2. To our knowledge, there are no reports of KS confined to female external genitalia not associated with HIV infection. Here, we report the first case of classic KS restricted to the vulva in an HIV-negative patient. An 85-year-old Caucasian woman presented to our clinic for evaluation of asymptomatic vulvar lesions that appeared over the last year and progressed. Physical examination showed several brownish-violaceous angiomatous nodules and slightly raised plaques on both labia majora and minora (Fig. 1). No other significant mucocutaneous lesions were observed, and there was no evidence of inguinal lymphadenopathy. Furthermore, no other signs or symptoms suggestive of HIV infection or immunosuppression were present. The patient denied other health problems and drug use. Skin biopsy from a lesion on the right labia majora was performed for histological examination. The clinical diagnosis of KS was confirmed on the basis of revealing dermal proliferation of spindle cells, slit-like vascular spaces, and extravasated red blood cells (Fig. 2A). Immunohistochemical investigation also demonstrated positivity for D2-40, CD34, and CD31 (Fig. 2B). Moreover, polymerase chain reaction assay revealed HHV-8 DNA sequences in the lesional skin tissue; positive and negative controls were also tested and yielded the expected results. HHV-8 in the lesional tissue was also detected by in situ hybridization. Serological test for HIV was negative; chest x-ray as well as abdominal and pelvic computed tomography showed no visceral lesions. The patient refused all proposed treatments for the vulvar lesions, including intralesional therapy with bleomycin, cryotherapy, and laser photocoagulation. The 6-month follow-up did not show any disease progression. Fig. 1 (A) Several brownish-violaceous angiomatous nodules and slightly raised plaques on both the labia majora and minora, (B) magnified image of the lesions on the right labia majora. Fig. 2 (A) Dermal proliferation of spindle cells, slit-like vascular spaces, and extravasated red blood cells (H&E, ×200), (B) immunohistochemical positivity for vascular marker CD31 (×100). Overall, KS restricted to the external genitalia is a very rare finding that is more frequent in men, particularly on the penis; approximately 50 cases have been reported in the English-language literature3. Meanwhile, it is very uncommon in women, with only 9 reported cases, all of which involved the vulva2,4. Most cases of KS of the external genitalia are related to HIV infection. In fact, to our knowledge, only 15 well-documented cases of primary penile KS in HIV-negative patients have been reported5, while there are no instances of KS confined to female external genitalia not associated with HIV infection. All previous cases of vulvar KS were monolesional forms, clinically presenting as a non-specific mass, nodule, papilloma, or abscess; none were initially suspected to be KS2. The present case of classic KS restricted to the vulva is of particular interest because of its more typical clinical appearance than previous cases, with multiple lesions showing an angiomatous aspect as well as onset in an HIV-negative patient; the latter finding emphasizes the need to include KS in the differential diagnosis of vulvar disorders in immunocompetent women, especially elderly women.

Spanish consensus on vulvar disorders in postmenopausal women

IntroductionThe consequences of vulvar disorders in terms of health, sexuality, and quality of life are usually undervalued, with disparities in the conceptual, diagnosis and treatment criteria. AimThe objective of this guide will be to analyse the factors associated with the diagnosis and treatment of vulvar disorders and to provide recommendations for the most appropriate diagnostic and therapeutic measures. MethodologyA panel of experts from various Spanish scientific societies related to sexual health (Spanish Menopause Society [SMS] and the Asociación Española de Patología Cervical y Colposcopia [AEPCC]) met to reach a consensus on these issues and to decide the optimal timing and methods based on the best evidence available. ResultsWe recommend a biopsy of all vulvar lesions with an uncertain diagnosis, especially with asymmetry, irregular borders, variegated and irregular colour and diameter >6mm. For vulvodynia, we recommend the use of lubricants or topical treatments with lidocaine or bupivacaine, amitriptyline, baclofen or triamcinolone. For vulvar epithelial disorders, we recommend beginning with topical corticosteroids of moderate to high potency. For sexual dysfunction, a multidisciplinary approach is the best management strategy in these patients.

Management of persistent vaginitis.

With vaginitis remaining a common condition that leads women to seek care, it is not surprising that some women develop chronic vulvovaginal problems that are difficult to diagnose and treat. With a differential diagnosis that encompasses vulvar disorders and infectious and noninfectious causes of vaginitis, accurate diagnosis is the cornerstone of choosing effective therapy. Evaluation should include a symptom-specific history, careful vulvar and vaginal examination, and office-based tests (vaginal pH, amine test, saline and 10% potassium hydroxide microscopy). Ancillary tests, especially yeast culture with speciation, are frequently crucial to obtaining a correct diagnosis. A heavy but normal physiologic discharge can be determined by excluding other causes. With vulvovaginal candidiasis, differentiating between Candida albicans and non-albicans Candida infection has important treatment ramifications. Most patients with C albicans infections can be successfully treated with maintenance antifungal therapy, usually with fluconazole. Although many non-albicans Candida, particularly Candida glabrata, may at times be innocent bystanders, vaginal boric acid therapy is an effective first choice for many true non-albicans Candida infections. Recurrent bacterial vaginosis, a difficult therapeutic challenge, can often be controlled with maintenance therapy. Multiple options, especially high-dose tinidazole, have been used for metronidazole-resistant trichomoniasis. With the aging of the U.S. population, atrophic vaginitis and desquamative inflammatory vaginitis, both associated with hypoestrogenism, are encountered frequently in women with persistent vaginitis.

Vulvar inflammatory dermatoses: an update and review.

Currently, urogenital complaints are among the most common problems encountered by family practitioners, gynecologists, and dermatologists. In response to the intricacy of vulvar disorders, the International Society for the Study of Vulvovaginal Disease was created to facilitate the exchange between clinicians and pathologists involved in the care of these patients. Recent classifications for inflammatory disorders and intraepithelial neoplasm have been proposed. In addition, vulvar skin biopsies are the most common source of intradepartmental consultation during dermatopathology sign-out. The purpose of this article is to review the various inflammatory dermatoses of the vulva and to update readers with new advances regarding these entities.

Therapies and Nursing Care of Women with Vulvar Dermatologic Disorders

Vulvar dermatologic disorders are common among women, and prevalence increases with age. Treatment can provide women with symptomatic relief and can halt further progression of disease. Numerous therapies are available, and nurses who work with women across the life span should have an understanding of vulvar dermatologic disorders and therapeutic modalities. We provide an overview of general vulvar care, four vulvar dermatologic disorders, and common treatment modalities including topical and systemic pharmacologic management.

Vulvitis circumscripta plasmacellularis in pre-existing lichen sclerosus

Vulvitis circumscripta plasmacellularis (VCP) is a rare, benign vulvar disorder that presents with erythematous patches and erosions. Patients with VCP usually experience vulvodynia, pruritus, or dyspareunia, which may cause severe discomfort. A 72-year-old woman presented with 10 years of vulvar pruritus and whitish patches on the labia minora and majora. A biopsy was performed on the labia minora and lichen sclerosus was diagnosed. Her condition improved after treatment with a topical steroid. After 5 months, however, her symptoms reappeared with aggravated skin lesions. A rebiopsy was performed and VCP was diagnosed. There have only been two reported cases of concurrence of VCP with lichen sclerosus. We herein report an unusual case of VCP in pre-existing lichen sclerosus.

The development and evaluation of a questionnaire to assess the impact of vulval intraepithelial neoplasia: a questionnaire study

To develop and evaluate a questionnaire to assess the burden of vulval intraepithelial neoplasia (VIN) in women. A questionnaire development study. Vulval Disorders Clinic serving a regional population. Fifty-eight women with a histological diagnosis of VIN registered with the Vulval Disorders Clinic. A 37-item questionnaire was developed through a comprehensive literature review, consultation with specialist clinicians and pretesting to assess the burden experienced by women. The questionnaire was assessed for validity and reliability against existing questionnaires used in related disease areas. Spearman correlations were calculated between items in the VIN questionnaire with the scores of the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Sabbatsberg Sexual Self-Rating Scale (SSRS) and the Process Outcome Specific Measure (POSM) to assess the new questionnaire's validity. Internal consistency was measured using Cronbach's alpha. Test-retest reliability was calculated using quadratic weighted kappa. The VIN questionnaire had a high degree of internal consistency (Cronbach's alpha, 0.89). Test-retest reliability was assessed, with most questions showing a quadratic weighted kappa value of 0.5 or above. Most questions showed a stronger correlation with the corrected total VIN score than with HADS anxiety and depression subscales and the SSRS, indicating discriminant validity. Most questions correlated significantly with the DLQI and POSM scores, indicating convergent validity. Initial assessment of the VIN questionnaire demonstrated that it is a valid and reliable measure of the burden of disease for women. The questionnaire could be used to compare new and existing treatments for VIN or to assess or monitor the impact of care.

Zoon Vulvitis as a Differential Diagnosis in an HIV-Infected Patient

Vulvitis circumscripta plasmacellularis or Zoon vulvitis is a rare benign condition that affects the vulva chronically. We herein report a case of Zoon vulvitis in a 52-year-old HIV-infected patient with an uncommon ulcerovegetating lesion diagnosed by histopathologic findings. The patient was treated with clobetasol propionate ointment and oral corticosteroid. Zoon vulvitisis is a rare vulvar disorder that offers a challenging diagnose and therapy. The patient was appropriately treated and remains disease free.