Úlcera vulvar de Lipschütz: diagnóstico diferencial de la úlcera vulvar en la paciente adolescente

Lipschütz ulcer, or acute ulceration of vulva, is an infrequently reported form of genital ulceration that appears in the labia minora of adolescent girls. Clinical features include one or more acutely painful ulcers with a purulent base and raised edges, accompanied by systemic symptoms. Although recent reports have related Lipschütz ulcers with Epstein-Barr virus primary infection, the etiology is unknown and the diagnosis is often made by exclusion of other causes of acute genital ulceration. Consequently, careful differential diagnosis is of the utmost importance.     

Úlcera genital aguda en adolescentes. Úlcera de Lipschütz

The development of genital ulcers, of apparently non-venereal origin, in adolescents and young girls is a rare entity known as acute genital ulcer or Lipschütz ulcer. Because of their low incidence, these ulcers are little known and can cause confusion when they occur. This confusion is increased by the lack of a clear cause and the occurrence of these ulcers in an age group that falls between the pediatric and young adult populations. We describe a case of Lipschütz ulcer treated in our hospital.     

Síndrome de Behçet como diagnóstico diferencial de las úlceras genitales

A nonspecific genital ulcer can be the first manifestation of several diseases. The best-known and most frequent cause of these ulcers is sexually transmitted diseases. Nevertheless, genital ulcers can also be a manifestation of a neoplasm or a systemic disease with genital involvement, such as Behçet syndrome, in which one of the diagnostic criteria is relapsing genital ulcers. We present the case of a patient diagnosed with Behçet's syndrome, an entity that should be included in the differential diagnosis of patients with recurrent genital ulcers.     

Úlcera vulvar aguda o de Lipschütz: comparación de 2 casos clínicos

We present the cases of two prepubertal girls with a clinical picture characterized by systemic and oropharyngeal symptoms a few days before the appearance of vulvar ulcers.     

Útero septo completo con duplicidad cervical y septo vaginal. Abordaje histeroscópico

Uterine malformations are estimated to occur in 3-4%, of which 35% correspond to septate uterus. Consequently, this anomaly is the most common uterine malformation, with a prevalence of 1-2% in the general population.Uterine septum is caused by incomplete absorption of the junction of the two Müllerian ducts, which can lead to a complete or a partial septum. Complete septum reaches the internal os, dividing the uterus completely in two cavities. Partial septum, or subseptate uterus, divides the uterus partially and does not reach the internal os. Complete septum is classified as class Va and incomplete septum as class Vb.Septate uterus with double cervix and vaginal septum is not included in Buttram and Gibbons’ classification or in that of the American Society of Fertility.We describe the hysteroscopic management of three cases with the same diagnosis. The technique described by Vercellini et al was used. We also provide a review of this rare uterine malformation, which has rarely been reported in the literature.     

Vulvar ulcers in young females: a manifestation of aphthosis

STUDY OBJECTIVE: To examine the etiology, clinical course, and outcomes of non-sexually transmitted vulvar ulcers in young females. DESIGN: A prospective cohort study of subjects referred to a tertiary center who had active vulvar ulcers and no evidence of sexually transmitted infections were evaluated with a structured clinical and laboratory protocol and followed with visits or telephone calls. RESULTS: Twenty eligible subjects had a mean age of 14 years (range 10-19), and five were premenarchal. Nineteen reported systemic symptoms such as fever, malaise, and headache. Most ulcers were >1cm in diameter (range 0.3-5 cm) and were located on the medial aspect of the labia minora. All viral, bacterial, and fungal cultures were negative. Serologic testing for Epstein-Barr virus (EBV) infection demonstrated 10 subjects with evidence of prior infection, two with acute infection, one indeterminate, and seven negative for infection. Two subjects had evidence of possible acute cytomegalovirus (CMV) infection. Other laboratory findings were nonspecific. The median duration of pain was 10 days (range 6-30), and 75% healed by 21 days. Follow up was available for 19 subjects (median 14 months). Seven experienced recurrent ulcers 2-16 months after the initial episode, and 10 had experienced oral aphthous ulcers. None met criteria for other etiologies of vulvar ulcers reported in the literature. CONCLUSIONS: No single infectious agent was identified as a cause of vulvar ulcers. Most cases were not temporally associated with either acute EBV or CMV infection. These ulcers are consistent with aphthous major or complex aphthosis that arise in response to acute illness.     

Clinical relationship and psychological experience of hospitalization in “high-risk” pregnancy

Objective

To explore, in a systemic view, the reciprocal perceived relationship between hospitalized “high-risk” pregnant women with uncertain fetal prognosis and the multidisciplinary prenatal care team, by the use of specifically developed questionnaires.

Study design

A pilot study in a high-risk pregnancy department. We enrolled 52 pregnant hospitalized women and 17 clinical operators and we interviewed them by the use of open-ended and close-ended question questionnaires.

Results

We described patients’ perception of doctors and staff communication, patients’ feelings and emotions relating to “high-risk” pregnancy and hospitalization, operators’ emotions, perceived facilitating factors, difficulties and resources. In a “high-risk” pregnancy condition, some difficulties in the relationship between hospitalized women and health operators occur. For inpatients the emotional difficulties were mostly connected to the pathologic situation and the contingent loneliness. Although the majority of women said that they understood staff communication and that they established a basic trust towards the entire clinical staff, there was a request for greater outspokenness. For clinical operators the relational and communication difficulties specifically concerned the overall management of the relationship with the patients studied. In particular, they perceived themselves to be called to a greater clearness and clinical reliability.

Conclusions

Overcoming the dyadic model of the doctor–patient relationship (in a systemic view) by incorporating clinical operators’ and inpatients’ points of view, seems a useful tool to highlight critical and facilitating factors about the relationship and communication in “high-risk” conditions.Condensation Overcoming the dyadic vision of the doctor–patient relationship, by crossing clinical operator's and inpatient's points of view, seems a useful tool to highlight critical and facilitating factors about the relationship and communication in “high-risk” pregnancy conditions.     

Vulvar Aphthous Ulcers in Perimenarchal Adolescents after COVID-19 Vaccination: A Multicenter Case Series

This case series from 3 academic hospital-based pediatric and adolescent gynecology services outlines the temporal association between vulvar ulcers in female adolescents and COVID-19 vaccination. We identified 8 cases and describe each patient's presentation, differential diagnosis, diagnostic workup, complications, treatment modalities, and overall course of illness. All cases seek to illustrate the clinical experiences of patients and providers interfacing with vulvar aphthous ulcers and contribute to the emerging literature exploring the novel association between vulvar aphthous ulcers and COVID-19 vaccination. To date, this is the largest described case series of this association in the literature.Key Words: COVID-19, Vaccine, Aphthous ulcers, Vulva, Adolescent     

Gigantomastia gravídica asociada a tejido mamario ectópico vulvar

We report the case of a primigravida who had previously undergone breast reduction and who developed gigantomastia associated with a vulvar adenoma, diagnosed as an ectopic mammary adenoma. Despite its low frequency, physicians should be familiar with this entity due to its major effects on the patient and health team, requiring decisions with important repercussions on the health – and sometimes life – of the woman and fetus.     

Vulvar ulcers: a differential diagnosis between Behçet’s disease and Lipschütz ulcus

Vulvar ulcers are often misdiagnosed and mistreated as herpetic ulcers. This article describes two other vulvar ulcerous diseases, Behçet’s disease and Lipschütz ulcus, to show the importance of a careful clinical examination and diagnostic testing.     

‘Off everyone's radar’: Australian women's experiences of medically necessary elective caesarean section

Introduction

despite an exponential rise in the number of medically initiated elective caesarean sections over the last two decades, women's experiences of this birth mode remain largely unknown. The aim of this study was to address this gap by describing women's experiences of medically necessary elective caesarean section.

Methods

a grounded theory approach was used to collect and analyse interview data collected from 28 Australian women who had an elective caesarean section for a medical reason, 14 of whom were also observed during their caesarean section. The analyses of the non-participant observations were used to contextualise the women's experiences.

Findings

prior to having their baby, women expected to play an active part in their caesarean section and to be supported to take up their ‘mother’ role as soon as their baby was delivered. Postnatally however, they reported having felt invisible, superfluous and disregarded during the event. There was evidence that hospital routines and processes contributed to women feeling displaced and unimportant in their baby's birth. Three sub-categories were formed from the analysis of the data that together are represented by the in-vivo label ‘off everyone's radar’. These were ‘just another case on an operating list’, ‘striving to be included while trying to behave’ and ‘unable to be my baby's mum’.

Discussion

our findings suggest that when women are ignored during childbirth, any fear they hold may escalate into peritraumatic disassociation, which in turn has implications for women's postnatal mental and emotional health in the short and long term. In addition, the separation of the mother–baby dyad was found to have a devastating impact on maternal–newborn attachment that lasted well into the postnatal period. To optimise women's childbirth satisfaction and foster their attachment to their baby, both of which are essential for ongoing emotional well-being, it is vital that they are located at the centre of their birth experience and that if at all possible they are not separated from their newborn.     

Vulvar Aphthous Ulcer in an Adolescent After Pfizer-BioNTech (BNT162b2) COVID-19 Vaccination

BackgroundVulvar aphthous ulcers are a rare type of genital lesion most common in non-sexually active adolescents. Vulvar aphthous ulcers are typically associated with viral infections. To date, there have been several cases reported in patients infected with COVID-19. Vulvar aphthous ulcers following vaccination have not been previously reported in the literature.CaseWe present the case of a 16-year-old adolescent who developed vulvar aphthous ulceration following Pfizer-BioNTech (BNT162b2) vaccination.Summary and ConclusionThrough an extensive literature search, we found no previous reports of vulvar aphthous ulcer following vaccination. Our case highlights a potential novel side effect of Pfizer-BioNTech COVID-19 vaccination and a new etiology for vulvar aphthous ulcers. This case suggests that vulvar aphthous ulcers might be associated with COVID-19 vaccination through a yet undetermined mechanism that requires further investigation.     

Vulvar Aphthous Ulcer in an Adolescent With COVID-19

BackgroundVulvar aphthous ulcers have been associated with various prodromal viral illnesses. We describe the case of an adolescent girl who developed vulvar aphthous ulcers during infection with Coronavirus, SARS-CoV-2.CaseA 19-year-old girl presented to the emergency department with cough, sore throat, fevers, and rash, and tested positive for COVID-19. She re-presented 2 days later with vulvar pain and was found to have a vulvar aphthous ulcer. She was admitted for pain control and treated with oral steroids. Improvement in her vulvar pain was noted, along with resolution of fevers, cough, and rash.Summary and ConclusionThis case illustrates the novel association of COVID-19 with vulvar aphthous ulcers in adolescents. Use of oral steroids for symptomatic management of COVID-19 led to rapid clinical improvement.     

Ecthyma Gangrenosum: Vulvar Ulcers,Pseudomonas, and Pancytopenia: A Case Report of an 18-Month-Old Female Toddler

Background

An 18-month-old female toddler presented with severe vulvar ulcers and pancytopenia with investigations revealing Pseudomonas aeruginosa bacteremia.

Vulvar reconstruction using the “lotus petal” fascio-cutaneous flap

Introduction

Vulvar reconstruction using the “lotus petal” fascio-cutaneous flap offers a relatively novel means to restore symmetry and functionality after extirpative gynecologic or oncologic procedures. We sought to assess the success rates and morbidity in a large series of consecutively treated patients.

Methods

We performed a retrospective review of 59 consecutive cases of lotus petal flaps performed at a single institution to more accurately assess success and complication rates.

Results

We identified 80 flaps performed among the 59 patients between September 1, 2008 and March 30, 2013. The median (range) age was 59 years (24–89) and the median (range) BMI was 27 kg/m² (19–34). The indications for vulvar/perineal excision were as follows: 39 (66.1%) vulvar carcinoma or melanoma, 12 (20.3%) vulvar dysplasia, 5 (8.5%) colorectal disease and 3 (5.1%) cases of hidradenitis suppurativa. The mean defect area, determined by post-fixation pathology specimen was 29 cm². Medical or surgical complications occurred in 36% of patients of which superficial wound separation was the most common (15%). There were no cases of complete flap loss, but partial loss occurred in 7 (8.8%) cases. 3 (5.1%) patients required re-operation prior to discharge with one case requiring skin grafting. Delayed surgical revision was required in 4 patients for partial flap loss (2) or stricture/stenosis (2).

Conclusion

The lotus petal flap is safe for use in gynecologic reconstruction, with acceptable short- and long-term complication rates. Previous reports of smaller series likely underestimate the risk of complications through case selection.     

Vulvar Aphthous Ulcer Following Pfizer-BioNTech COVID-19 Vaccine – A Case Report

BackgroundIn this case report, we describe a potential association between the Pfizer-BioNTech COVID-19 vaccine and development of a vulvar aphthous ulcer in a virginal 14-year-old girl.CaseA 14-year-old patient reported vulvar pain and visible lesion. Exam findings were consistent with vulvar aphthous ulcers. Two days prior to the onset of her symptoms she received her second Pfizer-BioNTech COVID-19 vaccine. The evening of vaccine administration, she experienced several hours duration of fatigue, muscle aching and insomnia but had otherwise been recently healthy and testing for common viral associations of vulvar ulcers was negative.Summary and ConclusionVaccination, in general, has been associated with mucosal side-effects and oral ulceration has been reported in subjects who received Pfizer-BioNTech COVID-19 vaccine. It is reasonable to hypothesize that vulvar ulceration may be caused by a similar mechanism and should be considered a rare side effect of this vaccine.     

Pronóstico reproductivo de las malformaciones müllerianas

A significant percentage of the patients with obstetric complications have a type of abnormality known as Müllerian malformations. Many studies have tried to establish the incidence of these abnormalities to determine their impact on human reproduction.     

Útero incarcerado recidivante

We describe the case of a woman in her first pregnancy with acute urinary retention associated with a retroverted gravid uterus. In her second pregnancy, the process of incarceration of a gravid uterus recurred. On both occasions, the patient was successfully treated by manual repositioning of the gravid uterus. In the tenth week of the patient's third pregnancy, a pessary was placed in the vagina, which prevented uterine incarceration. Several aspects of the frequency, etiology, treatment and possibility of recurrent incarcerated retroverted uterus are discussed.     

Trends in incidence and survival of women with invasive vulvar cancer in the United States and Canada: A population-based study

Aim

The aim of this study is to estimate trends in incidence and relative survival in women diagnosed with invasive squamous cell vulvar cancer in the United States (U.S.) and Canada over the periods of 1973–2010 for U.S. and 1992–2008 for Canada.

Methods

We identified patients with primary invasive squamous cell vulvar cancers in the Surveillance, Epidemiology, and End Results cancer registry database and the Canadian Cancer Registry dataset. Women younger than 40 years were excluded because of the small number of patients in this age group. A flexible parametric model was used to estimate two- and five-year relative survival ratios and excess mortality rate.

Results

In total 15,041 patients diagnosed with invasive squamous cell vulvar cancer were included in this analysis. The incidence rate of vulvar cancer increased in both U.S. and Canada. Two- and five-year relative survival ratios decreased over time for both countries, particularly for patients 80 years and over.

Conclusions

The incidence rate of invasive vulvar cancer continued to increase in U.S. and Canada while its two- and five-year relative survival ratios gradually decreased for all age groups over the last few decades. Also, excess mortality rate reaches to its peak after about 6 months from diagnosis and then starts to decline. This is the first report that examine relative survival ratio for vulvar cancer in Canada and U.S. and serves as a basis for future similar studies.     

The relationship between female genital cutting and women’s autonomy in Eritrea

Objective

To investigate the relationship between women’s autonomy and attitudes toward female genital cutting (FGC) and having a daughter with FGC in Eritrea.

Methods

Data from a nationally representative sample of 8754 women aged between 15 and 49 years from the 2002 Eritrea Demographic and Health Survey were analyzed. Multivariate logistic regression was used to determine significant predictors of the practice of and attitudes toward FGC, including women’s autonomy.

Results

Sixty-three percent (n = 3168) of women sampled had at least one daughter who had undergone FGC and 50.1% (n = 4848) of women believed FGC should continue. When controlling for sociodemographic characteristics, the odds of supporting the continuation of FGC were greater among women who justified wife beating (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.23–1.66). Among women who participated in household decisions, the odds of them supporting the continuation of FGC were less than among women who did not participate in household decisions (aOR 0.87; 95% CI, 0.75–0.99).

Conclusion

Interventions addressing women's autonomy, specifically attitudes toward gender norms and increasing women’s involvement in household decisions that carry a greater responsibility, may be a useful approach to reduce the support for and practice of FGC.