Vulvar Care Research Articles

Prevalence and indicators of cure of Italian women with vulvar squamous cell carcinoma: A population-based study

ObjectiveFive-year net survival and conditional survival from vulvar squamous cell carcinoma (VSCC) patients in Italy have shown no progress during the past three decades. This study aims to estimate the complete prevalence and multiple indicators of cure. MethodsObserved prevalence was estimated using 31 Italian cancer registries covering 47 % of Italian women. A subset of 22 cancer registries was used to estimate model-based long-term survival and indicators of cure, i.e., complete prevalence, cure fraction (CF), time to cure (TTC), proportion of ‘already cured' patients, and cure prevalence. ResultsIn 2018, VSCC patients alive in Italy (complete prevalence) were 6620 or 22 per 100,000 women. The cure fraction (the proportion of newly diagnosed patients who will not die of VSCC) did not change between 2000 and 2010 both for all patients (32 %) and in each age group. The time to cure (5-year conditional net survival >95 %) was 11 years for patients aged ≥44 years, but excess mortality remained for >15 years in the other age groups. This led to a negligible (5 %) proportion of ‘already cured’ patients (living longer than time to cure). The proportion of patients alive <2 years (21 %) was the same as that of patients surviving ≥15 years. The cure prevalence (patients who will not die of VSCC) was 64 %. A considerable proportion of patients will not be cured even among those who survived ≥5 years. ConclusionThere is an urgent need to reshape the current vulvar care model in Italy.

HUBUNGAN TINGKAT PENGETAHUAN TENTANG VULVA HYGINE DENGAN KEBIASAAN PERAWATAN VULVA SAAT MENSTRUASI PADA WANITA USIA SUBUR (WUS) DI DESA WRINGINANOM

Menstruation is a physiological event that occurs in women as a sign of being fertile. Knowledge of vulvar hygiene and vaginal care habits is an important thing that needs to be considered during menstruation by women of childbearing age because they can experience vaginal irritation and itching. The purpose of this study was to analyze the relationship between the level of knowledge about vulvar hygiene and the habit of caring for the vulva during menstruation in Wringinanom Village, Probolinggo Regency. This research method was an analytic survey with a cross sectional design, involving 45 respondents, who celllected with purposive sampling technique. method of data collection with questionnaire techniques and data analysis using rank spearman. The results of this study indicate the level of knowledge of women of childbearing age about vulvar hygiene and vulvar care habits during menstruation, more than half in the sufficient category (60%), there is a significant relationship between the level of knowledge about vulva hygine and vulvar care habits during menstruation in women of childbearing age. women of childbearing age in Wringinanom village (P= 0.02). This study concludes the importance of the influence of knowledge about vulvar hygiene and improving the habits of women of childbearing age with vulvar care during menstruation.

"Check Your Vulva"-A Patient Education and Virtual Vulva Care Pilot Project.

The aim of the study is to identify whether vulvar self-examination learned from a web site could lead to a self-identification of vulvar lesions and the feasibility of virtual vulvar care with patient submitted photos. The study used a prospective cohort design in a tertiary academic hospital over a 1-year period. Eligible participants who self-identified a vulvar lesion/skin changes were invited to send vulvar photos through a secure patient portal and schedule a phone consult to discuss diagnosis/management. Clinical data, photo interpretability, and patient satisfaction measures were collected. Self-referral patients versus vulva clinic waitlist patients were analyzed separately. Few people were interested in submitting vulvar photos online. Twenty-eight participants directly contacted the study, 8 consented, and 6 sent in vulvar photos. Forty four of 476 on the waitlist consented but only 24 of 44 sent in photos (5% of waitlist patients). The median time for a virtual assessment was 7 days for study participants while it was 18 months for the in-person usual care pathway. Most patient submitted photos were assessable. However, 60% participants needed help from another person to take the photos. More than 90% of patients required an in-person visit for their vulvar condition/concerns. While most patients were happy with the virtual process, 58% rated their satisfaction with the ease of taking photos of the genital region as "fair" or "poor." Virtual care with photos/phone calls might be feasible, although most patients are unlikely to participate. Because of patient discomfort, unease with taking photos, and patient privacy concerns, vulvar care should continue to be in-person for most new consults.

51. Trends in Vulvar Hygiene Practices in Prepubertal Patients

<h3>Background</h3> Vulvovaginitis is a common condition among prepubertal female patients, with hygiene and behavioral education often recommended as first-line intervention. Depending on the provider, parents may receive inconsistent education regarding vulvar care recommendations. To date, there have been no studies assessing where parents are obtaining their knowledge regarding caring for their child's vulva, nor what the current trends are in hygiene practices. <h3>Methods</h3> This was a cross-sectional study that was deemed IRB exempt. Parents of female children aged 3-10 years old presenting to dermatology and gynecology clinics from 8/1/2020-9/30/2020 were surveyed. Data collected included information about bathing/shower habits, soaps and detergents, undergarments, current or previous vulvar conditions and treatments, and where information was obtained for care of their daughter's vulvar region. Free-text comments could also be entered. <h3>Results</h3> We collected 70 surveys. The mean patient age was 6.88 years. Most patients (44.9%) bathe in the shower, 20.3% take baths, and 34.8% take both showers and baths. Of the patients who take baths, 83.1% reported using plain water only. Cotton underwear was the most common undergarment worn during the day and at night. Body wash for sensitive skin was the most common cleansing product (24.2%). While the majority of patients (82.8%) had never used a topical anti-fungal, Monistat (miconazole cream) or Nystatin were the most common in those that had (7.8%). Of those that had used a topical anti-fungal agent, 81.8% reported that it was recommended by a medical provider. Baking soda baths (10.4%) and vinegar baths (3.0%) were both used for vulvovaginal irritation. These were recommended by a medical provider for 62.5% of those who utilized these treatments. The most common source of information regarding care of genital skin was pediatricians (53.0%) followed by gynecologists and family members, both 28.8%. Most parents (83.1%) felt they have received sufficient guidance from healthcare providers on caring for their daughters' genital area. However, comments received included "doctors don't typically advise on this topic" and "I was relieved to hear that this is a common problem with girls this age. Previously did not feel like received sufficient guidance." <h3>Conclusions</h3> There are a variety of vulvar hygiene practices reported by parents of prepubertal patients. Most parents feel they are receiving adequate guidance, though there remains room for improvement as only 53% reported receiving information from their pediatrician. As general pediatrics providers are often the first point of contact for vulvovaginal complaints, incorporating vulvovaginal care into anticipatory guidance is prudent.

Aetiology, diagnosis, and clinical management of vulvodynia.

Chronic vulvar pain or discomfort for which no obvious aetiology can be found, i.e. vulvodynia, can affect up to 16% of women, and it may be found in girls and women across all age groups and ethnicities. Most patients describe it as burning, stinging, irritation, or rawness. The symptoms may spread to the whole vulva (generalised vulvodynia) or only to part of it, such as the clitoris (clitorodynia) or the vestibule of the vagina (vestibulodynia). This condition is often underreported and underrecognised by health care providers. Vulvodynia is a significant burden to society, the health care system, the affected women, and their intimate partners. It has a negative impact on quality of life. Vulvodynia is a diagnosis of exclusion with unknown aetiology. The gynaecologist plays a key role in excluding other causes of vulvar pain, and collaborating with other health care providers to manage the patient’s pain. Although many therapeutic options are available, such as vulvar care measures, psychological approaches, local treatment, oral medications, surgical procedures, electrical nerve stimulation, and laser therapy, there is no single treatment effective for all patients. That is why individualised management is needed. An individualised, holistic, and often multidisciplinary approach is needed to effectively manage the patient’s pain and pain-related distress.

Clinical and epidemiological profile of patients attended in a vulvar clinic of the dermatology outpatient unit of a tertiary hospital during a 4-year period.

Vulvar complaints are among the most frequent causes for a woman to visit a healthcare provider. The diseases of this area of the body may be a challenge to diagnose. In this study, we assess epidemiologic and clinical data of patients in an outpatient vulvar clinic in the dermatology department of a tertiary hospital. We performed an observational retrospective study of patients who attended our consultation service for vulvar diseases at the Dermatology Division at Hospital das Clínicas da Faculdade de Medicina da USP during a 4-year period. Data were obtained by patient medical records and by phone. During the 4-year period under study, a total of 136 patients were treated in the outpatient service specialized in vulvar care. All patients were included in the study. The most frequent diagnoses were lichen sclerosus et atrophicus (64.7%), lichen planus (8.8%), and vitiligo (8%). We registered that 26.7% of the patients showed extravulvar involvement. Women with vulvar diseases need specific care, considering not only genital aspects but also all skin changes. In this context, the dermatologist is a very well trained professional to take good and complete care of these patients. However, ideally vulvar clinics should have a multidisciplinary team.

Comparison of Serum Vitamin D Levels in Relation to Bowel and Bladder Symptoms in Women with Vulvar Diseases.

Objectives: We sought to investigate associations between vitamin D levels and bowel and bladder disorders in women with vulvar diseases. Methods: This is a planned sub-analysis of a cross-sectional study comparing the prevalence of bowel and bladder symptoms in women with biopsy-proven vulvar lichen sclerosus (LS) to a control group of women with non-lichenoid vulvar diseases. All subjects were recruited from a tertiary referral vulvar care clinic in a university-based practice. Serum vitamin D levels were measured and subjects self-completed questionnaires during study recruitment. Pelvic floor disorders were determined from the following questionnaires: Rome III Functional Bowel Disorders Questionnaire, the Bristol stool scale, the Medical, Social and Epidemiologic Aspects of Aging Questionnaire, and the Overactive Bladder-8 Question Version. Results: 181 women with vulvar diseases were included: 88 with LS and 93 with non-LS vulvar diseases. The mean age was 52.5 ± 15.3 years, and 94.5% were Caucasian. Vitamin D levels (26.8 ± 13.1 vs 29.5 ± 19.0 ng/mL), prevalence of low vitamin D levels (51.1% vs 45.2%), and vitamin D supplementation (42.0% vs 47.8%) were similar in women with and without LS (p ≥ 0.27). These factors did not differ between women with and without overactive bladder (OAB) (vitamin D levels 30.1 ± 17.8 vs 26.3 ± 14.8 ng/mL), urinary incontinence (27.9 ± 15.2 vs 26.4 ± 11.0 ng/mL), constipation (26.7 ± 14.8 vs 28.5 ± 16.8 ng/mL), or irritable bowel syndrome (IBS) (30.8 ± 22.1 vs 27.6 ± 13.4 ng/mL). Conclusions: In this cohort of women with vulvar diseases, vitamin D levels and supplementation were not significantly different amongst women with vulvar lichen sclerosus or other non-lichenoid vulvar diseases. Furthermore, vitamin D levels are not serum biomarkers for OAB, urinary incontinence, constipation, or IBS.

HP-05-004 Vulvar opinions on washes survey (VOWS)

Vulvar care and hygiene is an often-neglected topic of discussion between the health care provider and their female patients. With increasing non-hormonal products on the market for the treatment of genitourinary syndrome of menopause, vulvar hygiene products, wipes, and cleansers are becoming more widely recommended and utilized by women of all ages. In order to better understand the misunderstanding the present vulvar care habits of women, this survey was completed. This is an in-office survey that was a random sampling of women who attended a community based gynecology office. A total of fifty women were asked to complete the survey while waiting for their regularly scheduled office appointment. Surveys were completed on paper, in person and participants were not compensated for their time. All answers were anonymous. Two hundred and twenty (220) women completed the survey and their mean age was 43.3 years (range 18-89). The current use for external genitals was: 72% used soap and 12% used specialty wash or cleanser. Most women received information concerning genital products and hygiene from their (38%) Mother, (26%) Self, (3%) Internet and 15% from their Gynecologist. Fifty six (56%) of women were aware that there were commercially available products that could help maintain the health of the vulvar skin and provide a soothing moisturizing qualities and comfort for the vulva. Only 32% of women would be willing to purchase these vulvar cleansers. The average price that a woman is willing to pay for a high quality vulvar cleanser was $14.30 US; Range: $3.00 - $50.00 USD. Sixty six percent of women were familiar with fragrances as a potential irritant for the vulva. In addition the majority of women were familiar with potential irritants as common ingredients within genital products including: parabens, glycerin, fragrances, colors, bacteriocides and spermicide.

Effect of Vestibulectomy for Intractable Vulvodynia

Study ObjectiveTo assess the effectiveness of vestibulectomy in treating vulvodynia for patients with inadequate response to vulvar care guidelines and medical management. DesignRetrospective case series (Canadian Task Force classification II-2). PatientsAll patients who underwent a vestibulectomy from 2004 to 2013 for vulvodynia. InterventionsAll patients in this study underwent a vestibulectomy. Measurements and Main ResultsIn this study we analyzed 31 patients' overall reported pain scores and Q-tip test scores before and after vestibulectomy. The efficacy of vestibulectomy on reduction of pain was then analyzed after surgical management. There was no significant difference in pain scores from initial visit compared with the last visit before vestibulectomy after vulvar care guidelines and medical management were initiated (p = .48–.94). However, mean subjective pain scores before and after vestibulectomy decreased by 67% (p < .001). Q-tip testing showed reductions of pain by 63% (p < .001) and 73% (p < .001) at the right and left Bartholin gland areas, respectively. There was approximately a 60% decrease of pain scored around the bilateral periurethral areas (p < .05). ConclusionsVestibulectomy is an effective treatment for vulvodynia. For those with intractable pain, vestibulectomy is an appropriate next step after unsuccessful medical treatment. The surgery leads to a significant decrease in patients' pain scores, nearly eliminating it in most cases.

Vulvovaginal Complaints

Teaching patients the proper vulvar care is the first, and arguably the most important, aspect of treating vulvovaginal complaints in the pediatric population. Other treatments, which will be discussed in this chapter, will be less effective with a high risk of recurring symptoms if the patient and her parents do not adopt good vulvar care habits. Vulvovaginitis usually can be managed with conservative measures, including proper hygiene and education on vulvar care guidelines. These include avoiding chemical irritants and excessive hygiene, wearing white cotton underwear, avoiding dryer sheets, wiping from front to back, and limiting tight-fitting clothing. Additionally, it is important to discuss bathing, including recommending showers or baths without soaps and bubble products. If both the child and the parents follow these simple rules, the vast majority of vulvovaginal complaints will dramatically improve. Consistently following the vulvar care guidelines will not only help relieve the symptoms of itching and irritation but will also aid in the healing and treatment of vulvovaginitis. If the girl is infected with a specific organism, the treatment should be directed at that organism, and the girl should be educated on proper vulvar care. Finally, any condition that requires topical steroid ointment or simple barrier creams will be treated more quickly and effectively when good vulvar hygiene is added to the treatment regimen.

Responses to the McGill Pain Questionnaire predict neuropathic pain medication use in women in with vulvar lichen sclerosus.

The goal of this study was to test the hypothesis that responses to the McGill Pain Questionnaire are predictive of adjunctive neuropathic pain medication use by women with lichen sclerosus (LS). This is a retrospective chart review of 430 women with vulvar LS treated at a tertiary referral vulvar care clinic. Demographics, responses to the McGill Pain Questionnaire, and use of neuropathic pain medications were collected. Bivariate and multivariable logistic regression analyses were performed to identify factors significantly associated with use of neuropathic pain medications. Of the 430 subjects, 119 (27.7%) used neuropathic pain medications for vulvar pain. Factors significantly associated with use of these medications include lower body mass index (odds ratio [OR] = 0.96, p = .02), non-White race (OR = 2.97, p = .05), and total McGill Pain Questionnaire score (OR = 1.05, p < .001). Vulvar pain is a common presenting symptom in women with LS. Responses to the McGill Pain Questionnaire may be helpful in the long-term management of women with LS as a screen to identify those patients who might benefit from adjunctive neuropathic pain medication use.

The Effect of Vestibulectomy for Intractable Vulvodynia

To assess the effectiveness of vestibulectomy for vulvodynia in patients with inadequate response to vulvar care guidelines and medical management.

2013 Vulvodynia Guideline Update

Vulvodynia is a complex disorder that can be difficult to treat. Most patients describe it as burning, stinging, irritation, or rawness. Vulvodynia is a costly disease both economically and on its negative impact on patient quality of life. Although many treatment options are available, no one treatment is effective for all patients, thus the need to individualize management. Measures such as gentle vulvar care, medication, biofeedback training, physical therapy, sexual counseling and surgery, as well as complementary and alternative therapies are available to treat the condition with varying success.

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.

Continuing Education from the Journal of Midwifery &amp; Women's Health

For more than 20 years, the Journal of Midwifery & Women's Health (JMWH) has been dedicated to offering continuing education that will update readers on the latest content in the field and expand their knowledge and skills. The Journal's Home Study Program was launched in 1989 with a 2-part series on AIDS. Later, the Home Study Program title changed to special continuing education issues, and publishing single articles with continuing education was initiated. The JMWH continuing education offerings have covered diverse topics as evidenced by just the theme issues from the past 5 years, which focused on intrapartum care, promoting and supporting breastfeeding, infectious disease, the effects of violence and trauma on women's health, antepartum care, normal birth, nutrition, and pharmacology. The Journal currently has 2 continuing education theme issues per year in May/June and November/December as well as occasional single-article continuing education opportunities in other issues. Until 2011, readers who wanted to obtain continuing education units (CEUs) from the Journal had to complete a paper test and mail or fax it and a form to the Journal offices before proof of completion could be obtained. The usual turnaround time to receive a CEU certificate is within 4 weeks, though expedited processing is available for a fee. One year ago, JMWH launched a continuing education Web site, http://www.jmwhce.org, to facilitate a faster, more convenient process. To purchase CEUs online, you must set up a user name and password then log in to purchase tokens for CEUs by credit card. Once you have purchased your tokens for a theme issue, you can take the associated test and complete the participant evaluation. After test and evaluation completion, you will be automatically e-mailed a certificate of completion. In addition, test takers can log in to the CEU site at any time to download a PDF of their earned certificates. The CEU Web site offers readers the advantage of having their certificates immediately available via the CEU site rather than having to wait to receive them by mail. Many certified nurse-midwives (CNMs) and certified midwives (CMs) are seeking new options to receive CEUs now that all CNMs/CMs are required to participate in the American Midwifery Certification Board's Certificate Maintenance Program (CMP). Each of the Journal's continuing education theme issues contains the 2.0 CEUs (20 contact hours) needed for the 5-year certification cycle. I hope you will consider obtaining your CEUs through JMWH if you are not doing so already. Currently the CEUs for both of the 2011 theme issues on pharmacology are available online as well as the CEUs for this issue, which is the first in a 2-part series on gynecology. When it came time to choose the theme for this year's continuing education issues, the 2010 reader survey provided a clear choice. I have been delighted with the scope and quality of manuscripts that were submitted for this gynecology series. This first issue begins with articles on vulvar dermatologic disorders1 and vulvodynia,2 which are challenging conditions for women and clinicians. These articles are accompanied by related Share with Women patient education handouts on vulvar care and vulvodynia, which I hope will be valuable resources for you and your patients. The remainder of the issue covers a wide variety of conditions encountered in gynecologic care. I hope you will find the articles in this issue valuable for your clinical practice, teaching, or research. I also hope this year's theme issues will remind us what comprehensive gynecology services midwives are providing. One of the biggest misconceptions about CNMs/CMs is that the care we provide is limited to pregnancy and birth. It is important for CNMs/CMs to continue to promote that we are clinicians who are with women for a lifetime and are an excellent choice for women seeking gynecologic care. Looking forward, the JMWH editors are now soliciting manuscripts for our 2013 continuing education issues, which will focus on health education and promotion. We invite submissions that address optimizing women's health and reproductive health outcomes and are open to a broad range of topics. Please contact me at [email protected] if you are interested in submitting a manuscript. Our goal is to develop high-quality continuing education offerings that meet the educational needs of the JMWH readers. If you have any comments about our continuing education articles or Web site or suggestions for topics for future continuing education theme issues, please let me know.

Recognition and Management of Vulvar Dermatologic Conditions: Lichen Sclerosus, Lichen Planus, and Lichen Simplex Chronicus

Lichen sclerosus, lichen planus, and lichen simplex chronicus are dermatologic conditions that can affect the vulva. Symptoms include vulvar itching, irritation, burning, and pain, which may be chronic or recurrent and can lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships. With symptoms similar to common vaginal infections, women often seek care from gynecological providers and may be treated for vaginal infections without relief. Recognition and treatment of these vulvar conditions is important for symptom relief, sexual function, prevention of progressive vulvar scarring, and to provide surveillance for associated vulvar cancer. This article reviews these conditions including signs and symptoms, the process of evaluation, treatment, and follow-up, with attention to education and guidelines for vulvar care and hygiene.

Role of Vulvar Care Guidelines in the Initial Management of Vulvar Complaints

This study aimed to determine the effectiveness of vulvar care guidelines as the initial treatment of vulvar complaints. A chart review was conducted at the Saint Louis University Vulvar and Vaginal Disease Center. Women with vulvar symptoms in the absence of specific identifiable causes were evaluated and given guidelines for vulvar care. An 11-point Likert scale was used to rate symptoms at the initial and follow-up visits. Compliance level was determined. A decrease in mean scores was shown for dyspareunia (7.5 ± 2.0 to 4.6 ± 3.1, p < .001), burning after intercourse (6.8 ± 2.7 to 3.4 ± 2.4, p = .10), vulvar burning (5.7 ± 2.6 to 2.1 ± 1.9, p < .001), vulvar itching (4.9 ± 2.8 to 2.5 ± 2.6, p < .001), and vulvar pain (5.8 ± 2.8 to 2.2 ± 3.0, p < .01). The mean dyspareunia difference scores were significant between the low- and high-compliance groups. Vulvar care guidelines are successful for the management of vulvar complaints.

Clinical Care of Vulvar Pruritus, with Emphasis on One Common Cause, Lichen Simplex Chronicus

Vulvar pruritus is a common and distressing condition for patients, and its presentation is often delayed and complicated by home remedies. The true prevalence cannot be accurately estimated. Vulvar pruritus is a symptom, and an underlying cause must be sought and not assumed. This is best accomplished by obtaining a careful history of vulvar care regimens and treatments, performing a detailed physical examination, and considering a broad differential diagnosis. This article provides a practical and clinical approach to the evaluation of vulvar pruritus and then focuses specifically on one common cause, lichen simplex chronicus.

ACOG Committee Opinion No. 345: Vulvodynia

Vulvodynia is a complex disorder that can be difficult to treat. It is described by most patients as burning, stinging, irritation, or rawness. Many treatment options have been used, including vulvar care measures, medication, biofeed training, physical therapy, dietary, modifications, sexual counseling, surgery. A cotton swab test is used to distinguish generalized disease from localized disease. No one treatment is effective for all patients. A number of measures can be taken to prevent irritation, and several medications can be used to treat the condition.

The Vulvodynia Guideline

To provide a review of the literature and make known expert opinion regarding the treatment of vulvodynia. Experts reviewed the existing literature to provide new definitions for vulvar pain and to describe treatments for this condition. Vulvodynia has been redefined by the International Society for the Study of Vulvovaginal Disease as vulvar discomfort in the absence of gross anatomic or neurologic findings. Classification is based further on whether the pain is generalized or localized and whether it is provoked, unprovoked, or both. Treatments described include general vulvar care, topical medications, oral medications, injectables, biofeedback and physical therapy, dietary changes with supplementations, acupuncture, hypnotherapy, and surgery. No one treatment is clearly the best for an individual patient. Vulvodynia has many possible treatments, but very few controlled trials have been performed to verify efficacy of these treatments. Provided are guidelines based largely on expert opinion to assist the patient and practitioner in dealing with this condition.