Vulvodynia and vulvar vestibulitis: challenges in diagnosis and management. (1/120)

Vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. Vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential (dysesthetic) vulvodynia and vulvar dermatoses. Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery or laser therapy. Since vulvodynia is often a chronic condition, regular medical follow-up and referral to a support group are helpful for most patients.  (+info)

Epidemiology of vulvar vestibulitis syndrome: an exploratory case-control study. (2/120)

BACKGROUND: Vulvar vestibulitis syndrome (VVS) is a chronic, persistent syndrome characterised by vestibular pain, tenderness, and erythema. The aetiology of VVS is unknown and few of the hypothesised risk factors have been tested in controlled studies. METHODS: Using a matched case-control study design, medical, sexual, health behaviour, and diet history of 28 women with VVS were compared with 50 friend controls without VVS to identify possible causal factors. RESULTS: Cases were more likely than controls to report every vaginal and urinary symptom at the time of interview measured, particularly vaginal soreness or pain (60.7%) and pain during intercourse (64.3%). There were no significant differences between cases and controls with respect to sexual behaviour. Cases were more likely than controls to report self reported history of physician diagnosed bacterial vaginosis (OR = 22.2, 95% CI = 2.8, 177.2, p value = 0.0001), vaginal yeast infections (OR = 4.9, 95% CI = 1.4, 18.0, p value = 0.01), and human papillomavirus (OR = 7.1, 95% CI = 0.6, 81.2, p value = 0.08). There were no differences between cases and controls with respect to dietary intake of oxalate. Cases were more likely than controls to report poor health status (OR = 5.7, 95% CI = 1.1, 28.7, p value = 0.02) and history of depression for 2 weeks or more during the past year (OR = 4.4, 95% CI = 1.6, 12.3, p value = 0.002). CONCLUSION: Self reported history of bacterial vaginosis, yeast infections, and human papillomavirus were strongly associated with VVS. An infectious origin for VVS should be pursued in larger controlled studies, using questionnaire and laboratory measures.  (+info)

Acupuncture for vulvodynia. (3/120)

Vulvodynia is the sensation of burning and/or pain of the vulva in the absence of abnormal clinical findings. We offered acupuncture to twelve patients with this syndrome. All had experienced severe distress and impairment of sexual function and usual treatments had failed. The patients attended weekly for acupuncture and progress was monitored at each visit by enquiry, a questionnaire and a visual analogue scale for pain. Half had treatment for the first five weeks only, the other half for the second five weeks only. Side-effects were negligible. Two patients felt so much improved that they declared themselves 'cured'; three believed their symptoms had improved and wished to continue acupuncture; four felt slightly better and judged acupuncture more effective than any other treatment; and three noted no effect at all. Acupuncture is time-consuming and a large part of its beneficial effect in this study may have come from the regular specialist contact. However, in view of the patients' lack of response to other measures their satisfaction with the acupuncture was surprisingly high.  (+info)

Multiple, genital lobular capillary haemangioma (pyogenic granuloma) in a young woman: a diagnostic puzzle. (4/120)

A 21 year old woman presented with multiple lobulated lesions on the labia majora. The surface of most of the lesions was ulcerated revealing a glistening surface. All lesions were excised. The histopathology revealed features suggestive of lobular capillary haemangioma (pyogenic granuloma). Pyogenic granuloma is considered as a reactive hyperproliferative vascular response to trauma or other stimuli. A literature search revealed reports of a few cases of lobular capillary haemangioma of the glans penis but not on the female genitalia. This case is presented to help physicians become aware that lobular capillary haemangiomas (pyogenic granuloma) may occur at this site.  (+info)

Operative laparoscopy and vulvar hematoma: an unusual association. (5/120)

Few cases of intraoperative or postoperative complications associated with laparoscopic adnexal surgery have been reported in the literature. We describe a case of laparoscopic abdominal vascular injury and persistent bleeding in the matrix of the ovary following laparoscopic cystectomy. During the first postsurgical day, the patient was syncopal. The physical examination showed a vulvar hematoma and minimal bleeding from a laparoscopic incision in the abdominal wall. Vulvar hematoma and an unstable patient may signal serious vascular bleeding.  (+info)

p73 is over-expressed in vulval cancer principally as the Delta 2 isoform. (6/120)

p73 was studied in squamous cancers and precursor lesions of the vulva. Over-expression of p73 occurred commonly in both human papillomavirus (HPV)-positive and -negative squamous cell cancers (SCC) and high-grade premalignant lesions. Whereas expression in normal vulval epithelium was detected only in the basal and supra-basal layers, expression in neoplastic epithelium increased with grade of neoplasia, being maximal at both protein and RNA levels in SCC. p73 Delta 2 was the principal over-expressed isoform in the majority of cases of vulval SCC and often the sole form expressed in SCC. Over-expression of p73 was associated with expression of HPV-encoded E7 or with hypermethylation or mutation of p16(INK4a) in HPV-negative cases. There was a close correlation between expression of p73 and p14(ARF) in cancers with loss of p53 function. The frequent over-expression of p73 Delta 2 in neoplastic but not normal vulval epithelium, and its co-ordinate deregulation with other E2F-1 responsive genes suggests a role in the oncogenic process.  (+info)

Oxygen embolism after hydrogen peroxide irrigation of a vulvar abscess. (7/120)

We report a case of venous oxygen embolism in a 33-yr-old healthy woman after irrigation of a vulvar abscess with 25 ml of 3% hydrogen peroxide. Venous oxygen embolism was diagnosed by the development of sudden hypoxia associated with a decrease in end-tidal carbon dioxide concentration from 5.3 kPa to 3.2 kPa, and a 'mill-wheel' sound on cardiac auscultation soon after injection of the solution. The patient responded to corrective treatment including the Trendelenburg position and 100% oxygen. She made an uneventful recovery. We discuss the possible causative mechanism of this embolism, the different diagnostic methods, and the controversial aspects of available treatments. We emphasize that hydrogen peroxide is a dangerous and unsuitable agent for routine wound irrigation and debridement.  (+info)

Vulvar myiasis. (8/120)

BACKGROUND: To report a rare case of vulvar myiasis caused by Wohlfartia magnifica, including clinical and microscopic observations. CASE: A vulvar lesion was found in a 31-year old married female villager with the history of dropping fly larvae from vulva, vulvar pain and itching sensation. The larvae were identified as the species of Wohlfartia magnifica. The lesion was washed with batticon over a period of five days and the patient was discharged. CONCLUSION: Vulvar myiasis should be considered in the differential diagnosis of genital lesions. The diagnosis can be easily established based on microscopic features of the maggots, especially those relating to stigma structures.  (+info)

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