Synechiae of the vulva occurs especially in girls in the so-called resting hormonal period with a minimal serum concentration of estrogens. If the external genitalia of the girl are not treated properly, the mucous membrane of the vaginal entrance is not regularly checked and mechanically removed, then the smegma of the opposite mucous membranes of the vulva can stick together. The place of the adhesion of epithelium in the vaginal introitus can be covered by a new epithelium and can create a firm adhesion, synechiae of the vulva, which is usually asymptomatic and is discovered incidentally during pediatric examination. Clinically significant vulvar synechiae can cause impaired bladder evacuation and recurrent lower urinary tract infections. Dissection of synechiae in the stage of conglutination or thin adhesion is performed manually on an outpatient basis, but extensive and firm adhesions must be divided surgically under general anesthesia. Local application of cream with estriol or betamethasone is also used for the therapy of synechiae of the vulva, but this treatment is more time-consuming compared to rapid manual separation and requires good compliance of the girls and their parents. The prevention of synechiae is based on the education of parents by pediatricians and gynecologists about the need for regular checks of the external genitalia and sufficient hygiene.
- Klíčová slova
- conglutination vulvae infantum, conservative therapy, conservative treatment, manual separation, synechiae of the vulva, vulvovaginitis,
- MeSH
- adheze tkání etiologie MeSH
- dítě MeSH
- estrogeny MeSH
- lidé MeSH
- nemoci vulvy * etiologie patologie terapie MeSH
- vagina MeSH
- vulva patologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- estrogeny MeSH
OBJECTIVE: A comprehensive overview of the surgical treatment of vulvar cancer, including recurrent forms. METHODOLOGY: A review work providing a basic overview of the pathogenesis, dia-gnosis and surgical treatment of vulvar cancer with a focus on the possibilities of treatment of its recurrences. It includes an illustrative case report presenting a patient with invasive squamous cell carcinoma of the vulva with iterative local recurrences and subsequent development of tumor triplicity and distant metastatic involvement. CONCLUSION: Surgical treatment remains the main modality of vulvar cancer therapy, even in the case of locally advanced or recurrent findings. In these cases, multidisciplinary cooperation of operational fields is necessary. The discipline of treated patients with participation in regular dispensary care plays an important role in the early detection of recurrences. (Chemo) radiotherapy remains a possible alternative to the surgical solution; in clinical practice, radiotherapy has an irreplaceable place in adjuvant therapy. Regional and distant recurrences are characterized by a poor prognosis.
- Klíčová slova
- Chemoradiotherapy, concurrent chemoradiotherapy, distant recurrence, groin (inguinal) recurrence, local recurrence, operative treatment, surgery, vulvar cancer,
- MeSH
- lidé MeSH
- lokální recidiva nádoru patologie MeSH
- nádory vulvy * chirurgie patologie MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- spinocelulární karcinom * chirurgie patologie MeSH
- staging nádorů MeSH
- vulva patologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
OBJECTIVE: Epidemiology and evaluation of the importance of surgical margins in the treatment of vulvar H-SIL - analysis of own data. MATERIAL AND METHODS: The prospective study included women dia-gnosed with HPV-associated vulvar epithelial neoplasia from 10/2016 to 1/2022. A total of 65 women were included. After surgical treatment, the women were distributed to groups according to surgical margins and were followed-up at regular intervals. RESULTS: Seventeen women (26%) dia-gnosed with HPV-associated vulvar intraepithelial neoplasia were under 49 years, whereas 48 women (74%) were older than 49 years. Recurrence rates of HPV-associated precancers were 12.3%, 1.5% and 3.1% in excisions with positive margins up to 1mm peripheral margins and 1-3mm peripheral margins, respectively. The risk of recurrence when the lesion reaches the margin is statistically significant, compared to a healthy margin of 1-3mm. CONCLUSION: Keeping the minimal healthy margin (1-3mm) seems to be an acceptable risk of recurrence of HPV-associated vulvar intraepithelial neoplasia with positive cosmetic effect and minimal risk of disturbing the psychosexual functions of women. Long-term regular follow-up is necessary.
- Klíčová slova
- Epidemiology, H-SIL, surgical margins, type 1 diabetes, vulvar intraepithelial neoplasia,
- MeSH
- infekce papilomavirem * MeSH
- karcinom in situ * chirurgie patologie MeSH
- lidé MeSH
- nádory vulvy * chirurgie patologie MeSH
- Papillomaviridae MeSH
- prospektivní studie MeSH
- resekční okraje MeSH
- vulva patologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Case presentation, differential dia-gnostic, possible therapeutic procedure and a brief literature report. CASE REPORT: An 84-year-old woman was repeatedly examined for chronic extended dermatologic lesion on lower abdomen, external genitals, perianal region, groin and adjacent inner thighs. CONCLUSION: Neither colposcopy with dermatovenerologic consultation, nor histopathological examination led to a precise conclusion. Only a special dermatopathologic expertise showed a dia-gnosis of inverse psoriasis with suggested therapy.
- Klíčová slova
- Psoriasis, psoriasis, vulval lesion,
- MeSH
- lidé MeSH
- psoriáza * diagnóza farmakoterapie patologie MeSH
- senioři nad 80 let MeSH
- vulva patologie MeSH
- vulvitida * MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Aesthetic surgery of the female genitalia is on the rise. Many procedures are performed. Body dysmorphic disorder (BDD) is a psychiatric disorder and often goes unrecognized in plastic surgery. This review examines actual knowledge of plastic surgery in gynecology, knowledge of motivational factors of women, and BDD. We carried out a systematic electronic search. We used a combination of relevant keywords to construct the search strategy. Included studies were systematic reviews or primary studies published 1990-2017 and containing information about BDD. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis. The research revealed a variety of plastic procedures available and why women consider undergoing labia reduction surgery.
- Klíčová slova
- Body dysmorphic disorder, female genital cosmetic surgery, labiaplasty, motivational factors, plastic surgery,
- MeSH
- lidé MeSH
- představa o vlastním těle psychologie MeSH
- rozhodování * MeSH
- spokojenost pacientů MeSH
- tělesné dysmorfické poruchy psychologie chirurgie MeSH
- vulva chirurgie MeSH
- zákroky plastické chirurgie psychologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Primary Extra-mammary Paget's disease (EMPD) is a very rare cutaneous adenocarcinoma affecting anogenital or axillary regions. It is characterized by a prolonged course with recurrences and eventually distant metastatic spread for which no specific therapy is known. METHODS: Eighteen EMPD (13 vulvar and five scrotal) and ten mammary Paget's disease (MPD) cases were comprehensively profiled for gene mutations, fusions and copy number alterations, and for therapy-relevant protein biomarkers). RESULTS: Mutations in TP53 and PIK3CA were the most frequent in both cohorts: 7/15 and 5/15 in EMPD; 1/6 and 4/7 in MPD HER2 gene amplification was detected in 4/18 EMPD (3 vulvar and 1 scrotal case) in contrast to MPD where it was detected in the majority (7/8) of cases. TOP2A gene amplification was seen in 2/12 EMPD and 1/6 MPD, respectively. Similarly, no difference in estrogen receptor expression was seen between the EMPD (4/15) and MPD (3/10). Androgen receptor was also expressed in the majority of both cohorts (12/16 EMPD) and (7/8 MPD).Here ARv7 splice variant was detected in 1/7 EMPD and 1/4 MPD cases, respectively. PD-L1 expression on immune cells was exclusively observed in three vulvar EMPD. In contrast to MPD, six EMPDs harbored a "high" tumor mutation burden (≥10 mutations/Mb). All tested cases from both cohorts were MSI stable. CONCLUSIONS: EMPD shares some targetable biomarkers with its mammary counterpart (steroid receptors, PIK3CA signaling pathways, TOP2A amplification). HER2 positivity is notably lower in EMPD while biomarkers to immune checkpoint inhibitors (high TMB and PD-L1) were observed in some EMPD. Given that no consistent molecular alteration characterizes EMPD, comprehensive theranostic profiling is required to identify individual patients with targetable molecular alterations.
- Klíčová slova
- extra-mammary Paget's disease, immune therapy, molecular profiling, targeted therapy,
- MeSH
- amplifikace genu MeSH
- cílená molekulární terapie MeSH
- dospělí MeSH
- extramamární Pagetova nemoc farmakoterapie genetika patologie MeSH
- individualizovaná medicína MeSH
- kůže patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrosatelitní nestabilita MeSH
- mutace MeSH
- nádorové biomarkery antagonisté a inhibitory genetika metabolismus MeSH
- nádory kůže farmakoterapie genetika patologie MeSH
- nádory prsu farmakoterapie genetika patologie MeSH
- Pagetova nemoc prsu farmakoterapie genetika patologie MeSH
- protokoly protinádorové kombinované chemoterapie farmakologie terapeutické užití MeSH
- prsy patologie MeSH
- retrospektivní studie MeSH
- sekvenční analýza DNA MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- skrotum patologie MeSH
- variabilita počtu kopií segmentů DNA MeSH
- vulva patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- nádorové biomarkery MeSH
BACKGROUND: Surgery is the optimal treatment for a severe form of clitoral phimosis (CP) that is initiated by lichen sclerosus (LS) and causes female sexual dysfunction. AIM: We aimed to determine the etiology of clitoral phimosis, its influence on sexual function, and outcomes after surgical treatment. METHODS: In this prospective cohort study, we observed the occurrence of clitoral phimosis and related changes in a group of 3,650 sexually active heterosexual women with a mean age of 34.8 ± 14.9 years (20-45 years) from September 2014 to September 2016. Ultimately, we compared the changes in sexual function and distress and satisfaction with postoperative genital appearance in 9 patients with severe clitoral phimosis at 12 months after surgical treatment. MAIN OUTCOME MEASURES: Sexual function was evaluated using the Female Sexual Distress Scale-Revised and the Female Sexual Function Index, and the patient's genital self-image was evaluated using the Female Genital Self-Image Scale; gynecologic examinations were performed on all patients. RESULTS: Various forms of CP were found in 46 of 3,650 patients (1.3%). Severe forms of CP were found in 9 cases, but it was complicated by stenosis of vaginal introitus in only 2 cases. These 9 patients underwent circumcision, and 2 of them underwent perineoplasty. Female sexual dysfunction occurred mainly in those with LS and severe forms of phimosis. Sexual function, as indicated by the total Female Sexual Function Index score, was significantly improved at 12 months after surgery (17.9 ± 0.9 vs 26.6 ± 0.5; P < .001). The Female Genital Self-Image Scale score assessing genital perception was significantly higher after surgery than before in women who underwent clitoral circumcision (20 ± 3.0 vs 12.3 ± 3.3; P < .001). The Female Sexual Distress Scale-Revised score was significantly lower after surgery than before (21.3 ± 6.2 vs 33.8 ± 6.9; P < .001). Sexual function in 2 women with CP and stenosis of vaginal introitus improved after surgery, but the sexual distress level did not decrease significantly. CLINICAL IMPLICATIONS: The results of this study will help clinicians to centralize treatment methods and advise patients on the management of clitoral phimosis. STRENGTHS & LIMITATIONS: This is a study evaluating postoperative results of sexual function, distress, and satisfaction with genitalia in women with severe CP, using validated questionnaires. However, the small number of patients and the absence of an appropriate control group are limitations. CONCLUSION: Surgical treatment of clitoral phimosis can improve sexual function, but because LS-a common underlying cause-is chronic in nature, patients may experience recurrence. Chmel R, M Nováčková, Fait T, et al. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2019;16:257-266.
- Klíčová slova
- Clitoral Circumcision, Clitoral Phimosis, Female Sexual Dysfunction, Lichen Sclerosus, Perineoplasty, Stenosis of the Vaginal Introitus,
- MeSH
- dospělí MeSH
- klitoris patofyziologie chirurgie MeSH
- kohortové studie MeSH
- lichen sclerosus vulvy patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- představa o vlastním těle MeSH
- prospektivní studie MeSH
- sexualita * MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie metody MeSH
- zdravotnické služby pro ženy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Vulvovaginal atrophy is a condition that affects women, although it is mainly associated with the onset of menopause mainly due to hormonal changes vulvovaginal laxity and mucosal atrophy can also affect women at different life stages such as after pregnancy or for cancer patients who have undergone chemo or endocrine therapy. This condition negatively influence quality of life, sexual desire, and self-confidence. Many therapies have been considered mainly with inconclusive or transient results in terms of benefit factor. Recently, a new non-invasive product, containing hyaluronic acid, oligopeptides, and antioxidants was introduced to the market. Its name is "Primavera," by Renaissance, Italy. The aim of this product is to allow a vulvo-vaginal biostimulation and considered simple, safe, and satisfactory.
- Klíčová slova
- hyaluronic acid, primavera, vulvovaginal atrophy,
- MeSH
- antioxidancia škodlivé účinky terapeutické užití MeSH
- atrofie MeSH
- lidé MeSH
- nemoci vulvy farmakoterapie patologie patofyziologie MeSH
- obnova funkce MeSH
- oligopeptidy škodlivé účinky terapeutické užití MeSH
- omlazení * MeSH
- vagina účinky léků patologie patofyziologie MeSH
- vaginální onemocnění farmakoterapie patologie patofyziologie MeSH
- vulva účinky léků patologie patofyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antioxidancia MeSH
- oligopeptidy MeSH
BACKGROUND: Labia minora hypertrophy is a congenital or acquired condition in which both labia minora (or more rarely only one) protrude beyond the edge of the labia majora. The authors present a surgical technique of volumetric reduction of hypertrophic labia minora, associated with lipofilling of the labia majora. METHODS: Between 2005 and 2014, 27 patients underwent surgical reduction of labia minora, as described by Altier and Rouzier. The indications for surgical treatment varied and were as follows: interference with sexual intercourse; poor hygiene; difficulty wearing tight-fitting pants; difficulty while performing sporting activities such as cycling; aesthetic complaints. The surgical resection was associated with fat graft injection in labia majora in order to protect and cover the labia minora. The mean follow up was 1 year. RESULTS: The labia majora, increased in volume and firmness, cover and protect the labia minora slightly hypertrophic or surgically reduced. All patients reported an improvement in comfort, aesthetic appearance, when wearing close-fitting clothes and an improvement in their sexuality. In one case we recorded a "recurrence", with an increase of dimensions in width of labia minora, still lower than the preoperative situation but greater than the immediate postop. CONCLUSIONS: The reduction of labia minora hypertrophy with conservative techniques allows achieving excellent results in terms of aesthetics and functionality. The simple lipofilling of labia majora allows preserving and protecting the labia minora through a volumetric increase of the labia majora.
- Klíčová slova
- Labia minora hypertrophy; labia minora lipofilling; labiahypertrophy treatment.,
- MeSH
- estetika MeSH
- hypertrofie MeSH
- lidé MeSH
- vulva * chirurgie MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The normal histology of anogenital mammary-like glands (AGMLG) has been studied previously, but some aspects, including glandular depth, presence of columnar epithelium resembling columnar cell change/hyperplasia as defined in mammary pathology, and distribution of elastic fibers, have not been previously investigated. To address these issues, we studied 148 AGMLG identified in 133 paraffin blocks sampled from 64 vulvar wide excision or vulvectomy specimens (64 patients, various indications for surgery). The depth of AGMLG ranged from 0.64 to 3.9 mm. Epithelial columnar cell change was noted in 33.1% of all AGMLG, whereas columnar cell hyperplasia was detected in 10.1%. Occasionally, combinations of cuboidal epithelium and columnar cell change were seen within 1 histological section. Of 22 specimens stained for elastic fibers, in only 6 (27.3%) cases were elastic fibers found around glands. Periductal elastic fibers were demonstrated around 3 of the only 5 ducts, which were available for analysis in slides stained for elastic fibers. The depth of AGMLG should be taken into account when planning topical and surgical therapies for lesions derived or evolving from AGMLG. Alterations identical to columnar cell change may represent a normal variation of AGMLG.
