Genital filler – the 5Ws – What, Who, Where, When, Why?

Genital filler – the 5Ws – What, Who, Where, When, Why?

Elena Fasola – Orcid

Gyplast Medical Institute, Milan

 

fasolaelena@yahoo.it


DOI: 10.53146/lriog1202110

Abstract

The recent introduction of injectable products in the market, hyaluronic acid based, indicated to counteract the signs and symptoms of tissue atrophy in vulvar area, inevitably generates the need to deepen the subject. The focus will be placed on the biochemical peculiarities and the ractional use of these products, to clarify how they are “processed” before being put on the market and therefore of what is infiltrated into the tissues at the end of the production process; what is the precise anatomical site in which they can be used, for what indications, with what techniques, contraindications and side effects. Among the products based on hyaluronic acid, first it is important to dwell on the big difference between non- cross-linked and cross-linked gels hyaluronic acid based, having themselves two different indications. The firsts are indicated for cutaneous and mucosal atrophy with eutrophication and biostimolating purposes, the seconds are used for iatrogenic scarring results, for example post-episioraffia or for reconstructive purposes in hypo / dystrophies of the fatty body of the Labia Majore and in macroscopic iatrogenic scarring with tissue loss. Also the technique by which they are injected is different (with needle or blunt tip cannula), with different contraindications and side effects. With a practical slant, the author intends to develop the topic with the aim of providing valid help to the doctor in his practical clinic.

Keywords: injectable hyaluronic acid; vulvar filler; atrophy; iatrogenic scarring; needle; cannula.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Covid: related cutaneous and mucosal lesions

Covid: related cutaneous and mucosal lesions, focus on vulvar and perineal area

Gabriella Fabbrocini1 – Orcid, Lucia Gallo2 – Orcid

1 – Dermatological Clinic, Department of Clinical Medicine and Surgery, University of Naples Federico II

Corresponding author: Gabriella Fabbrocini

gabriella.fabbrocini@unina.it


DOI: 10.53146/lriog120219

Abstract

The novel coronavirus disease (COVID-19) is associated with significant morbidity and mortality. While much of the focus has been on the cardiac and pulmonary complications, there are several important dermatologic components that clinicians must be aware of. There are several types of skin findings described in association with COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, purpura, chilblains. While most of these dermatologic findings are self-resolving, they can help increase one’s suspicion for COVID-19. It is important to be aware of the dermatologic manifestations and complications of COVID-19. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications.

Keywords: covid-19; coronavirus; dermatology; skin; mucoses.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Lichen sclerosus

Lichen sclerosus

Paolo Inghirami1 – Orcid, Roberto Senatori– Orcid

1 – Medical Director, Obstetrics and Gynecology, S. Eugenio Hospital, Rome

2 – Freelance Professional, Villa Margherita Nursing Home, Rome

Corresponding author: Paolo Inghirami

inghiramip@tiscali.it


DOI: 10.53146/lriog120218

Abstract

Lichen Sclerosus (LS) is a chronic inflammatory disease of genital and extra-genital muco-cutaneous districts, presenting a double pick of incidence in pre-puberty and peri-post menopausal women. The pathognomonic symptomatology is represented by itch, but also pain, dysuria, restriction of micturition and entry dyspareunia. If not treated, it might cause a significant and permanent subversion of vulvar anatomy with scarring of the clitoral hood, stenosis, and disappearance of skin reliefs. Uncertainty exists around its pathogenesis, however, there are important hypotheses involving an autoimmune target for its formation and progression. The gold standard in treatment is topical steroids. Second line treatment includes calcineurin inhibitors, phototherapy, plated-rich plasma therapy, fractional Co2 laser. Surgery is reserved only for the treatment of obliterative complications such as introital stenosis. Patient education and long follow up have primary importance.

Keywords: lichen sclerosus; itching; topical steroids; differentiated VIN.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Bartholini’s gland cysts

Bartholini’s gland cysts

Franco Anglana – Orcid, Michela Angelucci – Orcid

 

Corresponding Author: Franco Anglana

franco.anglana@gmail.com


DOI: 10.53146/lriog120217

Abstract

Bartholin’s glands are symmetrical vestibular tubular glands that produce a clear, transparent fluid to lubricate the vulval vestibule. When the opening of these glands becomes obstructed, the fluid remains within the gland, causing a cyst. This condition is more frequent in nulliparous women and is rare in menopausal and postmenopausal women. The overall prevalence is 2%, and the average age of the patients is 20-29 years. If the fluid becomes infected with bacteria, the cyst develops an abscess. The most frequently isolated pathogens are Escherichia coli, Neisseria gonorrhoeae and Chlamydia trachomatis. The main symptom is a tender, painful lump near the vaginal opening associated with discomfort while walking or sitting and pain during intercourse. When taking a medical history, doctors should research triggers that might cause the duct to become obstructed (previous infections, poor hygiene, tight clothing, hair removal, oestrogen/progestin use and consequent vulvar atrophy). Bartholin’s cysts are easily diagnosed by clinical examination: no laboratory or radiographic tests are necessary. However, surgery is required to treat them. Marsupialization consists of suturing the cyst wall open to ensure the gland can drain freely, thus restoring its anatomical and functional integrity.

Keywords: cyst; abscess; bartolini gland; vulvar swelling; vulvar neoformation.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Clitoris: target of many vulvar diseases

Clitoris: target of many vulvar diseases

Pietro Lippa1 – Orcid, Federica Frascani2 – Orcid

1 – AIED, Viale Gorizia 14, Rome

2 – BIOS Via Archimede 12, Rome

Corresponding author: Pietro Lippa

dermatologopietrolippa@gmail.com


DOI: 10.53146/lriog120216

Abstract

This article aims to bring attention to how frequently the clitoris, despite being a small anatomical niche within the vulvar region, deserves careful diagnostic observation.
In fact, various inflammatory diseases often originate in the clitoral area and have specific clinical, symptomatic and perceptive characteristics. Lichen planus and scleroatrophic lichen are among the most frequent inflammatory vulvitis to originate in this anatomical region.
We describe in the morphological details all the diagnostic phases of these two pathologies. Often the pathologies affecting the clitoral area are subject to diagnostic delays for subjective reasons of the patients (delays in medical checks, long periods of tolerance of the disorders) or due to lack of attention from clinicians. We want to underline how an early intervention can determine a partial regression of an initial damage, its stabilization and, therefore, an improvement in the patient’s subjective perception with considerable advantages also for the relationship life. The clitoral area, being placed above the vulvar introitus, can very often be subject to in-depth observations. An adequate diagnostic observation, also with the help of the colposcope, a targeted biopsy and a consequent therapeutic behavior suitable for the clinical evolutionary phase in which the pathology itself is located, would also allow to intercept the possible proliferative changes that initially occur indeed in this anatomical site. On the basis of an algorithm based on these observations, it is possible to opt for drug therapy or non-invasive surgical therapy aimed at preventing and removing initially and potentially aggressive lesions.

Keywords: lichen sclerosus; lichen planus; vulva; clitoris; diagnosis; initial forms.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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Vulvar pain and diagnosis of comorbidities

Vulvar pain and diagnosis of comorbidities
Key factors from the Vu-Net study on 1183 cases – part 1

Alessandra Grazziottin1 – Orcid, Dania Gambini 2 – Orcid, Filippo Murina3,4 – Orcid e i ricercatori del gruppo Vu-Net

1 – Director of the  Gynecology and Medical Sexology Center, H. San Raffaele Resnati, Milan

2 – Alessandra Graziottin Foundation for the treatment of pain in women – Onlus

3 – Lower Genital Tract Pathology Service, V. Buzzi Hospital – University of Milan
4 – Italian Vulvodynia Onlus Association

Corresponding author: Alessandra Graziottin

direzione@studiograziottin.it


DOI: 10.53146/lriog120215

Abstract

The Vu-Net (Vulvodynia Network) project is aimed at investigating chronic vul- var pain and its medical and sexual comorbidities, given its remarkable impact on the quality of life of both women and couples. The reported incidence of chronic vulvar pain (lasting 3-6 months) in women is 16%. This cross-sectional study involved 1183 patients with chronic vulvar pain attending 21 Italian medical centers from December 2016 to November 2018. 70.7% of enrolled women were between 20 and 49 years of age. Main diagnoses were spontaneous or provoked vestibulodynia (70.8%) and generalized vulvodynia (27.3%). The main reason for consultation was introital pain on penetration (64.2%), together with associated sexual dysfunctions, such as vaginal dryness (29.8%), hypoactive sexual desire disorder (22.1%) and sexual arousal disorder (21.3%). 48.3% had prolonged pain, lasting 1 to 5 years, with a mean diagnostic delay of 4 years and 7 months. The main comorbidities that emerged from the study include high association with intestinal disorders (94.7%), in particular IBS (27.3%), constipation (23.5%), and food allergies (10.1%); bladder infections (37.4%) including recurrent cystitis (19.5%) and post-coital cystitis (17.9%); recurrent vulvovaginal candidiasis (32%); headache (25.7%); mental disorders (22.6%); allergies (17.5%); endometriosis (11.7%). 77.4% of the Vu-Net patients had previously been treated without improving their condition. The analysis of the comorbidities allows the gynecologist to recognize the clusters of patients that will obtain the best results when treated with a multimodal intervention.

Keywords: chronic vulvar pain; dyspareunia; vulvovaginal candidiasis; comorbidities.


Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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