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Joint Report on Terminology for Cosmetic Gynecology. Female Pelvic Med Reconstr Surg 2022; 28:351-366. [PMID: 35608063 DOI: 10.1097/spv.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. METHODS This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. RESULTS A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. CONCLUSIONS A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
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Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J 2022; 33:1367-1386. [PMID: 35604421 DOI: 10.1007/s00192-021-05010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. METHODS This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. RESULTS A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. CONCLUSIONS A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
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Cao Y, Li F, Li S, Zhou Y, Li Q. A preliminary observational study on the vascular, nerve, and lymphatic anatomy and histology of the labia minora from cadaveric and surgical samples. Int Urogynecol J 2021; 32:1169-1176. [PMID: 33078343 DOI: 10.1007/s00192-020-04551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To better understand details of the fine anatomy of the labia minora, present images of the vascular anatomy and characterize the nerve and lymphatic distribution of the labia minora. METHODS Two fixed and five fresh cadaveric specimens were perfused and dissected, and the vascular network was photographed. Labia minora samples, prepared from cadavers, and tissue resulting from labia reduction surgery underwent hematoxylin and eosin staining and S100 and D2-40 immunohistochemical staining. RESULTS Arteries emanated from the base to the edge of the labia minora, where there was a larger feeding artery, and the arteries were anastomosed. The veins formed anastomotic branches in the same direction as the edge of the labia minora. Arteries and veins that accessed the labia minora were successfully perfused at the same time with no obvious association. Sensory nerve endings were abundant, mostly larger with myelinated nerve trunks and Schwann cells in the central area with suggested neurovascular associations and smaller with no obvious aggregation at the edge. The medial area had 23.63 ± 11.82 nerves/view, the lateral area 21.30 ± 11.49 nerves/view (P > 0.05). The thickest nerve bundle was 3.16 ± 1.41 mm from the medial epidermis and 3.13 ± 1.47 mm from the lateral epidermis. Lymphatic vessels showed no obvious regional distribution. Labia minora were 21.77 ± 5.69 mm wide with 252.87 ± 63.01 lymphatic vessels at 3.67 ± 1.61/mm2 density. The shortest inner diameter of dilated lymphatic vessels was 161.09 ± 49.99 μm. CONCLUSION A larger feeding artery exists in the labia minora, which should be noticed in the pre-surgery design of labiaplasty. No difference was observed in the nerve distribution between the medial and lateral sides. Lymphedema might not be the cause of labial hypertrophy.
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Affiliation(s)
- Yujiao Cao
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Fengyong Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Senkai Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Yu Zhou
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China
| | - Qiang Li
- Gynecological Plastic Surgery Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi Jing Shan District, Beijing, 100144, People's Republic of China.
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Hedberg ML, Chibnall RJ, Compton LA. Symptomatic vulvar demodicosis: A case report and review of the literature. J Cutan Pathol 2020; 47:1063-1066. [PMID: 33448447 DOI: 10.1111/cup.13816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022]
Abstract
Demodex folliculorum is a mite that commonly inhabits the pilosebaceous units of facial skin, particularly in a perioral and periorbital distribution. While typically an incidental and asymptomatic parasite, Demodex spp. are proposed to contribute to the pathogenesis of facial folliculitis, chronic blepharitis and papulopustular rosacea. Reports of demodicosis in anatomic locations other than the face are exceedingly rare. Here we report a 36-year-old woman with symptomatic Demodex spp. infestation of Fordyce spots of the labia minora. She was referred to dermatology after a 9-month history of tender red bumps on the vulva that would arise and drain over a 24 to 72 hours period, several times per week. Physical examination revealed erythema of the labia minora and introitus with a 4 mm, pink, dome-shaped soft papule on the left labium minus. Wet mount, microbiologic cultures and sexually transmitted infection (STI) screenings were unremarkable. Histopathologic examination revealed a well-circumscribed nodule of suppurative granulomatous inflammation arising in a background of mucosa with Fordyce spots, the majority of which were infiltrated by Demodex spp. Treatment with oral ivermectin and topical metronidazole cream resulted in a symptom-free period of 22 months. This case represents an unusual presentation of symptomatic Demodex infestation.
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Affiliation(s)
- Matthew L Hedberg
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rebecca J Chibnall
- Department of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leigh A Compton
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.,Department of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA
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Gulia C, Zangari A, Briganti V, Bateni ZH, Porrello A, Piergentili R. Labia minora hypertrophy: causes, impact on women’s health, and treatment options. Int Urogynecol J 2017; 28:1453-1461. [DOI: 10.1007/s00192-016-3253-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/20/2016] [Indexed: 12/22/2022]
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Carlson JA. Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae. Clin Dermatol 2015; 32:599-615. [PMID: 25160101 DOI: 10.1016/j.clindermatol.2014.04.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Whether primary or secondary, lymphedema is caused by failure to drain protein-rich interstitial fluid. Typically affecting a whole limb, it has become apparent that lymphedema can also affect localized regions of the skin, or it can be clinically silent but histologically evident, denoted by dilated lymphangiectases (latent lymphedema). Chronic lymph stasis has numerous consequences, including lipogenesis, fibrosis, inflammation, lymphangiogenesis, and immunosuppression. For example, lymphedema's disruption of immune cell trafficking leads to localized immune suppression, predisposing the area affected to chronic inflammation, infection (cellulitis and verrucosis), and malignancy (angiosarcoma and nonmelanoma skin cancer). The pathogenesis of lymphedema is reviewed and exemplified by describing how a combination of lymph stasis-promoting factors such as trauma, obesity, infection, and inflammatory disorders produces localized elephantiasis; furthermore, the finding of lymphangiectases is found to be common in numerous dermatologic disorders and argued to play a role in their pathogenesis. Lastly, it is discussed how antigen burden, which is controlled by lymphatic clearance, affects the immune response, resulting in immune tolerance, immunopathology, or normal adaptive immunity.
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Affiliation(s)
- J Andrew Carlson
- Divisions of Dermatopathology and Dermatology, Department of Pathology, Albany Medical College, MC-81, Albany, NY 12208.
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Oranges CM, Sisti A, Sisti G. Labia minora reduction techniques: a comprehensive literature review. Aesthet Surg J 2015; 35:419-31. [PMID: 25908699 DOI: 10.1093/asj/sjv023] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Many studies of techniques to reduce the labia minora have been published in recent decades, including case reports and retrospective case series. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. OBJECTIVES The authors performed a comprehensive literature review to determine outcomes and complications of labiaplasty techniques, including patient satisfaction. METHODS A search on PubMed/Medline was performed with the keywords labiaplasty, labioplasty, labial hypertrophy, and techniques plus labia minora reduction. The inclusion criterion was clinical studies in which techniques of labia minora reduction were described. Excluded from the study were publications not dealing with surgical procedures and review articles. RESULTS Thirty-eight studies, published from 1971 through 2014, were included; this represented 1981 treated patients. Eight labiaplasty techniques were identified from these studies: edge resection, wedge resection, deepithelialization, W-plasty, laser labiaplasty, custom flask, fenestration, and composite reduction. Satisfactory results, judged from clinical examination, were observed with all 8 techniques. Few postoperative complications occurred. In a small number of cases, complications required surgical revision or secondary resection. CONCLUSIONS All 8 labiaplasty techniques resulted in good outcomes, including high patient satisfaction and low morbidity.
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Affiliation(s)
- Carlo Maria Oranges
- Dr Oranges is a Resident in the Plastic, Reconstructive and Aesthetic Surgery School, Marche Polytechnic University, Ancona, Italy. Dr A. Sisti is a Resident in the General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Siena, Italy. Dr G. Sisti is a Resident in the Department of Science for Woman and Child Health, University of Florence, Florence, Italy
| | - Andrea Sisti
- Dr Oranges is a Resident in the Plastic, Reconstructive and Aesthetic Surgery School, Marche Polytechnic University, Ancona, Italy. Dr A. Sisti is a Resident in the General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Siena, Italy. Dr G. Sisti is a Resident in the Department of Science for Woman and Child Health, University of Florence, Florence, Italy
| | - Giovanni Sisti
- Dr Oranges is a Resident in the Plastic, Reconstructive and Aesthetic Surgery School, Marche Polytechnic University, Ancona, Italy. Dr A. Sisti is a Resident in the General and Specialist Surgery Department, Plastic Surgery Division, University of Siena, Siena, Italy. Dr G. Sisti is a Resident in the Department of Science for Woman and Child Health, University of Florence, Florence, Italy
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Labioplasty specimens: when should pathological findings be considered as abnormal? J Low Genit Tract Dis 2015; 19:e49-50. [PMID: 25811279 DOI: 10.1097/lgt.0000000000000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reply to Scurry et al.: vulvar lymphangiectasis, an indicator of lymph stasis, is an authentic sign of abnormal histopathology in labiaplasty specimens. J Low Genit Tract Dis 2015; 19:e50. [PMID: 25811280 DOI: 10.1097/lgt.0000000000000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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