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A 26-year-old woman under immunosuppression with infliximab due to Crohn’s disease was referred to the gynaecology emergency room with dispersed and coalescing vesicular lesions on the vulvar region extending to the right lower limb involving S2–S3 dermatome, associated with severe pain. Clinical history, physical examination and serological testing was consistent with herpes zoster infection. The patient was treated with valaciclovir for 14 days and cefradine for 7 days (due to the possibility of secondary bacterial infection). Significant symptomatic improvement was noted after 1 week. The 1-year follow-up was unremarkable. According to our knowledge and review of the literature, this is one of the few cases reported of vulvar herpes zoster, especially related to infliximab.

Objective: A comprehensive overview of the surgical treatment of vulvar cancer, including recurrent forms. Methodology: A review work providing a basic overview of the pathogenesis, dia gnosis and surgical treatment of vulvar cancer with a focus on the possibilities of treatment of its recurrences. It includes an illustrative case report presenting a patient with invasive squamous cell carcinoma of the vulva with iterative local recurrences and subsequent development of tumor triplicity and distant metastatic involvement. Conclusion: Surgical treatment remains the main modality of vulvar cancer therapy, even in the case of locally advanced or recurrent findings. In these cases, multidisciplinary cooperation of operational fields is necessary. The discipline of treated patients with participation in regular dispensary care plays an important role in the early detection of recurrences. (Chemo)radiotherapy remains a possible alternative to the surgical solution; in clinical practice, radiotherapy has an irreplaceable place in adjuvant therapy. Regional and distant recurrences are characterized by a poor prognosis. Key words: vulvar cancer – surgery – local recurrence – groin (inguinal) recurrence – distant recurrence – chemoradiotherapy

Background Sentinel node biopsy in vulvar cancer is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery. Materials and methods In 24 female cadavers, injections of patent blue (at various localizations mediallyunilaterally and bilaterally) were used to visualize the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analyzed. Subsequently, a map of vulvar superficial lymphatics was created. Results The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localized in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer. Conclusions There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localization of the groin. The surgeon should take this variability into account.

Objective: Case presentation, differential diagnostic, possible therapeutic procedure and a brief literature report. Case report: An 84-year-old woman was repeatedly examined for chronic extended dermatologic lesion on lower abdomen, external genitals, perianal region, groin and adjacent inner thighs. Conclusion: Neither colposcopy with dermatovenerologic consultation, nor histopathological examination led to a precise conclusion. Only a special dermatopathologic expertise showed a diagnosis of inverse psoriasis with suggested therapy. Key words: psoriasis – vulval lesion

The female reproductive system consists of several structures. These organs are constantly undergoing changes throughout the lifetime of a woman. Most of these occur due to changes in estrogen and progesterone levels at key transitions in life such as puberty, pregnancy, and menopause. Laxity and atrophy occur during pregnancy and menopause, respectively, can cause significant symptomology for women. Although some women do have return to normal anatomy following pregnancy, many do not and develop pelvic organ prolapse that worsens over their lifetime. Symptoms are often underreported, but for those who do have symptoms, surgical intervention may be warranted.

Radiofrequency is an effective and safe method for both pelvic floor restoration and nonsurgical labiaplasty. Bipolar radiofrequency with temperature control is more effective than monopolar radiofrequency for volumetric heating of vulvovaginal tissue. Combination of electrical muscle stimulation and radiofrequency can provide combined nonsurgical restoration of the vulvovaginal tissues.

En el marco del proyecto de «Caracterización del macizo y sistema kárstico de Alkerdi, de la cueva de Alkerdi y de su entorno de protección», se continúa con el estudio científico de la cavidad de Alkerdi 2. Las labores de prospección espeleológica del desarrollo kárstico de la cavidad han permitido localizar una galería decorada inédita en 2020. En un primer estudio se ha identificado en su interior un conjunto de pinturas y de grabados compuestos principalmente por representaciones animales de bisontes, caballos y uros, a los que se unen un panel decorado con vulvas y dos conjuntos de trazos pareados en rojo. Within the framework of the characterization project of the karstic massif of Alkerdi and its system, the cave of Alkerdi and its protected environment, we have continued with the scientific study of the cave of Alkerdi 2. The speleological prospecting work of the karstic development of the cave has allowed locating an unknown decorated gallery in 2020. In a first study, a set of paintings and engravings has been detected inside, composed mainly of animal representations of bison, horses and aurochs, to which a panel decorated with vulvas and two sets of paired red traits are added

The genital skin may be affected by a variety of dermatoses, be it inflammatory, infectious, malignant, idiopathic, or others. The red scrotum syndrome is characterized by persistent erythema of the scrotum associated with a burning sensation, hyperalgesia, and itching. Its cause is unknown, but proposed mechanisms include rebound vasodilation after prolonged topical corticosteroid use and localized erythromelalgia. The condition is chronic, and treatment is often difficult. Here we review the etiology, the physical and histopathologic findings, and the management of this condition. We also describe related conditions such as red scalp syndrome, red ear syndrome, and red vulva syndrome. Finally, we summarize the different cases reported in the literature and discuss the features that help in the differentiation of red scrotum syndrome from its mimickers.

Multiple handheld three-dimensional (3D) systems are available on the market, but data regarding their use in detecting small volumes are limited. The aim of this study was to compare different portable 3D technologies in detecting small volumetric enhancement on a mannequin model and a series of patients. Five portable 3D systems (Artec Eva, Crisalix, Go!Scan, LifeViz Mini, and Vectra H1) were tested in a controlled environment with standardised volumes and in a clinical setting with patients undergoing small volume fat grafting to face, vulva, and hand. Accuracy was assessed with absolute and relative technical error measurement (TEM and rTEM); precision with intra- and inter-observer reliability (r

Rhytiphora fulva (Pascoe, 1875) Corrhenes fulva Pascoe, 1875: 70. TL: Rockhampton, Queensland (syntype in BMNH, examined here) Moved to Rhytiphora fulva: Ślipiński & Escalona, 2013: 204 Distribution: QLD Host plants: Solanum nemophilum ?; Xanthium occidentale (ANIC specimen data), Published as part of Ashman, Lauren G., Keyzer, Roger De & S ́ Lipińsk, Adam, 2023, The Australian genus Rhytiphora (Coleoptera: Cerambycidae: Lamiinae) with a revision of the Rhytiphora collaris group, pp. 1-62 in Zootaxa 5312 (1) on page 41, DOI: 10.11646/zootaxa.5312.1.1, http://zenodo.org/record/8129680, {"references":["Pascoe, F. P. (1875) Notes on Coleoptera, with descriptions of new genera and species, part III. Annals and Magazine of Natural History, Series 4, 15, 59 - 73. https: // doi. org / 10.1080 / 00222937508681025","S´lipin´ski, A. & Escalona, H. E. (2013) Australian Longhorn Beetles (Coleoptera: Cerambycidae). Vol. 1. Introduction and Subfamily Lamiinae. CSIRO Publishing, Melbourne, 503 pp. https: // doi. org / 10.1071 / 9781486300044"]}

Corethrella (Corethrella) fulva Lane, 1939 Fig. 31; Appendix 1 Diagnosis Larva Only bromeliculous species (one record of a ground-dwelling specimen) with the following combination of characters: exuvia pale (Fig. 31D); postmentum elongate, with margins tapering from base (Fig. 31E); prementum with 13 darkly pigmented teeth, mesial one largest, alternating laterally between larger and smaller teeth (Fig. 31E). Pupa Only New World species with cephalothorax darkly pigmented and pale abdomen (Fig. 31F); abdominal dorsal setae III–IV longer than respective segments, remaining weakly developed (Fig. 31H). Material examined BRAZIL – Santa Catarina State • 1 ♂, adult, with pupal exuvia; Bombinhas, Zimbros, Praia vermelha; 27°12ʹ06ʺ S, 48°34ʹ13ʺ W; 18 m a.s.l.; 15 Oct. 2011; Fabris and Ganzer leg.; bromeliad; CE-MHS • 1 ♂, adult; Rebio Arvoredo; 27°17ʹ30ʺ S, 48°22ʹ01ʺ W; 26 m a.s.l.; 17 Feb.–9 Apr. 2016; L.C. Pinho et al. leg.; Malaise trap; CE-MHS • 1 ♂, adult, with pupal exuvia; Santo Amaro da Imperatriz, Plaza Caldas, weir; 27°44ʹ01ʺ S, 48°48ʹ47ʺ W; 22 Jul. 2014; L.C. Pinho, A.P. Amaral, V. Gonçalves and P.L. Scarpa leg.; bromeliad; CE-MHS. – Bahia State • 1 ♂, adult, with pupal exuvia; Porto Seguro, RPPN Veracel, muçununga, pools; 16°21ʹ33ʺ S, 39°08ʹ15ʺ W; 72 m a.s.l.; 31 Aug. 2019; A.P. Amaral leg.; hand net; CE-MHS • 1 ♀, adult, with larval and pupal exuviae; Porto Seguro, RPPN Estação Veracel, Trilha 12-09; 16°19ʹ36ʺ S, 39°07ʹ26ʺ W; 74 m a.s.l.; 28 Aug. 2019; A.P. Amaral leg.; bromeliad; CE-MHS • 1 ♀, adult, with larval and pupal exuviae; Ilhéus, Cabruca da UESC; 14°47ʹ33ʺ S, 39°10ʹ23ʺ W; 38 m a.s.l.; 5 Sep. 2019; A.P. Amaral leg.; stream; CE-MHS • 1 ♀, adult, with larval and pupal exuviae; Ilhéus, Jóia do Atlântico; 14°38ʹ27ʺ S, 39°03ʹ55ʺ W; 6 m a.s.l.; 15 Apr. 2020; A.P. Amaral leg.; bromeliad; CE-MHS. Description Male and female adults (4 ♂♂, 3 ♀♀) HEAD. Sensilla (Fig. 31A): Ocular row with 2 thick offset setae at ventral part, more dorsally with 15–18 setae extending to mid-posterior portion of head. Subocular row poorly defined anteriorly, with about 4–6 setae on posterior portion. Interocular space and vertex with many slender setae. Postgenal row with 7–9 slender setae, ranging from posterior part of ocular row to ventromedially. With 2–3 thick ventromedial setae. THORAX. Sensilla (Fig. 31B):Antepronotum with 4–10 intermediate, slender ventral setae.Postpronotum with 1 thick dorsal seta; 1 thick and 0–3 slender setae more posteriorly.Scutum, prescutal area with about 3–7 thick/intermediate setae grouped anteriorly; 1 thick ventral and 2 thick dorsal setae more posteriorly. Antealar area with 6–7 thick/intermediate setae vertically arranged, next to prescutal suture; 7–9 thick/ intermediate ventral setae more posteriorly, forming a U-shape; 11–20 spread slender setae, with a group near dorsocentral row. Supraalar area with 2–3 thick and 1–2 intermediate setae logitudinally aligned, surrounded by about 7–15 slender setae. Dorsocentral row, posterior part with cluster of 15–21 thick setae, inserted in a shallow cuticular depression; 23–28 thick/intermediate and approximately 28–40 slender ones filling row. Scutellum with 13–14 thick setae. Posterior anepisternum bare. Anepimeron with 5–9 slender setae. WING. Male R 3 /R 1: 0.41 (0.38–0.46); R 2+3 /R 2: 0.80 (0.65–0.90). Female R 3 /R 1: 0.50 (0.49–0.51); R 2+3 / R 2: 0.58 (0.50–0.63). LEGS. Empodium (Fig. 31C) of intermediate length, slender, with 3 branches. Male Ta1/Ta2: 3.26 (3.13– 3.53); Ta3/Ta4: 0.70–0.70. Female Ta1/Ta2: 3.00 (2.94–3.06); Ta3/Ta4: 1.05 (1.00–1.09). Larva (n = 3) EXUVIA (Fig. 31D). Uniformly pale; without tergal plates. HEAD (Fig. 31E). Wide, roughly triangular in dorsoventral view, 1.20 (1.17–1.25) times as wide as long. Antenna 0.51 (0.50–0.52) times length of head; antennal groove 1.23 (1.14–1.31) times length of antenna. Ventral margin of antennal groove without well-developed denticles, with a few minute spinules. Postmentum elongate, gently tapering from base to midlength and more abruptly distally; 1.14 (1.09–1.19) times as wide as long; length 0.47 (0.46–0.49) of head. Prementum somewhat curved, with 13 triangular darkly pigmented teeth, central one largest, second small, third large, fourth smaller, fifth large and remaining gradually smaller. Anteroventral projection of gena strongly projected anteriorly, surface smooth. Postcoila extending to lateral margin of gena. Subgenal carina with multiple small spinules. Crown with 14–18 spines, regularly distributed, sizes growing towards lateral, ventral spines shortest; largest spine 0.10–0.12 mm long. Seta 16-C somewhat anterolateral to crown. Mandible with darkly pigmented teeth; apical tooth length 2.06 (2.00–2.17) times that of first dorsal tooth; seta 3-Mn 0.43 (0.39–0.49) times length of 4-Mn; lacinia mobilis with 7 blades; mandibular lobe well-developed, pale, contiguous to teeth. Sensilla: 9-C moderately elongate, fan-like; 10-C elongate, simple; 11-C elongate, bifurcated; 12-C elongate, simple; 13-C short, fan-like; 14-C moderately elongate, simple; 15-C moderately elongate, simple or forked; 16-C elongate, simple. 0a-Mn short, fan-like; 0b-Mn elongate, simple. 6-Mx short, simple; 4-Mx short, simple; 5-Mx short, fan-like. SIPHON. 0.23 mm (0.21–0.24) long. Seta 1 bifurcated, at about 0.30 of length from base; 6-S pale, 9-S darkly pigmented; length of 6-S/9-S: 0.58 (0.55–0.61). Pupa (n = 6) EXUVIA (Fig. 31F). Cephalothorax dorsally pale, dark brown ventrally; metathorax and segments I and II uniformly dark brown; segments III–VIII and terminal process light/medium brown, more darkly pigmented mesially; setae moderately pigmented, with cephalothorax dorsal 1 apparently paler. CEPHALOTHORAX. Length 1.38 mm (1.20–1.44). Respiratory organ (Fig. 31G) tubular, short, swollen at midlength, with narrow apical opening; trachea not spiraled; 0.11 mm (0.10–0.13) long. Dorsal seta 1 short, somewhat thick; about two lengths apart from dorsal 2; dorsal 2 slender, about three times as long; both setae arising from undifferentiated cuticle. Metathoracic 2 and supraalar 2 sensilla present. Metathoracic seta 1 elongate and simple. ABDOMEN (Fig. 31H). Elongate, somewhat ovate, gently tapering from IV–VII, surface of tergites smooth; length of segments I–VIII: 1.38 mm (1.17–1.51), width/length: 0.54 mm (0.51–0.58). Margins smooth, not expanded laterally. Setae D-2 elongate on III–IV, shorter on V–VII. Lateral setae slender and elongate on I, somewhat elongate and thick on V–VII. Largest seta D-2-III, 1.78 (1.56–1.94) times length of segment. Terminal process short, basal width 0.83 (0.65–0.91) of length, with paddles strongly tapering from base; D-1-IX elongate, located at about 0.60 from base; apical spine articulated; ventroapical seta V-1-IX about two times as long as apical spine; female genital lobe tapering at midlength; genital lobe elongate in male, extending almost to level of apical spine. Chaetotaxy as illustrated. Distribution and biology The examined specimens of Corethrella fulva were reared from immatures collected from tanks of both epyphitic and ground level Aechmea sp. and Vriesea sp. bromeliads, and from ground pools. Sampled localities were Atlantic forest areas in Bahia and Santa Catarina states, at altitudes ranging from 18 to 72m a.s.l. The specimens from Santa Catarina have previously been reported by Amaral et al. (2019). It has also been recorded from the Atlantic forest in the states of BA, RJ, SC, and SP, at altitudes ranging from 0 to 880 m a.s.l. (Borkent 2008; Amaral et al. 2019). This is the first record of this species occurring in ground pools. Borkent (2008: 251) discussed the habitat diversification of Corethrellidae, arguing that species are restricted to certain types of habitats, distinguished by him as ground-dwelling or phytotelmata. These records, along with the specimen of C. davisi found in a bromeliad, may indicate that at least some species may be more flexible that previously thought, or that more than one species may be represented under the same name. Further collections should help solve these questions. Remarks Lane (1953) described the pupal respiratory organ as apically expanded; however, in the specimens examined here and in the type specimens deposited in DEFS, it appears to be narrowed at its apex. This difference may be due to preservation, but we consider the morphology of the respiratory organ an important diagnostic feature of the species. Six individuals collected in Lençóis (Chapada Diamantina National Park), Bahia, keyed out to Corethrella fulva but were not included in this study as they may represent an undescribed species, with a uniformly medium brown pupa and one sensillum coeloconicum on each of the flagellomeres (I–II, X–XIII). Two individuals collected in Maraú, Bahia, not included here, also keyed out to this species but had two sensilla coeloconica on each of flagellomeres XII–XIII, as well as uniformly colored pupae. Currently it is not possible to confidently determine whether those individuals are members of C. fulva or a different species., Published as part of Amaral, André P., Mariano, Rodolfo & Pinho, Luiz Carlos, 2023, Description of five new species of frog-biting midges (Diptera, Corethrellidae) from Brazil and examination of new morphological characters with utility for taxonomic and phylogenetic studies, pp. 1-120 in European Journal of Taxonomy 874 (1) on pages 66-69, DOI: 10.5852/ejt.2023.874.2135, http://zenodo.org/record/8037742, {"references":["Amaral A. P., Mariano R. & Pinho L. C. 2019. Four new species and some new records of Brazilian frog-biting midges (Diptera: Corethrellidae). Zootaxa 4706 (1): 103 - 120. https: // doi. org / 10.11646 / zootaxa. 4706.1.4","Borkent A. 2008. The frog-biting midges of the world (Corethrellidae: Diptera). Zootaxa 1804 (1): 1 - 456. https: // doi. org / 10.11646 / zootaxa. 1804.1.1","Lane J. 1953. Neotropical Culicidae. Volume I. University of Sao Paulo, Sao Paulo."]}

Women with labial hypertrophy may opt for labiaplasty. The aim of the study was to analyze the complications, long-term follow-up of clinical outcomes and satisfaction in this population over the past 10 years.All women who underwent labiaplasty with or without clitoral hood reduction at our center between January 2008 and August 2020 were retrospectively identified. Retrospective study was conducted, recording follow-up outcomes, motivations, techniques, postoperative complications, reasons requiring reoperation, and surgical satisfaction concerned different clinical characteristics. A concrete analysis of each specific outcome and a detailed knowledge of these procedures were performed.A total of 52.41% reported functional impairment, 20.25% cited aesthetics complains, and 27.34% were motivated by both the previously mentioned reasons. Women undergoing surgical correction sometimes mixed with various psychological aspects. A total of 91.06% reported that they were moderately (6.04%) or extremely (85.02%) satisfied with the outcomes after surgery, and 37 (8.94%) reported dissatisfied. Revision surgery was needed in a small number of patients (n = 7 of 414 patients, 1.69%) because of undesirable appearance. The most common complication in our patients was asymmetry (6.28%). Women requested labiaplasty in the last 2 reasons or procedures or without psychological distress were more likely feel satisfied with the results (satisfaction rate90%). There was a significant difference in satisfaction among the 3 concerns as well as between the 2 kinds of psychological conditions ( P0.05). Satisfaction of patients with aesthetic complains compared with the other 2 worries was significantly lower ( P0.05). There was no significant difference among the 3 procedures in this comparison group ( P0.05). In addition, satisfaction in labiaplasty with or without clitoral hoodoplasty, neither of which was statistically different ( P0.05). Patients aged 30 to 39 years reported the lowest satisfaction in comparison with the other age groups.Labiaplasty of the labia minora is the most commonly performed genital cosmetic surgery procedure. This study on 414 patients demonstrated that it is associated with a high degree of patient satisfaction and low morbidity and provided evidence of safety and effectiveness preliminary, indicating that the procedure may be regarded as safe.

The human papillomavirus (HPV) vaccine, introduced in New Zealand (NZ) in 2008, is predicted to substantially lower the incidence of HPV-associated precancers and cancers. The aim of this study is to estimate the proportion of vulvar intraepithelial neoplasia (VIN) lesions and invasive vulvar squamous cell carcinomas (SCCV) attributable to HPV in NZ women treated by the Auckland Regional Gynecological Oncology Service, covering an estimated 50% of the NZ population.Polymerase chain reaction and reverse hybridization were used to analyze retrospective histologically proven SCCV from 1990 to 2007 and VIN lesions from 2000 to 2007 for HPV content and genotype in a collaborative study with the Catalan Institute of Oncology. Immunohistochemistry for p16INK4a was performed on SCCV, which were attributed to HPV if both tested positive.Polymerase chain reaction testing for HPV content and genotype was performed on 66 VIN lesions (all high-grade squamous intraepithelial lesions) and 189 SCCV. In addition, p16 immunohistochemistry was performed on 168 of the 189 SCCV (88.9%) tested for HPV-DNA. Overall, 61 SCCV cases (36.3%) were attributed to HPV (HPV+/p16+), and 89 SCCV cases (53%) were considered to have developed independently of HPV (HPV-/p16-). Known high-risk HPV genotypes were present in 96.8% of HPV-DNA-positive vulvar high-grade squamous intraepithelial lesions and 98.4% of HPV-attributable SCCV. Human papillomavirus 16 represented the most common genotype in both.Overall, the HPV vaccine is likely to substantially alter the profile of SCCV in our region. The results provide a baseline assessment of the HPV status of vulvar neoplasia before the introduction of the HPV vaccine.

Tumor budding activity (TBA) is recognized as a potential prognostic factor in carcinomas from several anatomic sites. This study evaluates the prognostic value of TBA in a cohort of squamous cell carcinoma of the vulva (VSCC). TBA, defined as clusters of5 tumor cells that are detached from the main tumor and that infiltrate into surrounding stroma, was assessed in 82 cases of surgically excised VSCC and correlated with patient outcomes. All cases were classified into one of 3 groups: no TBA, low TBA (1-14 foci), and high TBA (≥15 foci). Twenty-three (29.1%), 37 (45.1%), and 22 (26.8%) cases showed no, low, and high TBA, respectively. High TBA was associated with reduced overall survival (OS) on multivariate analysis independent of FIGO stage, human papillomavirus (HPV) status, and p53 status. The majority of tumors with high TBA displayed a p53 mutant staining pattern (77.3%, 17 of 22). The 17 patients whose tumors displayed a p53 mutant/high TBA profile had worse outcomes when compared with 15 patients whose tumors showed a p53 mutant/no TBA or p53 mutant/low TBA profile (mean OS 37.5 versus 63.3 months, respectively, P = .002). High TBA was observed in only 5 of 47 HPV-associated cases, and this subset also seemed to display a worse patient outcome as compared with the rest of the HPV-associated cohort (OS 16.8 versus 142.8 months, P .0001). In summary, these findings indicate that TBA is an independent prognostic indicator in VSCC patients, and that high TBA is associated with worse clinical outcomes.

O'Connell et al. proposed that the vestibular bulbs be renamed the "clitoral bulbs" because of their consistent relationship to the clitoris and inconsistent relationship to the vestibule. Normally such proposed esoteric changes in anatomical nomenclature would get little notice by anatomists, yet alone the general public; however, many subsequent articles and books placed this change in the context of centuries of male anatomists and physicians downplaying female sexual anatomy and sexuality. Most prominent is a 2022 book by Rachel Gross, Vagina Obscura: An Anatomical Voyage. Here we review this "Anatomical Voyage" and find author bias in omitting/including erroneous facts in this book. We also present a critique of a 1995 article that appeared in Feminist Studies; Graphical Representations in Anatomy Texts, c1900-1991. This article, which has been repeatedly cited in the clinical literature, asserts that between circa 1950-1980 anatomy textbooks purposely eliminated depicting/labeling the clitoris in illustrations because the authors of the textbooks were reflecting societal norms that de-emphasized the importance of the clitoris. Unfortunately, the methods used by Moore and Clarke are not replicable; and further, their conclusions were not justified because of clear bias in their description and depiction of the anatomy sources they review.

Objectives: To analyze the incidence and overall survival rate of patients with vulvar cancer in Poland, based on the reporting data from the National Health Fund. Material and methods: The incidence of vulvar cancer in Poland in 2008–2016 (9-year follow-up period) by voivodship and the number of patients undergoing combined hospital treatment were analyzed. For the group of patients treated systemically, overall survival (OS) probability was calculated using the Kaplan-Meier estimation method. Results: In the period 2008–2016 in Poland, the diagnosis of malignant neoplasm of the vulva (C51% group) was made in 29,702 patients. The mean annual prevalence rate per 100,000 inhabitants was 8.3 ± 1.2 for Poland. The largest numbers of patients were reported in Mazowieckie and Slaskie voivodeships and the lowest in Opolskie and Podlaskie voivodeships. The median overall survival of patients treated with the combined method in 2008–2016 in Poland was 64.7 months (95% Cl: 58.0–70.0). One-year survival rate was observed in 77.6% of patients, 2-year in 64.4%, 3-year in 58%, over 5 years — 54.22%. Conclusions: In the years 2008–2016 in Poland, based on the data reported to the National Health Fund, the incidence of vulvar cancer was 4 times higher than the statistics of the National Cancer Registry, the WHO or the USA, which indicates either substantive or reporting errors. In Poland, 54% of patients treated with the combined therapy survive over 5 years which is a much lower result compared to highly developed countries.

Sarcomas arising from the cervix are rare, and the reported prevalence is 0.20–0.55%. A 15-year-old Para 0+0 secondary school student presented to the emergency department in shock with a 1-year history of painless vaginal protrusion, vaginal bleeding, foul-smelling vaginal discharge, occasional passage of blood clots, fatigue, fainting episodes, and weight loss. She was resuscitated with intravenous fluids and blood transfusions. General examination revealed a young girl with a 16-week sized abdominal mass. Vaginal examination revealed a large mobile fleshy mass 14 cm by 10 cm with an offensive discharge and odour. It was externally friable, bled actively on contact, had areas of tissue necrosis, and was oedematous. It was difficult to determine the adnexa structures because of tenderness. Examination under anaesthesia showed that the mass was continuous with the cervix and was not attached to the vagina or vulva. The histology report of the biopsied specimens showed features consistent with cervical leiomyosarcoma (LMS). Cervical LMS was confirmed by immunohistochemistry and a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed as definitive treatment. Postoperative hormone replacement therapy was initiated. The patient's postoperative condition was stable and there was no tumour recurrence for >2 years on follow-up. Making a diagnosis and instituting surgical and adjuvant treatments for LMS in a low-resource setting are challenging. This is due to lack of access to universal healthcare coverage. A multidisciplinary approach with early diagnosis and complete surgical resection of the tumour provides the most favourable possibility of an improved survival and quality of life.

In this study, we discussed the relationship between Entermorpha linza polysaccharide (EP) and Bacillus subtilis, which can transform nitrate. A sole carbon source experiment showed that Bacillus subtilis could utilize EP, and the bacterial density was maximally increased by 54.43% in the EP groups. The results of reducing sugar determination proved the secretion of polysaccharide-degrading enzymes. Scanning electron microscopy (SEM) showed that the EP groups had fewer spores and shrunken bacteria, indicating that EP could improve the growth environment and maintain bacterial integrity. Additionally, the ratios of periplasmic nitrate reductase (NAP), nitrite reductase (NIR), and dissimilatory nitrate reductase (D-NRase) in the EP groups were maximally increased by 107.22%, 84.70% and 36.10%, respectively. Transcriptome analysis further confirmed the above mentioned results. For example, the high expression of quorum sensing genes indicated that EP groups had higher bacterial density. Moreover, the high expression of antioxidant genes in the EP groups may be related to morphological integrity. Our study provides a basis for further discussion of the mechanism.

[39] Parena (Parena) fulva sp. nov. Habitus: Figs 73C, 73D. Male genitalia: Fig. 75. Gonocoxites of ovipositor: Fig. 11U. Type locality. Tanzania, Dodoma, S6.17, E35.74, 1120 m. Type material. Holotype (MNHN, Fig. 73C): male, body length= 9.2 mm, board mounted, " Dodoma, E. Afr. / H.L. Andrewes, 1918 ", " Crossoglossa / ferruginea / Chaud. / Alluaud, det. 19 30 ", "MUSEUM PARIS / Coll. Ch. ALLUAUD" [blue label], "HOLOTYPE / Parena (Parena) / fulva sp. nov. / des. Shi H.L. 2022" [red label] . Paratypes (a total of 4 males, 3 females): Tanzania : 1 female (MNHN), " Dodoma, E. Afr. / H.L. Andrewes, 1918 "; "MUSEUM PARIS / Coll. Ch. ALLUAUD" [blue label]. 1 male (NHML), " Dodoma, E. Afr. / H.L. Andrewes, 1918 ", " Crossoglossa / ferruginea / Chaud. / Alluaud. det. 1924", "H.E. Andrewes Coll. / B.M. 1945-97.". 2 males (NHML), " Dodoma, E. Afr. / H.L. Andrewes, 1918 ", " H.E. Andrewes Coll. / B.M. 1945-97.". Zimbabwe: 1 female (CSF), "ZIMBABWE-S / BUBI env. / Bubi river / lgt. S. Bečvář 8.xii.1998 "; " Parena / ferruginea / CHD. / Det. Facchini " . 1 female (NHML), " S. Rhodesia: / Victoria Falls. / December 1915 / R. Lowe Thompson ", "Pres. By / Imp. Bur. Ent. / Brit. Mus. / 1925-184.", " Metallica / ? sp. nov. ", " Parena / ferruginea Chaud / E.B. Britton. / det. 6.3. 193 6 " . 1 male (NHML), " Rhodesia / Salisbury / ja. O'herl / 1920.143 ", " Empanduri /13.1.19", "Pres. by / Imp. Bur. Ent.", " Crossoglossa / ferruginea, Chd. / DET. FR. DESCR. / G.A.K. MARSHALL." . Diagnostic characters. Dorsum yellowish brown, elytra without pattern; antennae with basal three antennomeres yellow, apical half of fourth and remaining tarsomeres black; tarsi black; postgenae with a pair of suborbital setae; pronotum with lateral margins nearly straight before posterior angles; elytra discal depression indistinct; median lobe of aedeagus very stout; apical lamella thick and coniform. Comparisons. P. fulva sp. n. is different from most African species in having suborbital setae. Compared with the two other African species with suborbital setae, the new species can be readily distinguished in having the dorsum with paler color, antennae distinctly bicolored, elytra without discal depressions, and pronotum with lateral margins nearly straight before posterior angles. From the original labels, we found that several specimens of this new species were misidentified as P. ferruginea. However, P. fulva sp. n. is different from the latter species in having suborbital setae present and the pronotum wider and with lateral margins only faintly sinuate before posterior angles. In several important features, the "unicolor" form of P. fasciata distributed in the Oriental Realm is most similar to P. fulva sp. n., but the Oriental species differs in having antennae uniformly yellow and male genitalia much slenderer. The new species also differs from all other African species in having its male genitalia very stout (AL/AW = 3.7–3.9), resembling some species from the Oriental realm, such as P. latecincta. Description. Body length 9.2–10.4 mm; body median-sized in the genus, subconvex. Color. Dorsum uniformly yellowish brown, head and pronotal disc slightly darker than elytra; apices of mandibles dark brown; antennae distinctly bicolor: antennomeres 1–3, and basal half of antennomere 4 yellowish brown, remainder of antennae nearly black; venter uniformly reddish brown; legs yellowish brown, tarsomeres dark brown. Head with sparse fine punctures on vertex; frons with shallow V-shaped depression; eyes large and strongly prominent; tempora very short, abruptly narrowed behind eyes, length of tempora plus neck-constriction approximately one-third of diameter of eye; postgenae with a pair of suborbital setae, slightly shorter than supraorbital ones. Antennae nearly extended to pronotal base. Labrum quadrate, apex weakly convex; mandibles short and wide; mentum with a pair of very short median setae, lateral lobes short and wide, inner margins strongly oblique, outer margins completely rounded, epilobes wide. Pronotum nearly quadrate, PW/PL = 1.46–1.56, slightly wider than head, PW/HW = 1.01–1.08, widest at anterior third, lateral explanations slightly wide; lateral margins rounded at anterior half and then gradually narrowed to base, straight before posterior angles; posterior angles obtuse, rounded at apex; anterior margin nearly straight at middle; posterior margin gradually oblique at sides; disc convex, usually with very fine punctures and transverse wrinkles. Elytra weakly convex, slightly dilated to apex, surface without microsculpture. Striae very shallowly incised, with rows of fine punctures; intervals faintly convex, with very sparse fine punctures. Disc without depressions, lateral sides weakly depressed near anterior third. Elytral basal pore present on base of stria 1; interval 3 with three discal setigerous pores: first one on level of scutellar apex, adjacent to stria 3; second one slightly before middle, adjacent to stria 3; third one on apical eighth, adjacent to stria 2; interval 9 with 24–26 umbilicular pores. Apical truncation indistinct, evenly rounded, outer angles completely rounded, sutural angles indistinct. Venter. Apex of abdominal sternite VII with two setae on each side in both sexes, straight in females, very weakly emarginate in males. Males with biseriate adhesive setae on full length of mesotarsomeres 2–3. Male genitalia. Median lobe of aedeagus very stout (AL/AW = 3.7–3.9); in lateral view, ventral margin slightly swollen near middle, dorsal margin strongly expanded, apical lamella thick, coniform, very weakly bent to dorsum; in dorsal view, right margin weakly sinuate before apex, apical lamella narrow, LL equal to LW, slightly narrowed to apex, apex rounded. Endophallus with very large and thick flared basal expansion of primary sclerite; flagellum thick and short, extending slightly beyond middle of median lobe; apical sclerite widely V-shaped, weakly defined, basal core distinct, strongly extended forming a well-defined transverse scaled belt; basal sheath coarsely scaled, apical sheath finely scaled, smaller than basal sheath; squamate sac well divided, near middle of median lobe, dorsal to squamate sheath; proximal sac small and dorsal-ventrally compressed, distal sac larger than proximal sac. Female genitalia. Gonocoxite II of ovipositor nearly quadrate, slightly wider than length, apex nearly straight, weakly pointed near inner apical angle, with six ensiform setae on apical margin, two of them grouped on inner apical angle, other four equally arranged. Distribution (Map 12, red). Tanzania, Zimbabwe. Etymology. The scientific name " fulva " is derived from the Latin root " fulv- " meaning yellow. It refers to the uniformly reddish yellow dorsal color of the new species.

Biofouling is a major disruptive process affecting the fuel efficiency and durability of maritime vessel coatings. Previous research has shown that amphiphilic coatings consisting of a siloxane backbone functionalized with hydrophilic moieties are effective marine antifouling and fouling-release materials. Poly(ethylene glycol) (PEG) has been the primary hydrophilic component used in such systems. Recently, the morpholine group has emerged as a promising compact alternative in antifouling membranes but is yet to be studied against marine foulants. In this work, the use of morpholine moieties to generate amphiphilicity in a poly(dimethylsiloxane) (PDMS)-based antifouling and fouling-release coating was explored. Two separate coating sets were investigated. The first set examined the incorporation of an N-substituted morpholine amine, and while these coatings showed promising fouling-release properties for

Following gender-affirming penile inversion vaginoplasty or vulvoplasty, patients may seek vulvar revision procedures for a variety of common aesthetic and functional concerns. These indications for revision and accompanying techniques are not well-described in the literature.Patients who underwent vulvar revision surgery at the authors' institution were identified, and patient demographics, surgical indications, operative details, and complications were described. Common complaints requiring external genital revision were sorted into four categories: clitoral, labial, introital, and urethral.Thirty-five patients with a history of vaginoplasty underwent vulvar revision between May of 2017 and December of 2019. The mean age at surgical correction was 38.9 years. Ten patients (28.6 percent) had undergone prior secondary procedures (range, 1 to 3). Mean follow-up after revision surgery was 10.7 ± 8.7 months (range, 0 to 30.6 months). The majority of patients underwent concurrent revisions in multiple "categories". Labial aesthetic concerns were most common (n = 27, 77.1 percent), followed by clitoral (n = 20, 57.1 percent), urologic (n = 17, 48.6 percent), and introital complaints (n = 12, 34.3 percent). Twelve patients (34.3 percent) had canal stenosis requiring concurrent robot-assisted canal revision with peritoneal flaps. Complications included labial abscess (n = 1) and deep vein thrombosis (n = 1). Three patients (8.6 percent) underwent subsequent external genital revisions. Management approaches and surgical techniques for each of these common revision categories are provided.As more individuals seek vaginoplasty and vulvoplasty, surgeons must be prepared to address a range of common aesthetic and functional complaints requiring vulvar revision.Therapeutic, IV.

Low-grade fibromyxoid sarcoma (LGFMS) is a malignancy with propensity for late relapse that principally affects deep soft tissues of the extremities and trunk. Its occurrence in the lower female genital tract is rare, and thus it may not be always considered in the differential diagnosis. We describe the salient features of 7 vulvovaginal LGFMS identified in the authors' consultation files. Clinical information was obtained from referring pathologists. Archival slides were reviewed, and immunohistochemistry and fluorescence in situ hybridization were performed in cases with available material. Median age was 40 years (range, 34 to 58 y). Primary sites included vulva (n=6) and vagina (n=1). Tumors were 1.2 to 8.7 cm (median, 5.0 cm) in size and grossly circumscribed with firm to focally gelatinous cut surfaces. Microscopically, 5/7 had infiltrative edges. All tumors showed fibrous and myxoid areas, with lobulated myxoid foci in 5/7, comprising storiform, patternless, or (less often) fascicular arrangement of spindled to stellate cells with bland, slender to ovoid nuclei. In all cases, mitoses were1/2.4 mm 2 , and necrosis was absent. Capillary "arcades" were seen in 3/7. Margins were positive in 3/6. Immunohistochemistry showed positive epithelial membrane antigen in 4/6 and MUC4 in 5/6. Fluorescence in situ hybridization detected FUS rearrangement in 5/7. Both tumors without FUS rearrangement were also negative for EWSR1 rearrangement. All 5 patients with available follow-up were alive and disease-free 10 to 150 months (median, 57 mo) after diagnosis. However, a review of vulvovaginal/pelvic LGFMS previously reported shows recurrences as late as 45 years after initial diagnosis. Pathologists need to be aware that LGFMS can arise in the vulvovaginal region. Tumor lobulation, capillary arcades, and positive MUC4 are helpful features distinguishing LGFMS from other bland myxoid spindle cell neoplasms in the lower female genital tract. Molecular testing can be useful in challenging cases. Complete excision is feasible for most vulvovaginal LGFMS. Long-term surveillance is required as local and/or distant spread can occur decades after diagnosis.

This study aimed to evaluate the safety and efficacy of vulvovaginal intradermal injections of polynucleotides (PN) combined with hyaluronic acid (HA) in postmenopausal women affected by vulvovaginal atrophy (VVA).Postmenopausal women affected by VVA were treated with vulvar and vaginal intradermal injections of one prefilled syringe of 2 ml PN/HA every 2 weeks for four sessions. Patients were evaluated at T0 (baseline), T1 (after session 4) and T2 (1 month after session 4). Evaluation of the treatment was assessed by three international validated questionnaires: Vaginal Health Index (VHI), Vulvar Health Index (VuHI) and Female Sexual Function Index (FSFI). The Wilcoxon matched-paired signed-rank test was used to compare the differences in VHI, VuHI, FSFI and FSFI domains within the groups. Statistical significance was set atFifty patients were included in the study (mean age 59.9 ± 7.6 years). Overall, the VHI, VuHI and FSFI reported statistically significant differences between baseline and T1 (Vulvovaginal intradermal injection of PN/HA is a safe, effective treatment, is not expensive and is a reproducible procedure in postmenopausal women with VVA.

BACKGROUND: Chronic vulvar pain is a prevalent but often misdiagnosed and undertreated condition that adversely impacts quality of life. A large proportion of women report not seeking care for chronic vulvar pain, but little is known about the factors that underlie care-seeking decisions. MATERIALS AND METHODS: We used a large, population-based survey of women aged 18–40 years to assess a history of chronic vulvar burning, pain on contact, or itching that had lasted ≥3 months. The survey also captured demographic characteristics and comorbidities. Women were asked if they had ever sought care for their chronic vulvar condition. Demographic characteristics and comorbidities were evaluated across pain categories and by care-seeking behaviors. RESULTS: A higher proportion of women who described their pain as burning only and both burning and pain on contact had sought care for their pain (69.2% and 85.2%, respectively) compared with pain on contact only (41.8%). Women who described their pain as pain on contact only were also less likely to see multiple providers and to have ever received treatment for their pain. Care seekers were more likely to be married, have a college education, have a normal body mass index, and have multiple gynecologic comorbidities. CONCLUSIONS: Our study suggests that care-seeking behavior varies by pain type. Less than half of women who characterized their pain as pain on contact had sought medical care. Those who did seek care reported seeing fewer providers than those who experienced burning. Providers may wish to proactively ask patients about pain on contact.

Obesity is characterized by metabolic disorder and accompanying an altered and less diverse gut microbiota composition during a fat-enriched diet. Recent studies indicated that sulphated polysaccharide prevents high-fat diet (HFD) induced obesity, reduces metabolic disorder, and restores the gut microbiota. However, there are few studies about Ulva prolifera polysaccharide (UPP) may induce anti-obesogenic effects. Therefore, the present study investigates the enzymatic extracted UPP effects in HFD-fed mice. The results showed that UPP considerably slowed down the HFD-induced weight gain and improved metabolic disorders in HFD-fed mice. Notably, the effects were associated with lower body weight gain, reduced adipose tissue hypertrophy, triglyceride concentration in liver and systemic low-grade inflammation, and improved fasting blood glucose. Moreover, our result reveals that UPP may elevate the expression of AMPK via adiponectin activation. Interestingly, we found that UPP may induce PPARα agonist to enhance β-oxidation since the elevation of CPT-1 and PPARα expression simultaneously. Meanwhile, gut microbiota analysis revealed UPP promoted the growth of Parasutterella, Feacalibaculum, and Bifidobacterium, and reduced the abundance of Acetatifactor, Tyzerella, Ruminococcus_1, and Desulfovibrio. The changes in microbiota may have a positively correlated effect on improving obesity and metabolic abnormalities. UPP may prevent HFD-induced obesity and associated metabolic diseases, as well as modulate the composition of gut microbiota to facilitate the growth of probiotics.

There is a lack of published data investigating injection of autologous platelet rich plasma (A-PRP) alone in the treatment of postmenopausal VVA.In this pilot study, we aimed to investigate the safety and efficacy of injection of A-PRP alone in postmenopausal VVA in women without the history of cancer breast to explore its utility as a hormone free therapy for postmenopausal VVA and for vulvovaginal rejuvenation.In this pilot study, 47 women with postmenopausal VVA were included. Vulvovaginal condition was evaluated at the baseline by vaginal health index (VHI). Impact of VVA on quality of life and sexual life was evaluated at the baseline by vulvovaginal symptom questionnaire (VSQ). Treatment protocol was 2 sessions of A-PRP injection with 1 month interval. Response was evaluated 1 month after the last session by VHI and VSQ. Side effects were also evaluated.Postmenopausal VVA was significantly improved by A-PRP injection as indicated by significant improvement of total VHI score and its items at 1 month post-treatment (p value0.001). Moreover, there was significant improvement of burning, hurting, being irritated, being dry, discharge, desire to be intimate, sexual relationships, pain during sexual activity, and dryness during sexual activity at 1 month post-treatment as indicated by VSQ (p value =0.045 for being dry and0.001 for other items).Autologous platelet rich plasma injection is safe and effective as minimally invasive monotherapy for postmenopausal VVA without history of cancer breast and hence for vulvovaginal rejuvenation.

During menopausal transition, women are frequently affected by vulvovaginal atrophy (VVA), due to the decline of estrogen levels. Resulting symptoms are itching, burning, dyspareunia, and vaginal dryness (reported in up to 85%). The aim of this trial was to verify if medical device polycarbophil vaginal (PCV) moisturizer gel is not less effective than hyaluronic acid (HA) gel in treating vaginal dryness.This was a multicenter, open label, randomized, parallel group, comparative study with non-inferiority design. Female included were ≥45 to ≤55 years in the menopausal transition, with subjective dryness, any objective sign of VVA, pH 5, and body mass index of ≥18.5 to ≤36 kg/m53 subjects (mean age 49.45 ± 2.96 years) were analyzed. Vaginal health index showed an improvement (p 0.001) in both groups (from 12.54 ± 1.37 to 16.36 ± 2.66 for PCV, from 12.00 ± 1.91 to 16.60 ± 2.50 for HA), but the difference between final means (95%CI: -1.66 to 1.18) evidenced that PCV is non-inferior to HA treatment. Similarly, an improvement was evidenced in vaginal maturation index (p = 0.005 for PCV, ns. for HA), female sexual function index (p 0.001 for PCV, p 0.001 for HA), and SF-12 (p 0.001 for PCV, p 0.001 for HA), with no difference between groups. Safety was optimal and no adverse events were reported.The use of HA gel does not give additional benefits to those that are already provided by the moisturizing PCV.

Objectives: To measure the diagnostic accuracy of intraoperative frozen section examination of sentinel lymph nodes (SLN) in vulvar cancer and to describe associated patient outcomes. Methods: This retrospective cohort study included patients with invasive squamous cell carcinoma of the vulva who underwent SLN biopsy with intraoperative frozen section at one cancer centre from Jan 2008 - Feb 2020. Exclusion criteria were tumor size >4cm, multifocal tumor, palpable groin lymph nodes and neoadjuvant therapy. The SLN procedure was performed by injection of the primary vulvar tumor or scar with technetium-99m, ICG and/or blue dye. We compared the intraoperative SLN frozen section diagnosis and the paraffin section report for concordance. Recurrence location was described and recurrence free survival (RFS) was compared using the Kaplan-Meier method. Results: A total of 173 patients (258 groins) met inclusion and exclusion criteria. On frozen section, there were 36/258 positive groins on frozen section and 222 negative groins. On final pathology, there were 39/258 positive groin nodes: 30 macro-metastases, 7 micro-metastases, 2 isolated tumor cells (ITCs). There were 219 negative groins. The sensitivity and specificity for frozen section detecting any metastatic disease compared to final pathology, was 89.7% and 99.5%, respectively. The positive-predictive value (PPV) was 97.2% and the negative-predictive-value (NPV) was 98.2%. There were 4 cases of false negative frozen section where final pathology revealed two cases of ITCs, 1 micro-metastasis and 1 macro-metastasis. A total of 30 patients (17.3%) underwent a full inguinal femoral lymphadenectomy during the same operation due to the frozen section results and avoided a second operation. A total of 2 patients (1.2%) required a second operation for lymphadenectomy due to false negative results on frozen section. Median (range) follow up was 38.0 (1-137.8) months. Median RFS was 14.9 (3.6 to 98.2) months. There were 46 recurrences in the study population, of which 29 were confined to the vulva, 9 groin recurrences and 8 distant recurrences. Among patients with a negative SLN biopsy on both frozen section and final pathology, there were 10 (3.9 %) groin and/or distant recurrences. A total of 6 nodal recurrences were ipsilateral, 1 was contralateral, 2 were bilateral and 1 recurrence was distant. After exclusion of patients with local recurrence only, the RFS at 3 years was 91.6% (95% CI 86.2-97.4%) for patients with negative SLN on frozen section and 64.6% (95% CI 46.5-89.7%) for positive SLN on frozen section. On final pathology, patients with negative SLN had a 3-year RFS of 91.7% (95% CI 86.3-97.4%), macro-metastases 58.4% (95% CI 38.5-87.7%), and micro-metastases/ITCs was 100%. Conclusions: Intraoperative frozen section of SLNs in vulvar cancer is an accurate intraoperative guide to determine if complete inguinal femoral lymphadenectomy should be performed. SLN biopsy reduced the need for a second surgical procedure and does not appear to compromise patient outcomes.

This guidance refers to urogenital atrophy, a chronic and progressive condition due to estrogen deficiency, most commonly associated with the menopause. There is a potential negative impact on all urogenital tissue quality including the vulva, vagina, bladder and urethra. Symptoms may not become apparent for several years after the menopause and therefore any association is lost, with women accepting symptoms as a normal part of the aging process. There may be reluctance to discuss symptoms with a clinician and this is likely to be linked with under diagnosis and under treatment. Urogenital atrophy has been described as a silent epidemic with lack of awareness affecting an accurate diagnosis and access to treatment. Whilst vaginal estrogen (also referred to as local estrogen) therapy is the best-known treatment, newer drugs and interventions are now available.

The aim of this study was to describe genital hair thread tourniquet syndrome (HTTS) and its treatment by pediatric and adolescent health care providers through a systematic literature review.We performed a systematic literature review on pediatric male and female genital HTTS. Studies were included if they involved genital HTTS in males or females 21 years and younger and were published in English. The main outcomes were body parts involved, symptoms, treatment, anesthetic type, providers involved in diagnosis and management, and implications of delayed or missed diagnosis.There were 38 female cases from 33 publications (1973-2020) and 147 male cases from 47 publications (1951-2019). The average age among females and males was 9.1 and 5.1 years, respectively. Among cases involving female patients, 93% of them were premenarchal; patients were circumcised in 90% of reviewed cases of male HTTS. The most commonly involved body parts were clitoris and labia minora in females, and penis and urethra in males. Males most commonly presented with edema and urinary symptoms, whereas females most commonly presented with edema and pain. General anesthesia was used for tourniquet excision in most cases. Male and female genital HTTS were mostly managed by urologists and emergency medicine physicians, respectively.This systematic literature review of more than 150 cases of male and female genital HTTS describes evaluation and management of genital HTTS spanning 7 decades. The main treatment of genital HTTS remains prompt diagnosis and removal of the tourniquet, as well as education on prevention strategies. Delayed diagnosis due to lack of recognition of the HTTS can lead to serious sequelae. Development of national guidelines regarding best practices in management of genital HTTS disseminated to all providers taking care of pediatric and adolescent patients will lead to improved patient care.

To evaluate the quality of life (QoL) in women who underwent urethroplasty for urethral stricture.Twenty-two women who underwent ventral labium minus graft urethroplasty were included. Patients were assessed with uroflowmetry, urethral caliber and post-voiding residual urine (PVR). American Urological Association (AUA) symptom score, Urogenital Distress Inventory (UDI)-6 and Short Form-36 (SF-36) were used to evaluate QoL. Preoperative values were compared with patients' last visit data. The cure of the surgery was defined as a maximum flow rate 15 ml/s in uroflowmetry and no need for any further intervention.Median age was 55 (40-66) years. Cure was achieved in 20 (90.3%) patients with median 37 (13-52) months follow-up duration. The median Qmax increased from 4 (0-5) ml/s to 27.5 (8-55) ml/s (p 0.001). Median post-void residual volume (PVR) decreased from 52.5 (0-120) ml to 20(0-60) ml (p = 0.011). Both AUA symptom score [from median 30 (24-35) to 4.5 (0-20), p 0.001] and AUA-QoL score [from median 5 (4-6) to 0(0-3), p 0.001] decreased after surgery. Median UDI summary score at the last follow-up was 0 (0-44.4), which was 33.3 (22.2-61.05) at baseline visit. Improvement was observed in all domains except the 'Energy/Fatigue' domain of the SF-36.Urethroplasty is an effective surgical method to improve patients' QoL which is impaired because of female urethral stricture.

Objective The aim of the study was to identify whether desquamative inflammatory vaginitis (DIV) and plasma cell vulvitis (PCV) are distinct clinicopathologic entities. Materials and Methods The pathology database identified biopsies described as “vaginitis” or “vulvitis” occurring in nonkeratinized epithelium or mucocutaneous junction. Exclusions were age less than 18 years, unavailable slides or records, concurrent neoplasia, or histopathology consistent with other entities. Clinical data included demographics, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, epithelial thickness and characteristics, infiltrate, and vascular abnormalities. Cases were analyzed according to histopathologic impression of DIV or PCV based on previous pathologic descriptions. Results There were 36 specimens classified as DIV and 18 as PCV from 51 women with mean age of 51 years; 3 (6%) had concurrent biopsies with both. Pain was more common in PCV, but rates of discharge, itch, and bleeding were comparable. Rates of petechiae or erythema were similar and vaginal examination was abnormal in 72% of PCV cases. All DIV and 33% of PCV occurred in squamous mucosa; the remaining PCV cases were from mucocutaneous junction. Mean epithelial thickness, rete ridge appearance, exocytosis, and spongiosis were similar in DIV and PCV. Epithelial erosion, wide-diameter lesions, plasma cells, and stromal hemosiderin occurred in both but were more common in PCV. Lymphocyte-obscured basal layer, narrow-diameter lesions, hemorrhage, and vascular congestion were seen in both, but more common and marked in DIV. Conclusions Desquamative inflammatory vaginitis and PCV have overlapping symptoms, signs, and histopathologic features. They may represent a single condition of hemorrhagic vestibulovaginitis with varying manifestations according to location and severity.

We report a case of a vulvar verruciform xanthoma. Verruciform xanthoma is a rare benign lesion that occurs most commonly on the oral and genital mucosa. Under the microscope, this lesion displays acanthotic papillary epidermis with parakeratosis that extends deep into the epithelium, elongated rete ridges and xanthomatous cells in the papillary dermis. Vulvar lesions almost always occur in a local pathological context (lichen planus or sclerosus). It is important to be aware of this entity as it can mimic squamous carcinoma.

Objectives Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women. Materials and methods A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC. Results The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method. Conclusions Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.

Resume La maladie de Paget est une affection rare dont la pathogenie est mal connue. Nous decrivons ici l’aspect clinique, histopathologique de la maladie de Paget vulvaire qu’elle soit intra-epitheliale ou invasive.

Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short- and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2021;XX:XXX-XXX.

Coprinopsis fulva Sch ̧nemann, Diaz Val., Aguilar& R.M.Silveira, sp. nov. FIG. 4 Mycobank: 846928 Typification: — BRAZIL. Rio Grande do Sul: Derrubadas, Parque Estadual do Turvo, gregarious on decayed tree, 27°08’22.5”S, 53°52’57.3”W, 30 October 2017, B. L. B. Schünemann 113 (holotype ICN 200445), Gen Bank accessions: MK843961, ON640622, ON653381, ON707699. Diagnosis: —Pileus medium grey with white to greyish green umbo, brown veil in fibrillose patches, loosely attached, clavate with mucronate apex pleurocystidia, diverticulate, thick-walled and yellowish veil elements. Etymology: —The name fulvus refers to the yellowish brown color of veil elements. Description: —Pileus prior to expansion 3–5 × 2–3 mm, globose becoming ovoid, greenish grey (1B2), with brown (6E4) veil adhered in scales; 9–11 × 5–9 mm wide when expanded, ovoid to parabolic then applanate, plicate, medium grey (1E1) and the umbo white (1A1) to greyish green (1B2), fibrillose veil in patches all over the pileus, brown (6E4) and powdery towards margin, white (1A1), loosely attached, 15 × 2 mm when revolute, becoming translucid. Lamellae adnate, close, at young stage, pale grey (1A2) to dark brown (7F6), deliquescent, pleurocystidia visible with a magnifying glass. Stipe 10–30 × 1–2 mm, central, equal, fistulose, yellowish white (1BA). Annulus absent. Basidiospores 6–8 × 5–6 × 5.5–6.5 μm, Q= 1.07–1.33, Qav = 1.22; broadly ellipsoid in frontal view, light grey to brown in KOH, guttulate, thick-walled, smooth; apiculus visible; germ pore eccentric, covered with a hyaline cap. Basidia dimorphic, clavate 12–16 × 6–7 μm and long clavate 19–24 × 7–8 μm, hyaline, 4-spored, surrounded by 3–4 pseudoparaphyses. Cheilocystidia absent. Pleurocystidia 62–133 × 9–18 μm, clavate with mucronate apex, hyaline, thin-walled, abundant. Hymenophoral trama parallel to subparallel. Pileipellis a cutis with elongated hyphae, radially oriented, hyaline, anastomosing, thick-walled. Veil composed of branched and diverticulate elements, thin and thickwalled, brownish. Stipitipellis a cutis with elongated elements, hyaline. Clamp connections present. Habitat and known distribution: —Growing gregarious in decayed branches of Semideciduous Seasonal Forest and endophyte of cultivated rice under flooded system; recorded from Parque Estadual do Turvo, Derrubadas (Rio Grande do Sul, Brazil) and Puerto Naranjitos locality (Amazonas, Peru). Additional specimens examined: — Peru, Amazonas department, Utcumbamba province, Puerto Naranjitos locality, (S 05°49’7.6’’/ W 78°17’12.6’’), isolated from rice leaves, March 2021, leg. J. R. Díaz-Valderrama, INDES-VAR05, GenBank accessions: ON640612, ON640624. Comments: —The main distinguishing features of Coprinopsis fulva are the greyish pileus with brown fibrillose veil in patches, becoming powdery to the margin; the adnate lamellae; clavate pleurocystidia with mucronate apex; thin to thick-walled diverticulate and branched veil elements with brownish coloration and lignicolous habitat (FIG. 4). Based on diverticulate and thick-walled veil elements, Coprinopsis fulva belongs to the section Alachuani (Schafer 2010). In the phylogeny, C. fulva is included in the section / Coprinopsis (Wächter & Melzer 2020) due the veil strongly developed, consisting of chains of diverticulate, thin and thick-walled, hyaline or brownish pigmented cells and clavate pleurocystidia. Coprinopsis fulva is phylogenetically related to C. urticicola (Berk. & Broome) Redhead, Vilgalys & Moncalvo (2001: 232) in Redhead, Vilgalys, Moncalvo, Johnson & Hopple (2001), C. friesii (Quél.) P. Karst (1881: 27) and morphologically similar to C. caesia sp. nov. C. urticicola has free lamellae, subcylindrical to narrowly utriform and oblong pleurocystidia (40–70 x 10–15 μm), thin-walled veil elements and clamp connections absent (Asef et al. 2005). C. friesii has ovoid to slightly rhomboid basidiospores, oblong to narrowly conical pleurocystidia, strongly diverticulate thick-walled veil elements, growing in grasses (Uljé 2005; Keirle et al. 2004). Morphologically Coprinopsis fulva also is similar to C. caesia sp. nov. and other species included in / Coprinopsis clade. The veil elements are very important to distinguish these species, with C. fulva being unique in having both thin and thick-walled, yellowish brown, branched and diverticulate veil elements. In addition, it was found growing on decomposing wood., Published as part of Schünemann, Bárbara Letícia Botura, Westphalen, Mauro, Díazvalderrama, Jorge Ronny, Aguilar, Vilma & Silveira, Rosa Mara Borges Da, 2023, Coprinopsis (Psathyrellaceae, Agaricales) in the Neotropics: three new species and a new combination, pp. 113-134 in Phytotaxa 585 (2) on pages 126-127, DOI: 10.11646/phytotaxa.585.2.3, http://zenodo.org/record/7681516, {"references":["Schafer, D. J. (2010) Keys to sections of Parasola, Coprinellus, Coprinopsis and Coprinus in Britain. Field Mycology 11 (2): 44 - 51. https: // doi. org / 10.1016 / j. fldmyc. 2010.04.006","Wachter, D. & Melzer, A. (2020) Proposal for a subdivision of the family Psathyrellaceae based on a taxon-rich phylogenetic analysis with iterative multigene guide tree. Mycological Progress 19: 1151 - 1265. https: // doi. org / 10.1007 / s 11557 - 020 - 01606 - 3","Redhead, S. A., Vilgalys, R., Moncalvo, J. M., Johnson, J. & Hopple, J. S. (2001) Coprinus Pers. and the disposition of Coprinus species sensu lato. Taxon 50: 203 - 241. https: // doi. org / 10.2307 / 1224525","Ulje, C. B. (2005) Coprinus. Flora Agaricina Neerlandica 6: 22 - 109.","Keirle, M. R., Hemmes, D. E. & Desjardin, D. E. (2004) Agaricales of the Hawaiian Islands. 8. Agaricaceae: Coprinus and Podaxis; Psathyrellaceae: Coprinopsis, Coprinellus and Parasola. Fungal Diversity 8: 33 - 124."]}

Fibroepithelial polyps are benign lesions that may appear in the vulvovaginal region. They usually occur in women of reproductive age and tend to grow up to 5 cm, but there are some rare cases in which they grow up to 20 cm. We report a case of a 22-year-old woman in the third trimester of her first pregnancy with spontaneous bleeding from a pedunculated mass measuring 15 cm in the widest diameter on the right side of the vulva. Features of this case are discussed as well as its implications, especially regarding the decision of labour. Due to the big size of the mass and its propensity to bleed, we decided to perform an elective caesarean section as well as its excision.

In Thailand, sexual activity involving those under the legal age of consent may be legally and medically problematic, even if it is consensual. Thus, differentiating anogenital injury characteristics that occur during consensual versus nonconsensual acts with adolescent female subjects could aid legal advocates and improve health care and social support for these patients. Our study included postmenarche female patients having acute anogenital injuries after consensual and nonconsensual penetration. We found that nonconsenting patients had more cases of anogenital injury than consenting (69.8% vs 55.5%), with at least 1 abrasion, contusion, laceration, labia major or minor injury, and external or internal site injury. Both consensual and nonconsensual cases had the same common sites for injury type, reflecting the same injury mechanism; prior sexual intercourse was a significant protective factor against some anogenital injury prevalence, types, and sites for both groups. Adolescents forced into nonconsensual acts had more nonanogenital injuries. Looking at factors such as age, prior sexual activity history, and use of condom and/or contraceptive pills, it is very clear that early sexual education, particularly around consent, is critically needed in Thailand for the best interests of adolescents and children so that they and/or their guardians can access the health and legal resources required.

Acquired lymphangioma circumscriptum of the vulva is rare and can occur subsequent to malignancies of the anogenital and pelvic region. We sought to investigate the clinicopathologic characteristics of malignancy-associated acquired vulvar lymphangioma circumscriptum (AVLC).We identified all cases of AVLC within our institution with history of prior malignancy between 2005 and 2021. A similar search was performed in the PubMed database to identify published cases to date. The clinical and histopathologic information was recorded.A total of 71 cases were identified. The most common preceding malignancy was cervical carcinoma (71.8%, 51/71). Radiation therapy was given to 91.4% (64/70) of the patients and lymph node dissection was made on 70.2% (40/57). Median interval between the diagnosis of malignancy and the AVLC was 10 years (range 0-32 years). AVLC frequently presented as vesicular (31.6%, 18/57) or verrucous (28.1%, 16/57) lesions clinically. Common treatments for AVLC included excision (53.1%, 26/49) and laser therapy (16.3%, 8/49), with an overall recurrence rate of 42.9% (24/56) at a median follow-up interval of 1.8 years (range 0.04-32.3 years).AVLC is a rare, late complication of anogenital and pelvic malignancies causing debilitating physical symptoms and psychological stress. Further studies are warranted to determine the most effective treatment modalities to mitigate recurrence.

Objective To examine the female urogenital hiatus (UGH) and perineal body gross and topographic anatomy; to analyze the POP-Q recommendation for evaluating UGH and PB. Study design A prospective case series study on fifteen fresh human adult female cadavers was conducted in international settings. Stratum-by-stratum, macro-, and micro-anatomical dissections to study the UGH and PB gross-topographic anatomy. In addition, HGH and PB descriptive anatomy presented in the medical literature were analyzed. The primary outcome measured the accuracy of POP-Q in the assessment of UGH and PB. Additionally, digital photos were taken to document UGH and PB gross and topographic anatomy. Results The present study confirmed that the urogenital hiatus was a well-described structure in the medical literature. It is an oval-shaped structure that originated at the inferior pubic bone and was inserted into the posterior anal wall and superior surface of the PB. In all subjects, the location of UGH was in the Retzius space. Therefore, the recommendation by the POP-Q to evaluate UGH from the middle urethral meatus to the posterior hymeneal ring was incorrect because it did not accurately reflect the total longitudinal diameter of UGH. The PB topographic anatomy was not appropriately described in the literature. PB was an oval-shaped, solid, muscular mass without the central point of the perineum or fascia and rested between the posterior-distal vaginal wall and the anterior anorectal wall in a horizontal orientation and was not a part of the posterior perineum as the POP-Q system indicated. Therefore, a vertical measurement of the perineal body as recommended by POP-Q was impossible to obtain due to its horizontal orientation under the posterior-distal vaginal wall; PB had to be measured horizontally. The median length was 4.2 cm ± 1.6 (SD). Conclusions The POP-Q system does not adequately assess UGH and PB and needs revision.

Vulvar squamous neoplasms – intraepithelial and invasive – are now classified by their aetiological relationship with human papillomavirus. This distinction is imperfect on morphological assessment alone. This article discusses the new classification and the use of p16 and p53 in the distinction. Other recent developments, including FIGO 2021 staging of vulvar cancers, is discussed here.

Summary Background Worldwide, 200 million girls and women have been subjected to female genital mutilation. To restore the clitoral function and vulvar anatomy, clitoral repair has been performed since the 2000s. Nevertheless, there is a lack of precise and comprehensive data on the clitoral anatomy during surgical repair. This study aimed to precisely describe the terminal anatomies of the dorsal nerve and artery of the clitoris, and the clitoral neurovascular flap advancement for reconstruction in patients with female genital mutilation. Methods This study was performed on seven fresh female cadavers. The site of origin, diameter, length, and trajectory of each nerve and artery were recorded. The clitoral neurovascular flap advancement was measured after a midline transection of the suspensory ligament was performed and after extensive liberation of the dorsal bundles at their emergence from the pubic rami. Results At the distal point of the clitoral body, the width of the dorsal nerve and artery was 1.9 ± 0.3 mm and 0.9 ± 0.2 mm, respectively. The total length of the dorsal bundles was 6.6 cm (± 0.4). The midpart of the suspensory ligament was sectioned, which allowed a mean anteroposterior mobility of 2.7 cm (± 0.2). Extensive dissection of the neurovascular bundles up to their point of emergence from the suspensory ligament allowed a mean mobility of 3.4 ± 0.2 cm. Conclusion We described the anatomical characteristics of the dorsal nerve and artery of the clitoris and the mobility of the clitoral neurovascular flap for reconstruction post clitoridectomy. This was done to restore the anatomic position of the glans clitoris while preserving and potentially restoring clitoral function in patients with female genital mutilation.

Epidemiology and evaluation of the importance of surgical margins in the treatment of vulvar H-SIL - analysis of own data.The prospective study included women dia-gnosed with HPV-associated vulvar epithelial neoplasia from 10/2016 to 1/2022. A total of 65 women were included. After surgical treatment, the women were distributed to groups according to surgical margins and were followed-up at regular intervals.Seventeen women (26%) dia-gnosed with HPV-associated vulvar intraepithelial neoplasia were under 49 years, whereas 48 women (74%) were older than 49 years. Recurrence rates of HPV-associated precancers were 12.3%, 1.5% and 3.1% in excisions with positive margins up to 1mm peripheral margins and 1-3mm peripheral margins, respectively. The risk of recurrence when the lesion reaches the margin is statistically significant, compared to a healthy margin of 1-3mm.Keeping the minimal healthy margin (1-3mm) seems to be an acceptable risk of recurrence of HPV-associated vulvar intraepithelial neoplasia with positive cosmetic effect and minimal risk of disturbing the psychosexual functions of women. Long-term regular follow-up is necessary.

[421] Cordia fulva I.M.Johnst. J. Arnold Arbor. 16 (1): 20 [25 Jan. 1935] (Johnston 1935). NOTE. — Known only from the Guiana Shield. HERBARIUM DATA (FG). — 3 collections at CAY.Sel.exs.: E.M. Mélinon 137, 1877 (holo-, GH[GH00095576]; iso-, GH[GH00095577]). INVENTORY DATA (FG). — 1 tree, dbh = 27.7 cm., Published as part of Molino, Jean-François, Sabatier, Daniel, Grenand, Pierre, Engel, Julien, Frame, Dawn, Delprete, Piero G., Fleury, Marie, Odonne, Guillaume, Davy, Damien, Lucas, Eve J. & Martin, Claire A., 2022, An annotated checklist of the tree species of French Guiana, including vernacular nomenclature, pp. 345-903 in Adansonia (3) (3) 44 (26) on pages 444-445, DOI: 10.5252/adansonia2022v44a26, http://zenodo.org/record/7458777

Development of the Caenorhabditis elegans reproductive tract is orchestrated by the anchor cell (AC). This occurs in part through a cell invasion event that connects the uterine and vulval tissues. Several key transcription factors regulate AC invasion, such as EGL-43, HLH-2, and NHR-67. Specifically, these transcription factors function together to maintain the post-mitotic state of the AC, a requirement for AC invasion. Recently, a mechanistic connection has been made between loss of EGL-43 and AC cell-cycle entry. The current model states that EGL-43 represses LIN-12 (Notch) expression to prevent AC proliferation, suggesting that Notch signaling has mitogenic effects in the invasive AC. To reexamine the relationship between EGL-43 and LIN-12, we first designed and implemented a heterologous co-expression system called AIDHB that combines the auxin-inducible degron (AID) system of plants with a live cell-cycle sensor based on human DNA helicase B (DHB). After validating AIDHB using AID-tagged GFP, we sought to test it by using AID-tagged alleles of egl-43 and lin-12. Auxin-induced degradation of either EGL-43 or LIN-12 resulted in the expected AC phenotypes. Lastly, we seized the opportunity to pair AIDHB with RNAi to co-deplete LIN-12 and EGL-43, respectively, which revealed that LIN-12 is not required for AC proliferation following loss of EGL-43.