Vulvar Disorders Research Articles

Listing and Comparing the Immunogenicity, Safety, and Effectiveness of 9vHPV Vaccinations for Different Age Groups: 9-15 Years Old, 16-26 Years Old, 27-45 Years Old

The effectiveness of the Human Papillomavirus (HPV) vaccination in preventing high-risk HPV infections and accompanying serious vaginal, cervical, and vulvar disorders was verified. The development of the 9-valent HPV(9vHPV) vaccine yields greater coverage versus the quadrivalent (qHPV) vaccine. This study aims to assess the 9vHPV from immunogenicity, safety, and effectiveness in three different age groups respectively: 9-15 years old, 16-26 years old, and 27-45 years old. This paper searched PubMed and Embase databases to include related clinical trials of these three age groups and ensure a large-scale study population. Immunogenicity analysis for different age groups reported that the geometric mean titers (GMTs) decreased with age but could still stimulate robust and effective immune responses. The antibody levels of the subjects significantly increased to reach protective levels and persisted for a long time after vaccination. Besides, the 9vHPV vaccine has a high protective effect against the infection of nine subtypes of HPV. Both HPV infection rates and rates of associated diseases significantly decreased versus those who did not receive the vaccine. Additionally, the outcomes also demonstrated that the safety of the 9vHPV vaccines was good across all age groups. The intensity of most reported injection-site adverse events (AEs) and vaccine-related systemic AEs were not serious. Serious adverse reactions are very rare. In total, immunogenicity, efficacy, and safety in different age groups of the 9vHPV vaccination are overall good. These findings provide scientific evidence for the immunization of the 9vHPV vaccine and recommend the optimal age for vaccination.

The impact of labiaplasty on sexuality.

Hypertrophy of the labia minora and majora, or a prominent clitoral hood, are the primary reasons why women, particularly those seeking cosmetic gynecologists, may experience limitations in their social environments. At the same time, modern trends have made labiaplasty popular in recent years. This study investigated the effect of labiaplasty on women's genital self-perception and sexual functions. The composite reduction labiaplasty technique was performed on 33 women aged 18-50 with Grades 2-4 labia minora hypertrophy. The exclusion criteria included menopausal and sexually inactive women, as well as women with vulvar disorders, a history of vaginal or labial surgery, other gynecological disorders, psychological disorders, and malignancies. The Female Sexual Function Index (FSFI) and Female Genital Self-Image Scale (FGSIS) questionnaires were administered to the study subjects before and three months after their surgery, during their follow-up appointments. The mean age of the subjects was 30.73 ± 3.94 years. Their mean parity was 1.12 ± 0.82. Almost 70% of them had a university degree. Their most common reason for desiring labiaplasty was aesthetic concerns (48.48%). Their total FGSIS scores were 11.85 ± 1.35 preoperatively and 24.48 ± 1.66 postoperatively, and their total FSFI scores were 13.29 ± 1.68 preoperatively and 24.48 ± 1.66 postoperatively. Labiaplasty surgery is a safe surgical procedure. It has a positive effect on women's genital self-image and sexual functions.

Vulval disorders in paediatric and adolescent patients and their management

Key content Vulval disorders are one of the commonest complaints in the paediatric and adolescent population. They present with acute‐on‐chronic symptoms such as pruritus, vaginal discharge and vulval soreness. History‐taking and examination of young patients requires a sensitive approach and age‐appropriate use of language. The hypoestrogenic, exposed and neutral pH of the vulva in the paediatric patient is more susceptible to nonspecific inflammation and injury. Adolescents are more likely to present with dermatoses, thrush and infection caused by common pathogens such as Escherichia coli, group A streptococcus and sexually transmitted infections. A conservative approach with reassurance and follow‐up is required in most vulval disorders. Learning objectives To appreciate the different gynaecological history and examination techniques required for paediatric and adolescent patients. To understand the common presentations and conditions of vulval pathology in these groups of patients. To gain confidence in managing common, non‐malignant vulval pathology in young patients. Ethical issues Reassurance of normal vulval anatomy should be provided for young patients requesting labial reduction surgery.

LASER treatment in gynaecology –A randomized controlled trial in women with symptomatic lichen sclerosus

ObjectiveAim of our study was to evaluate the therapeutic effect of laser treatment in vulvar lichen sclerosus, mainly the reduction of existing symptoms as itching, burning and pain. We asked about the different outcome by using different application doses. Study designWe conducted a prospective randomized double-blind dose-controlled trial in our dysplasia unit specializing vulvar disorders. 67patients with active LS were included. LS was confirmed by biopsy or by the validated CSS (clinical scoring system of vulvar LS). Computer generated randomization resulted in two groups, each group received a different application dose.(LDG- low dose group, NDG- normal dose group) During the study period of 18 weeks all participants received three laser applications in three subsequent sessions of three weeks. Two follow-ups six and twelve weeks after the first application was performed. At every visit, the participants filled in the VAS (visual analogue scale) for recording the actual vulvar symptoms as itching burning or pain on a range from 0 to 10. ResultsBefore treatment the mean VAS-Score was 4.3 (STD ± 2.4) in the NDG and 5.1(±2.6) in the LDG. After 18 weeks, the mean reduction was −2.4 (±2.3) for NDG and −2.7 (±2.8) for LDG. Four patients (two of each group) reported more pain after than before treatment. Both groups show significant lower VAS-Scores 18 weeks after the treatment than before therapy (p < 0.0001).The reduction of symptoms after 18 weeks between NDG and LDG was not significant (p = 0.6244). ConclusionLaser treatment with the microablative CO2 laser leads to a significant improvement for symptoms of LS.A higher dosage of laser radiation shows no benefit concerning the symptoms. We have not observed any serious adverse events during this study.

Plasma Cell Vulvitis: A Case Series and Follow-Up Study.

Plasma cell vulvitis (PCV) is a rare inflammatory vulvar condition. The aim of this study was to describe the natural history, treatment, impact on quality of life, and factors associated with poorer outcomes for PCV. A mixed-methods approach was used combining a retrospective case note review with a cross-sectional telephone questionnaire. All women diagnosed with PCV attending the vulvar disorders clinic at the Royal Women's Hospital between January 2011 and December 2020 were included. During the 10-year study period, 7,500 women were seen at the vulval disorders clinic, of whom 21 were diagnosed with PCV (0.28%). Of these women, 12 who were followed up for more than 12 months agreed to participate in the study. At a median of 5 years follow-up, there was variability in symptom severity, with more than half of the women still symptomatic with pain, precipitated by friction and dyspareunia, resulting in a moderate to large impact on quality of life. There were 5 women who were asymptomatic. Only 1 woman had a preexisting history of lichen planus and lichen sclerosus. Potent topical corticosteroids were identified as the preferred treatment. Women with PCV can remain symptomatic for many years with significant impacts on quality of life, which may consequently require long-term support and follow-up.

The perioperative effect of anesthetic drugs on the immune response in total intravenous anesthesia in patients undergoing minimally invasive gynecological surgery.

Background: The specific mechanism of action of each anesthetic drug on the immune system is still incompletely known. It is important to know how the various anesthetics used in minimally invasive surgery (MIS) act on the inflammatory response because the choice of the anesthetic agent can influence the patient’s immune system. Aim: Evaluation of the effect of anesthetic drugs used for total intravenous anesthesia (Propofol and Midazolam) on the inflammatory response after minimally invasive gynecological surgery. Patients, Materials and Methods: The inflammatory response in 20 female patients who underwent minimally invasive gynecological surgery under which intravenous anesthesia was performed. Depending on the combination of anesthetics used, we subdivided the study group into two groups, Group 1 consisting of the patients (n=10) who were given for total intravenous anesthesia, the combination with Midazolam+Fentanyl, and Group 2 (n=10) the patients who received the combination of Propofol+Fentanyl, respectively. Surgical interventional procedures included day surgery: diagnostic and operative hysteroscopy, endometrial ablation, surgical treatment of vulvar disorders. Serological profiling of patients was performed by dosing the serum concentration of nucleotide-binding domain (NOD) and leucine-rich repeat protein 3 (NLRP3) inflammasomes, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), IL-10 before and two hours after the surgical procedure. Results: In our study, we found that in both groups of patients (Midazolam+Fentanyl – Group 1, Propofol+Fentanyl – Group 2), NLRP3 and cytokines concentrations in the serum were higher after MIS than those before MIS. Conclusions: It appears that both Midazolam and Fentanyl and Propofol and Fentanyl have an immunomodulatory action due to the anti-inflammatory effect of both anesthetics. Therefore, anesthesiologists must choose an anesthetic method that uses individualized anesthetic agents, depending on the patient’s immune status and disease.

Experience at a Multidisciplinary Pediatric Vulvar Dermatology Clinic

Background: Vulvar dermatology is a field in which pediatricians, gynecologists, adolescent medicine specialists, and dermatologists may lack sufficient comfort and training. Delays in diagnosis can prolong patient discomfort and result in irreversible anogenital anatomic changes. Relatively few multidisciplinary vulvar dermatology clinics exist in the United States. We present our preliminary experience at a multidisciplinary pediatric gynecology and dermatology clinic for pediatric and adolescent vulvar disorders.

Histopathological spectrum of vulvar lesions on a remote Indian Island

A wide spectrum of normal, benign, premalignant, and malignant lesions may occur on the vulva. Symptoms of vulvar disorders may be non-specific. Empiric treatment of vulvovaginal symptoms is common but usually not helpful. Though the varied clinical presentation and diverse histopathological spectrum of vulvar lesions have amazed Pathologists, only a few studies have been reported in the literature. The present study consists of a histopathological spectrum of vulvar lesions. 1.To evaluate the histopathological spectrum of vulvar lesions. 2. To compare the incidences of non-neoplastic and neoplastic lesions of the vulva. Present study includes all types of vulvar lesion specimens received in the Department of pathology over a period of four years. All thirty-nine vulvar biopsies received in the Department of Pathology were studied for histomorphologic features. The lesions were categorized as non-neoplastic, neoplastic. The neoplastic ones were further divided into benign, malignant, and premalignant. The age of the women ranged from 15 to 69 years (mean 36.18±12.71) with the maximum number of patients between 30 to 40 years of age. Non neoplastic lesions were more common (22; 56.4%) than the (17; 43.6%) neoplastic lesions. There were 15(38.5%) benign lesions while 2 cases (5.13%) were malignant. Among the non-neoplastic lesions, Bartholin's duct cyst was the most common histopathologic diagnosis (35.9%). The fibroepithelial polyp was the most common benign neoplastic lesion constituting 15.3%. In the present study nonneoplastic lesions were more common than neoplastic lesions. Among the neoplastic lesions, benign neoplasms were more frequent than malignant lesions.

Fractionated Carbon Dioxide Laser for the Treatment of Vulvar Lichen Sclerosus: A Randomized Controlled Trial.

To estimate the efficacy of fractionated carbon dioxide (CO2) laser therapy for vulvar lichen sclerosus. We conducted a prospective, double-blind, randomized, sham-controlled, trial conducted in a clinic specializing in vulvar disorders. The study participants were 40 women with active vulvar lichen sclerosus confirmed with biopsy who were abstaining from topical and systemic treatments for at least 4 weeks before enrollment. Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five fractionated CO2 treatments in a 24-week period. Study participants, treating clinicians, and the evaluating pathologist were blinded. The primary endpoint was the change in the histopathology scale score between pretreatment and posttreatment biopsies. We estimated 20 per group for 80% power to detect a 40% reduction in the histopathology scale score with up to 10% attrition. A secondary endpoint was the change in the validated CSS (Clinical Scoring System for Vulvar Lichen Sclerosus). From November 2018 to June 2020, 40 women were randomized to participate in the trial, and 37 women (19 fractionated CO2, 18 sham) were included in an intention-to-treat (ITT) analysis. Three women were excluded from the ITT analysis because they did not have posttreatment biopsies and, therefore, a posttreatment histopathology scale score could not be obtained. There was a 0.20 reduction (improvement) in histopathology scale score from baseline in the active treatment group (95% CI -1.1, 0.80, P=.74) and a 0.1 increase from baseline in the sham treatment group (95% CI -0.90, 1.0, P=.91). The change in histopathology scale score between the active and sham arm was not statistically significant (95% CI -1.14, 1.06, P=.76). Fractionated CO2 is not an effective monotherapy treatment for vulvar lichen sclerosus. ClinicalTrials.gov, NCT03665584. Additional funding for this study was supplied by El.En Group, Florence, Italy, the manufacturer of the laser used in this study. In addition, El.En Group supplied the laser used in the study.

Effect of labiaplasty on women’s sexual and psychological life

Background/Aim: The number of labiaplasties has increased in recent years, in accordance with the growing importance given to the female body. The main factors for labial surgery include emotional and physical discomfort, aesthetic concerns, and sexual disorders. Methods: We designed this prospective cross-sectional study to evaluate women’s sexual function and quality of life before and 3 months after labiaplasty. A total of thirty-four women with labium minus hypertrophy (LMH) and asymmetry were included in the study. Women with malignancies, psychological disorders, other gynecologic disorders, menopausal status, vulvar disorders, a history of vaginal or labial surgery, and those who were sexually inactive were excluded. We evaluated the Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI) scores before and 3 months after labiaplasty. Results: The mean total FSFI score of the patients after the surgery (24.91 (2.74)) was higher than before the surgery (24.14 (3.06)) (P=0.001). Postoperative desire, arousal, lubrication, orgasm, satisfaction, and pain scores of the patients in FSFI were significantly higher (P=0.023, P=0.026, P= 0.015, P=0.05, P=0.022 and P=0,004, respectively), while mean BDI scores were significantly lower (8.79 (4.51) vs. 10.90 (4.90)), P=0.037). Conclusion: Labiaplasty is a comfortable, safe method with a short recovery period, satisfactory aesthetic results, and low complication rates. By using the radiofrequency with the trimming method, the sexual and quality of lives of the patients improve, along with their self-confidence and body image.

Diagnostic Criteria for Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation.

ObjectiveThe aim of the study was to describe the features required for diagnosis of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM).Materials and MethodsThe International Society of the Study of Vulvovaginal Diseases tasked the difficult pathologic diagnoses committee to develop consensus recommendations for clinicopathologic diagnosis of vulvar lichen planus, lichen sclerosus, and dVIN. The dVIN subgroup reviewed the literature and formulated diagnostic criteria that were reviewed by the committee and then approved by the International Society of the Study of Vulvovaginal Diseases membership.ResultsDifferentiated vulvar intraepithelial neoplasia is the immediate precursor of human papillomavirus (HPV)–independent vulvar squamous cell carcinoma and shows a spectrum of clinical and microscopic appearances, some overlapping with HPV-related neoplasia. The histopathologic definition of dVIN is basal atypia combined with negative or nonblock-positive p16 and basal overexpressed, aberrant negative, or wild-type p53. The most common pattern of dVIN is keratinizing with acanthosis, aberrant rete ridge pattern, and premature maturation. The morphologic spectrum of keratinizing dVIN includes hypertrophic, atrophic, acantholytic, and subtle forms. A few dVIN cases are nonkeratinizing, with basaloid cells replacing more than 60% of epithelium. Vulvar aberrant maturation is an umbrella term for lesions with aberrant maturation that arise out of lichenoid dermatitis and lack the basal atypia required for dVIN.ConclusionsEvaluation of women at risk for dVIN and VAM requires a collaborative approach by clinicians and pathologists experienced in vulvar disorders. Close surveillance of women with lichen sclerosus and use of these recommendations may assist in prevention of HPV-independent squamous cell carcinoma through detection and treatment of dVIN and VAM.

Vaginal energy-based devices: characterization of adverse events based on the last decade of MAUDE safety reports.

Energy-based devices have gained momentum as minimally invasive procedures to treat both medical and cosmetic pelvic floor disorders including genitourinary syndrome of menopause, vaginal laxity, stress urinary incontinence, dyspareunia, and vulvar disorders such as lichen diseases and vestibulitis. However, the FDA recently issued a statement cautioning patients and providers that the safety and efficacy of energy-based devices for the treatment of vaginal symptoms has not been well established. Additionally, the FDA sent letters to the manufactures of energy-based devices with notifications that they could be violating the marketing standards of the FDA. The existing data on side effects is insufficient and limited to observational studies. We sought to characterize the safety events of vaginal energy-based devices by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database and specifically look at those events that occurred prior to the July 30, 2018 warning. The MAUDE database was queried between September 30, 2013 and October 31, 2019 for all vaginal energy-based devices. The incidence of safety events was reported for these devices and the most common complaints were described and characterized. Event reporting was analyzed before and after July 30, 2018. Forty-two unique and relevant medical device reports (MDRs) were retrieved. The Mona Lisa Touch had the highest number of MDRs (40.5%) followed by ThermiVa (16.7%) and Viveve (14.2%). Each medical device report was associated with a single patient experience and within the 42 medical device reports, there were 85 complaints. A majority of the MDR complaints (52.9%) were also indications for energy-based devices procedures, which include vaginal pain, dyspareunia, lichen sclerosis, and urinary frequency. Two-thirds of the complaints (68.2%) were related to pain, but serious adverse events such as third-degree burns (3.5%) were rare. Most of the reportable events occurred before July 30, 2018 (83.3%), but most were reported after July 30, 2018 (78.6%). MAUDE-reported data suggests that the majority of patient complaints after vaginal energy-based device treatment include vaginal pain, bladder pain, and urinary symptoms. This study suggests that the majority of complaints are not severe, and some may be related to progression of the disease. The few severe adverse events reported in the MAUDE database may have contributed to the FDA warning regarding energy-based devices. Recall bias after the FDA warning, as well as the potential for litigation, may have prompted an increase in adverse event reporting after July 30, 2018.

Clinicopathologic Diagnosis of Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation.

The aim of the study was to describe the demographic, clinical, and histopathologic features of differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar aberrant maturation (VAM). Specimens from 2010 to 2020 reported as dVIN or VAM were reviewed. Clinical data included age, rurality, symptoms, and evidence of lichen sclerosus (LS). Histopathologic data included epithelial thickness, keratinization, architectural and dyskeratotic features, stroma, p16, and p53. Differentiated vulvar intraepithelial neoplasia and VAM were distinguished by assessment of basal nuclear chromatin, enlargement, pleomorphism, and mitoses. One hundred twenty women with a median age of 71 years had 179 examples of dVIN and VAM. Squamous cell carcinoma was concurrent in 66% and associated with rurality. Ten percent were asymptomatic, and all but 3 had evidence of LS. Differentiated vulvar intraepithelial neoplasia showed a range of thickness, architecture, and dyskeratosis; its unifying !feature was basal atypia. Differentiated vulvar intraepithelial neoplasia displayed hyperchromasia in 83% and easily observed mitoses in 70%. Nonkeratinizing morphology, subcategorized into basaloid and intermediate, occurred in 24% of women with dVIN. Traditional dVIN represented 62% of keratinizing cases; the remainder were atrophic (13%), hypertrophic (13%), acantholytic (8%), or subtle (5%). Vulvar aberrant maturation had abnormal stratum corneum, acanthosis, premature maturation, and enlarged vesicular nuclei. Null p53 helped distinguish dVIN from VAM and dermatoses. The morphology of dVIN encompasses nonkeratinizing and keratinizing types, the latter subdivided into traditional, acantholytic, atrophic, hypertrophic, and subtle. Diagnosis relies on basal atypia with supportive p16 and p53. Atypia exists on a biologic spectrum with mild abnormalities of VAM and reactive change. Identification of dVIN and VAM requires collaboration between clinicians and pathologists experienced in vulvar disorders.

The Vulvodynia Experience Questionnaire: Qualitative Development of a New Patient-Reported Outcome Measure for Vulvodynia

IntroductionVulvodynia is defined as vulvar pain of at least 3 months duration without a clear identifiable cause. There are currently no validated questionnaires that assess the experience of women with localized vulvodynia of the vestibule (vestibulodynia, previously known as vulvar vestibulitis) that meet the requirements of the Food and Drug Administration's Patient Reported Outcome (PRO) Guidance. AimTo develop a new content-valid PRO assessment in accordance with the Food and Drug Administration's PRO guidance to assess the symptoms and impacts of localized vulvodynia. Material and MethodsParticipants were recruited for concept elicitation interviews (ie, interviews with open-ended questions with the goal of eliciting volunteered data about the symptoms and impacts of vulvodynia). Participants were identified as having localized vulvodynia by clinicians who were experts in treating vulvar disorders. Eligibility was confirmed by the recruiting clinician, and informed consent was obtained; participants were then scheduled for in-person interviews. 25 participants were interviewed from United States (US). After concept elicitation interviews, the draft Vulvodynia Experience Questionnaire (VEQ) was developed based on the results. Cognitive interviews were conducted with 20 participants from US sites to assess the content validity of the VEQ (eg, interpretation and clarity of the items, relevance of concepts). The VEQ was further revised after cognitive interviews. All interviews were conducted face-to-face, audio-recorded, transcribed verbatim, anonymized, and analyzed using a qualitative data analysis software program. Results17 unique symptoms and 32 unique impacts were reported during concept elicitation interviews. Pain (n = 25, 100%) and burning (n = 24, 96%) were the most frequently reported symptoms of localized vulvodynia, and negative impact on emotional well-being (n = 25, 100%) was the most frequently reported impact. After analysis, item generation, and cognitive interviews, the resulting VEQ v2.0 contains 3 parts (part 1, pain; part 2, associated symptoms; part 3, impacts) with a total of 25 items that measure the most frequently reported symptoms and impacts of localized vulvodynia. Strength and LimitationsThe VEQ is a multidimensional assessment of the core symptoms and impacts of localized vulvodynia that, after additional psychometric testing including the ability to detect change, may be used in clinical trials to characterize the benefits of novel treatments. The VEQ requires additional testing to establish its cultural relevance and linguistic validity in other countries. ConclusionThe VEQ is a novel method of collecting information on localized vulvodynia symptoms and impacts that may be suitable for use in clinical trials after psychometric testing.Goldstein AT, Diez PMQ, Kapanadze S, et al. The Vulvodynia Experience Questionnaire: Qualitative Development of a New Patient-Reported Outcome Measure for Vulvodynia. J Sex Med 2020;17:2055–2066.

Сytokine markers for different variants of sclerotic lichen in women

Our work was aimed for studying the role of systemic of IL-23 and IL-20 levels in different clinical variants of sclerotic lichen in women. The study was based on results of clinical data (anamnesis, examination, palpation, vulvoscopy) and immunological studies (determination of IL-20 and IL-23 cytokines in peripheral blood) in the patients with sclerotic lichen (114 patients aged 42.5±15.1 years). Group I included patients with atrophic variant of sclerotic lichen (n = 58); group II, with sclerotic variant of sclerotic lichen (n = 34). Group III included women with a sclero-atrophic variant of this disorder (n = 22). The control group consisted of conditionally healthy women without present, or previously documented vulvar pathology (30 persons). Criteria for inclusion were as follows: women 20 to 60 years old, the presence of a benign vulvar disease, absence of treatment with immunotropic drugs over past year. Exclusion criteria: presence of viral infection (HPV, HSV), detection of STI, presence of acute inflammatory process (including vulvitis and vaginitis), cancer diagnosis, symptoms of autoimmune disorders, pregnancy, and the patient’s reluctance to participate in the study.Predominant increase of IL-23 was revealed in all clinical groups of the examined patients, the most pronounced increase (2.7 times) was in severe sclerotic lichen (p &lt; 0.0001). IL-23 concentration in the 2nd clinical group corresponded to the reference age-matched values. There was a significant increase in the blood content of IL-20 in subgroup 2.2 of the patients with sclerotic lichen (p &lt; 0.0001), as well as in patients from group 3 with a mixed clinical course of its disorder (p &lt; 0.0001). Meanwhile, the absence of pronounced vulvar tissue sclerosis in sclerotic variant of sclerotic lichen (subgroup 2.1) was accompanied only by a tendency for increased IL-20 concentration (p = 0.502), and only a trend for decrease in atrophic variant of sclerotic lichen (p = 0.288). In general, analysis of these data presumes a significant role of IL-20 and IL-23 in pathogenesis of sclerotic lichen in women. The cytokine assays in various clinical variants of this vulvar disorder may provide additional differential diagnostics (IL-20), and to assess severity of atrophic and sclerotic changes in vulvar tissues (IL-23) in women with sclerotic lichen.

Chronic Pelvic Pain: ACOG Practice Bulletin Summary, Number 218.

Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists (1-4).

Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218.

Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists ().

Perspective study on vaginal, vulvar disorders in Kerala population

Perspective study on vaginal, vulvar disorders in Kerala population

The Vulval Disease Quality of Life Index in women with vulval lichen sclerosus correlates with clinician and symptom scores.

The Vulval disease Quality of Life Index (VQLI) is a new tool that assesses the burden of vulval disease on quality of life (QoL). Our objective was to assess the correlation between VQLI score and clinician-rated severity scores, overall patient itch/discomfort, disease duration, sexual activity, and age, in vulval lichen sclerosus (VLS) at a vulval disorders clinic. A retrospective case note review, including consecutive women with VLS who attended the clinic between April and October 2018. Outcome measures include the VQLI score, clinician-rated severity score, and patient symptom score. A total of 109 women with VLS were included. On multivariable analysis, there was evidence of a positive relationship between VQLI scores and the total clinician-rated score (mean increase in VQLI score per unit increase in clinician score 1.34, 95% confidence interval [CI] 0.31, 2.38; P=0.01); the relationship was stronger for the cutaneous component. There was little evidence for relationships of the VQLI with the patient's age, sexual activity or time since onset of symptoms. There was strong evidence for a positive relationship between VQLI score and overall itch/discomfort score (mean increase 2.38, 95% CI 1.88, 2.88; P<0.001). New and follow-up data were obtained on sequential visits for 12 women, among whom the VQLI score dropped a mean -2.75 points between visits (95% CI -6.05, 0.55; P=0.094). The clinician-rated severity correlates with the impact of VLS on QoL. The VQLI captures information included in a patient itch/discomfort score, which can be easily incorporated into routine assessment.

Clinico-epidemiological Profile of Women with Non-venereal Vulval Diseases: A Hospital-based Observational Study

Intorduction: Vulval disorders can be of venereal and non-venereal etiology. Establishing non-venereal causation of vulval disorder helps in alleviating fears in patients with the condition. These patients are better dealt in a multidisciplinary clinic as patients with these disorders frequently visit dermatologists and gynecologists for the treatment.&#x0D; Objectives: To study the clinico-demographic profile of women with non-venereal vulval disorders and to determine their relative frequency.&#x0D; Materials and Methods: This is an observational, descriptive study done at the Departments of Dermatology and Venereology and Gynecology and Obstetrics, Nepal Medical College Teaching Hospital. All consenting female patients with problems pertaining to female external genitalia were recruited for the study after excluding venereal diseases. Details of the patients were obtained and entered in a predesigned proforma.&#x0D; Results: Seventy-five females were recruited during a period of 20 months with a mean age of 34.79±17.90 years. Majority were married, uneducated and homemakers. Duration of disease ranged from 3 days to 35 years. Itching was the commonest presenting complaint (82.67%) followed by redness (32.00%), burning sensation (26.67%), white lesions (24.00%) and pain (24.00%). Commonest diagnosis was lichen sclerosus (17.33%), followed by candidiasis (14.67%). Patients presenting with vulval symptoms without lesions were diagnosed with non-specific vulval pruritus (9.33%) and vulvodynia (2.67%).&#x0D; Conclusion: Itching is the most common presenting complaint and contrary to the popular belief, inflammatory disorders especially lichen sclerosus, rather than infections were common diagnoses in females with non-venereal vulval disorders.