Treatment of a Chronic Vulvar Wound by Hyperbaric Oxygen Therapy (HBOT)

We hereby report the case of a 66-year-old obese patient (BMI 30) with type 2 diabetes, who presented a chronic vulvar lesion on the left labia majora following surgical drainage of an abscess. After multiple unsuccessful treatments by antibiotics and local wound care, we proposed a trial of hyperbaric oxygen therapy (HBOT). The patient fully recovered after 54 sessions at 2.5 ATA, 95 minutes each. HBOT has been studied for perineal lesion such as skin atrophy or necrosis caused by irradiation but not for vulvar nonhealing chronic lesions in the case of impaired vascularization caused by diabetes. This case is, to our knowledge, one of the first publications about the healing boost of HBOT in chronic vulvar wounds due to vascular impairment.

Disorder of Sex Development, Mosaic Genetic Disorder 45x, 46xy: A Case Report

Background. Disorder of sex development (DSD) is a congenital disorder associated with interference in chromosomes, gonads, or sexes anatomically. Individual affected with DSD can be recognized since birth due to external genital ambiguity. Sexual chromosome DSD occurred because sexual chromosome numeric or structural disorder. Mosaic karyotype 45X/46XY is among the rare sexual chromosome DSD with incidence less than 1:15,000 live births. DSD individuals are susceptible to stigmatization. This can cause stress, negative emotion, and social isolation. Therefore, DSD individual management should be done as optimal as possible. Case Presentation: Twelve years old girl complaining a bump arose from anterior side of her genital resembles male genital since 4 years prior to admission without micturition and defecation complains. Patient has not experienced menarche. On external genital examination, we found the normal female external genital such as mons pubis, pubic hair, labia majora, labia minora, hymen, perineum, but without clitoris which in this case it is replaced by a glans of penis, arising from anterior commissure of labia majora area, with an urethral estuary. Before the management is done, patient underwent multidiscipline consultations and further examinations. Subsequently, it was approved that the joint conference formation consisting obstetric and gynecology, urologist, and pediatric endocrinologist to determine the optimal management for the patient. Conclusion: In this case, diagnosis was made with history taking, clinical examination, and supporting investigation such as ultrasound imaging and could be followed by biochemistry test, voiding cystourethrography or genitogram to determine next management. Counseling should be done in detail towards the family to know what action is best for the patient. Multidiscipline team was required to get the optimum result either in medical, ethical, or religious point of view. Surgery in this case was considered followed by long term therapy afterwards.

Treatment of itching of the vulva

Wiener, (according to the ref. Doctor. Gaz., 1924, No. 10) recommends injecting into the outer edges of the labia majora for the treatment of idiopathic itching of the vulva. 1% solution of novocaine in the amount of 4 to. From. from each side.

Defining Ideal External Female Genital Anatomy Via Crowdsourcing Analysis

Background Despite existing anthropometric data in the literature regarding the variation of female external genital anatomy, the ideal aesthetic characteristics have yet to be defined. Objectives Authors used crowdsourcing in order to better evaluate preferred anatomic characteristics of external female genitalia. Methods Fifty-six total images were digitally created by altering the proportions of the labia minora, labia majora, and clitoral hood. Images with differing ratios were presented in pairs to Amazon Mechanical Turk (Seattle, WA, USA) raters. Three different experiments were performed with each varying two of the three image characteristics to permit two factor modeling. The Bradley-Terry-Luce model was applied to the pairwise comparisons ratings to create a rank order for each image. Preferences for each anatomic variable were compared using chi-squared tests. Results A total of 5000 raters participated. Experiment 1 compared differing widths of the labia majora and labia minora and determined a significant preference for larger labia majora width and mid-range labia minora width (p=0.007). Experiment 2 compared labia minora width versus clitoral hood length and showed a statistically significant preference for wider majoras (p<.001), but no significant preference in clitoral hood length (p=0.54). Experiment 3 compared clitoral hood length versus labia minora width and showed a statistically significant preference for mid-range labia minora widths (p<.001) but no significant preference in clitoral hood length (p=0.78). Conclusions Raters preferred a labia majora to labia minora width ratio of 3:1 with minimal preference in clitoral hood length.

Gigantic vulvar masses: a case series of benign large vulvar tumors

Benign vulvar masses are uncommon condition of the lower genital tract. To date, there is no recognized classification for benign tumors. Most of the vulvar tumors show no symptoms, unless large enough to be noted on self-examination. Presented are 3 cases of large vulvar masses. The first case is a Bartholin’s gland cyst in 56 years old, G5P4 (4014) with a 5-year history of gradually enlarging mass characterized as fleshy, approximately 16x14x12 cm, soft, non-tender located in the medial portion of the left labia majora. Grossly, the specimen consists of a unilocular cyst filled with serous fluid and had a smooth glistening inner capsule wall. The second case is a cellular angiofibroma in 61 years old, G0, who developed a fleshy mass, approximately 13x18x15 cm, soft, non-tender, attached to the left labia majora via a pedicle, which developed for 10 years. The specimen is described as an irregular mass with well circumscribed nodules with soft to rubbery, flesh cut surface. The third case is lipoblastoma-like tumor of the vulva in 31 years old, G2P2 (2002), who had a fleshy hypopigmented mass, approximately 15x12x10 cm, pendulous, soft, smooth, non-tender in the right inferolateral labia majora, which grew for 8 years. The specimen is characterized as an irregular mass partially overlain by skin with cut sections showing cream fatty lobulated surfaces. Benign vulvar masses may present similarly to one another hence careful and detailed assessment should be done. Histologic evaluation is critical in establishing an accurate diagnosis due to the fact that multiple diagnoses may have similar gross characteristics. Management is based on type and size of mass and symptomatology of patient.

Infected Bartholin Cyst - Ultrasonography Doppler, Magnetic Resonance Evaluation

Bartholin gland cyst is the most common vulval cyst that arises from the dilated duct resulting from the obstruction of its opening. Most cysts are asymptomatic, but if not treated adequately and remain obstructed, they get infected and can result in Bartholin gland abscess. Abscess is usually present in the women of reproductive age. Patients commonly present with fever and painful progressive swelling of labia. Imaging modalities are used to diagnose the disease and it also aids to understand its extension in the complex pelvic floor region. The vulvar region is a host of various benign and malignant lesions. Vulva is a collective term for several anatomical structures: Mons pubis, labia majora and minora, vestibule, Bartholin gland and clitoris. Most common vulva cysts are the Bartholin gland cysts. In majority of the cases, these cysts are asymptomatic or are incidentally found on imaging studies. If these cysts are not properly treated, they can get infected and cause complication such as Bartholin gland abscess. 2 % of women during their lifetime develop Bartholin gland abscess or cysts.1 Pain is one of the most common indicators of infection in Bartholin cyst. Bartholin abscess starts with progressive swelling of labia majora later accompanied by fever and painful swelling of affected vulva side.2 Imaging modalities such an ultrasonography and magnetic resonance imaging aid in the diagnosis and extension of the lesion. We present a case of 55-year perimenopausal female of Bartholin gland abscesses diagnosed using imaging modalities such as ultrasound sonography (USG) and magnetic resonance imaging (MRI).

The Pedicled Deep Inferior Epigastric Perforator (DIEP) Flap for Vulva Reconstruction

Pain, scar contracture and soft tissue defects are common late sequel of acne inversa and Fournier’s gangrene. Aesthetical as well as functional reconstruction of the external vulva and labia majora can be very challenging. We present two cases where a pedicled Deep Inferior Epigastric Perforator (DIEP) flap for vulva reconstruction was implemented. In order to reconstruct both labia majora, we partially split the flap and raised a bilaterally pedicled DIEP flap. Many local flap techniques have been published on vulvar reconstruction. The aim of this paper is a discussion of the present literature and a review of current strategies for soft tissue restoration with the DIEP flap for vulva reconstruction. Wepresent and discuss two cases which were successfully reconstructed using the described surgical technique

Laparoscopic Repositioning of Gonads from the Labia Majora or Inguinal Canal into the Abdominal Cavity in Pediatric Complete Androgen Insensitivity Syndrome Patients with Inguinal Hernia

Androgen insensitivity syndrome (AIS) is a congenital condition characterized by a 46,XY karyotype but with a female phenotype caused by mutations in the androgen receptor gene located on the X chromosome. In patients with complete AIS (CAIS), preservation of the gonad is recommended until puberty, and gonadectomy can be regarded subsequently. The location of the gonads should be considered, because positions in the labia majora or inguinal canals can cause discomfort. Here, the laparoscopic reposition of gonads into the abdominal cavity in pediatric patients with CAIS is reported. From 2013 to 2019, laparoscopic inguinal hernia repair was performed in 2,061 pediatric patients with inguinal hernias aged <10 years and with female external genitalia. Among them, 11 had CAIS. Gonads located in the labia majora or inguinal canal were repositioned into the abdominal cavity. The mean age was 18.9 months (range 1–110 months). The gonads were located in the inguinal canal in 7 patients, in the labia majora in 3, and in the abdominal cavity in 1. Laparoscopic repositioning of such gonads into the abdominal cavity is feasible in pediatric patients with an inguinal hernia and CAIS.