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According to the National Institutes of Cancer, there were an estimated 3,460 new cases in the United States in 2008 and approximately 870 deaths. Of concern is the dramatic rate at which vulvar cancer is rising. [ABSTRACT FROM AUTHOR]

Objective: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his or her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions.Accme Accreditation: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this continuing medical education activity for 1 hour Category I credit of the ASCCP's Program for Continuing Professional Development and the Physician's Recognition Award of the American Medical Association. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements.Disclosure: Faculty must disclose any significant financial interest or relationship with proprietary entities that may have a direct relationship to the subject matter. For this course, the author had no such relationship to report. [ABSTRACT FROM AUTHOR]

Objective: The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV), and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goals were to summarize the literature on anal cancer, HSIL, and HPV infection in women and to provide screening recommendations in women., Methods: A group of experts convened by the American Society for Colposcopy and Cervical Pathology and the International Anal Neoplasia Society reviewed the literature on anal HPV infection, anal SIL, and anal cancer in women., Results: Anal HPV infection is common in women but is relatively transient in most. The risk of anal HSIL and cancer varies considerably by risk group, with human immunodeficiency virus-infected women and those with a history of lower genital tract neoplasia at highest risk compared with the general population., Conclusions: While there are no data yet to demonstrate that identification and treatment of anal HSIL leads to reduced risk of anal cancer, women in groups at the highest risk should be queried for anal cancer symptoms and required to have digital anorectal examinations to detect anal cancers. Human immunodeficiency virus-infected women and women with lower genital tract neoplasia may be considered for screening with anal cytology with triage to treatment if HSIL is diagnosed. Healthy women with no known risk factors or anal cancer symptoms do not need to be routinely screened for anal cancer or anal HSIL.

Vulvovaginal pain problems are major health concerns in women of childbearing age. Controlled studies have shown that vulvovaginal pain can adversely affect women and their partners' general psychological well-being, relationship adjustment, and overall quality of life. These women have significantly lower levels of sexual desire, arousal, and satisfaction, as well as a lower intercourse frequency than normal controls. They also report more anxiety and depression, in addition to more distress about their body image and genital self-image. Empirical studies indicate that specific psychological and relationship factors may increase vulvovaginal pain intensity and its psychosexual sequelae. Randomized clinical trials have shown that psychosexual interventions, namely cognitive-behavioral therapy (CBT), are efficacious in reducing vulvovaginal pain and improving associated psychosexual outcomes. Women reporting significant psychological, sexual, and/or relationship distress should be referred for psychosexual treatment. A multimodal approach to care integrating psychosexual and medical management is thought to be optimal., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To explore women's experiences with vulvar intraepithelial neoplasia during diagnosis and treatment., Design: Two focus groups, each with 3 participants, were conducted as a pilot study. Participants were asked open-ended questions about their experiences, quality of life, sexual functioning, body image, and well-being. Responses were audio taped, transcribed, and independently analyzed by 2 researchers to identify themes and develop categories of the participants' experiences., Setting: Participants were recruited from an urban oncology clinic., Patients/participants: The study population consisted of 6 White women ranging in age from 22 to 72 years., Methods: Participants with a diagnosis of vulvar intraepithelial neoplasia were recruited using flyers posted in their oncologist's office. An interview guide was used focusing on participants' experiences., Results: Participants described a cyclic journey with vulvar intraepithelial neoplasia related to the recurrent nature of the disease. Two internal influences on the journey were described: spirituality and time in life. Five external influences were discussed: significant others, health care providers, family, friends, and others with vulvar intraepithelial neoplasia., Conclusion: Health care providers cannot alter the recurrent nature of vulvar intraepithelial neoplasia; however, they can better understand a woman's experience and the variables that impact her experience in a negative or positive way.

As aesthetic labial reduction is becoming a more common practice, it is necessary to look at the state of the science, what we know, and, more importantly, what we do not know about this practice. This article reviews the literature to date on labial reduction and describes the concerns related to the lack of understanding of the outcomes associated with this procedure.

Objectives: The objectives were to evaluate associations between size of excision, grade of VIN, demographic variables, location of excision and laterality and sexual function and quality of life (QOL) in women with vulvar intraepithelial neoplasia (VIN) following vulvar excision., Methods: Forty-three women with VIN who had undergone a vulvar excision completed the Female Sexual Function Index (FSFI) and the European Organization for Research and Treatment of Cancer QLQ-C30 (QLQ C-30) scale to provide an assessment of sexual function and QOL. Medical records of the participants were reviewed for pathology results, operative reports, and medication history. Correlation and multiple regression analyses were performed to determine associations between collected variables and sexual function and QOL scores., Results: Most participants (n=43) were Caucasian (76.6%) and smoked (69.8%). Age significantly correlated with FSFI total score (Pearson r=-.470, p=.001), along with size of excision (r=-.412, p=.009). Neither VIN grade, location of excision, nor time since excision correlated with sexual function or QOL., Conclusions: Older age and a more extensive vulvar excision were associated with poorer sexual function and QOL in women following surgical treatment for VIN. Further study with a larger sample and additional variables is needed to better understand the effect of vulvar excision on women's sexual function and QOL.

Objective: To compare sexualfunction and quality of life (QOL) in women with vulvar excision for vulvar intraepithelial neoplasia (VIN) with those in an age-matched, healthy comparison group., Study Design: This cross-sectional study contrasted women (n = 43) after vulvar excision for VIN with a healthy comparison group (n = 43). Participants were asked to complete the Female Sexual Function Index (FSFI) and the European Organization for Research and Treatment of Cancer QLQ-C30 to provide an assessment of sexual function and quality of life. Medical records of the participants were reviewed for pathology results, operative reports and medication history. Women with VIN were age matched +/- 2 years with healthy women attending a breast screening clinic., Results: Most participants were Caucasian (76.6%) and smoked (69.8%). Women after excision had poorer scores in sexual function (p = 0.015) and QOL (p = 0.003) than healthy women., Conclusion: Impairment of sexual function after vulvar excision for VIN appears to be of the psychologic domain, providing hope that counseling can have a meaningful impact for these women.

The present investigation extends the validation of the Female Sexual Function Index (FSFI; Rosen et al., 2000) to include women with vulvar excisions for vulvar intraepithelial neoplasia (VIN). No instrument previously has been validated in this population. We administered the instrument to 43 women (n = 43) with VIN treated with vulvar excision and age-matched healthy controls (n = 43). We found the FSFI to have high reliability and validity in the VIN excision population. Discriminant validity and internal consistency were within acceptable ranges. Using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C-30; Agronson et al., 1993) and the FSFI in this population, we found a correlation between a related construct of quality of life and sexual function.

The human papillomavirus (HPV) is the cause of virtually all cancers of the cervix, the fourth most common cancer in women in the United States. HPV is sexually transmitted, and the lifetime risk of contracting the virus is estimated to be 75%-90%. New methods of detecting HPV infection and cellular changes (dysplasia) caused by HPV can greatly reduce the mortality associated with this virus. More than 100 types of HPV exist and may be classified as low-, intermediate-, or high-risk in terms of causing cancer. The virus can cause genital warts, subclinical dysplasia, and cancer. Nurses play an important role in educating patients regarding HPV and preventive measures as well as in screening and treatment. Most women diagnosed with HPV need emotional support and factual information provided in a supportive, nonjudgmental manner. Nurses can meet this challenge and make a difference in reducing the incidence and mortality of cervical cancer.