1/38. vulvodynia and vulvar vestibulitis: challenges in diagnosis and management.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.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/38. Childhood vulval pemphigoid: a clinical and immunopathological study of five patients.We describe five girls with vulval pemphigoid: two had bullous pemphigoid confined to the vulva and three had cicatricial pemphigoid. They demonstrate a spectrum of severity from localized disease to extensive vulval scarring necessitating long-term immunosuppressive therapy and surgical correction. The age at onset of their disease ranged between 6 and 13 years. All presented with vulval discomfort and erosions. Three had oral lesions, two perianal and one eye and cutaneous involvement. Two girls with only vulval lesions and one with vulval and oral lesions responded well to topical steroids. In two, systemic treatment with prednisolone and dapsone or azathioprine was required. The diagnosis was made on the basis of histology and immunofluorescence (IF). All had positive direct IF with IgG and C3. Indirect IF demonstrated circulating IgG binding to the basement membrane zone in four, with dermal or epidermal binding on salt-split skin substrate. immunoblotting revealed antibodies to the BP230 and BP180 antigens. Immunoelectron microscopy in the child with dermal binding IgG and BP180 and BP230 on immunoblotting showed labelling at the lamina densa-lamina lucida interface adjacent to hemidesmosomes.- - - - - - - - - - ranking = 18.847252781728keywords = discomfort (Clic here for more details about this article) |
3/38. Bockenheimer's syndrome.A case of a very extensive form of the rare Bockenheimer's syndrome (genuine diffuse phlebectasia) in a 45-year-old female patient is presented. The subject presented phlebectasias of the upper right leg, the vulva and the right side of the abdomen. The diagnostic and therapeutic possibilities for cases of patients with Bockenheimer's syndrome are described.- - - - - - - - - - ranking = 0.0038691238480963keywords = upper (Clic here for more details about this article) |
4/38. Vulvar epithelial inclusion cyst as a late complication of childhood female traditional genital surgery.Epithelial inclusion cysts may be a late complication of traditional female genital surgery. We present the case of a 19-year-old Eritrean woman who had been circumcised at birth and sought treatment for an enlarging vulvar mass that arose after the onset of puberty. Symptoms included pain, pruritus, and interference with walking.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
5/38. Postpartum angiographic embolization for vulvovaginal hematoma. A report of two cases.BACKGROUND: Puerperal hematomas can become a life-threatening obstetric emergency. Their incidence is 1 or 2/1,000 deliveries. When mainstay methods of suture and packing fail, arterial embolization becomes an excellent alternative to definitive treatment, laparotomy. CASES: A 32-year-old woman, para 2-0-2-2, developed extreme rectal and vulvar pain one hour postpartum. A 12 x 10-cm vulvovaginal hematoma was identified, drained, sutured and packed. Bleeding continued, blood products were administered, and selective angiographic embolization of the pudendal and inferior gluteal arteries was successfully performed. A 31-year-old woman, para 1-0-1-1, developed a left vaginal hematoma immediately postpartum. She failed vaginal packing and underwent angiographic arterial embolization successfully. The patient was discharged on the fourth postpartum day. At six weeks postpartum, neither patient had evidence of hematoma formation. CONCLUSION: In the setting of a puerperal hematoma refractory to conventional first-line therapy, arterial embolization provides a rational, effective alternative for achieving hemostasis with minimal morbidity.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
6/38. High-dose-rate brachytherapy for vaginal cancer: learning from treatment complications.Historically, early stage vaginal cancer has been treated with low-dose-rate (LDR) brachytherapy with or without external beam radiation therapy (EBRT). Complication rates have been low and treatment efficacious. Although high-dose-rate (HDR) brachytherapy has been used for cervical cancer in many countries for over a decade, only more recently has it been integrated into treatment plans for vaginal cancer. This paper describes three patients treated with HDR brachytherapy who experienced significant late effects. Given the very limited amount of literature regarding the use of HDR brachytherapy in vaginal cancer, this analysis potentially contributes to an understanding of treatment-related risk factors for complications among patients treated with this modality.A focused review of hospital and departmental treatment records was done on three patients treated with HDR brachytherapy. Abstracted information included clinical data, treatment parameters (technique, doses, volume, combinations with other treatments) and outcomes (local control, survival, early and late effects). A review of the available literature was also undertaken. All patients had significant complications. Although statistical correlations between treatment parameters and complications are impossible given the limited number of patients, this descriptive analysis suggests that vaginal length treated with HDR brachytherapy is a risk factor for early and late effects, that the distal vagina has a lower radiation tolerance than the upper vagina with HDR as in LDR, and that combining HDR with LDR as done in our experience carries a high risk of late toxicity. Integration of HDR brachytherapy techniques into treatment plans for early stage vaginal cancers must be done cautiously. The etiology of the significant side effects seen here is likely to be multifactorial. For users of HDR brachytherapy in vaginal cancer, there is a need to further refine and standardize treatment concepts and treatment delivery. Ideally this will be based on continued careful observation and reporting of both favorable and unfavorable outcomes and experiences.- - - - - - - - - - ranking = 0.0038691238480963keywords = upper (Clic here for more details about this article) |
7/38. vulvodynia--new and more effective approaches to therapy.Two cases are described of treatment-resistant vulvodynia that responded well to gabapentin. Gabapentin, an anti-epileptic drug, has been used in the treatment of neuropathic pain such as diabetic neuropathy and post-herpetic neuralgia. However, there has been little experience of its use in the relief of symptoms in vulvodynia and we add our observations to the one report of its use in these circumstances that has been published so far.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
8/38. burning mouth syndrome and vulvodynia coexisting in the same patient: a case report.The 'dynias' are a group of chronic focal pain syndromes with a predilection for the orocervical and urogenital regions. This is a case report of stomatodynia (burning mouth syndrome) and vulvodynia coexisting in a middle-aged woman. The dynias are an enigma in terms of aetiology, which is multifactorial, making clinical investigations difficult and often requiring liaison with other specialties.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
9/38. Postherpetic neuralgia after shingles: an under-recognized cause of chronic vulvar pain.BACKGROUND: Vulvar shingles, an uncommon presentation of a common disease, probably affects 1.5 million American women during their lifetime and leaves about 150,000 with postherpetic neuralgia, a chronic neuropathic pain syndrome. Prompt diagnosis and treatment can minimize pain severity and duration. CASES: The case of an 88-year-old woman with sacral shingles is described. Complications led to her demise. A 35-year-old with a 6-year history of disabling vulvar pain and many diagnostic procedures was ultimately diagnosed with postherpetic neuralgia. CONCLUSION: Shingles needs to be included in the differential diagnosis of vulvar rashes because it is a modifiable risk factor for chronic vulvar pain. The possibility of postherpetic neuralgia must be considered in women with unexplained vulvar dysesthesia.- - - - - - - - - - ranking = 2.6666666666667keywords = pain (Clic here for more details about this article) |
10/38. Vulvar myiasis.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.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
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