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Bevilacqua F, Selk A, Stockdale C, Vieira-Baptista P, Adedipe T, Bohl T, Marozio L, Borella F, Gallio N, Pollano B, Robba E, Barbierato I, Benedetto C, Preti M. The International Society for the Study of Vulvovaginal Disease (ISSVD) Vulvar Awareness Day Campaign: Knowledge of Vulvovaginal Diseases Among Italian Obstetrics and Gynecology Residents. J Low Genit Tract Dis 2024; 28:91-94. [PMID: 37906606 DOI: 10.1097/lgt.0000000000000777] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES The objective of this study is to investigate vulvovaginal disease (VVD) awareness in Italian obstetrics and gynecology (Ob/Gyn) residents. MATERIALS AND METHODS A 25-question survey on VVD basic knowledge (17 questions) and willingness to improve it (8 questions) was distributed through Ob/Gyn resident online group chats, from different Italian Universities in January 2023. A total number of 250 residents were invited to participate; 124 responses were obtained (response rate: 50%). Data were collected and analyzed using descriptive statistics through REDCap. RESULTS Overall, 87 of the 124 respondents (70%) fully completed the questionnaire and represented the study group. Residents were distributed among years of residency: 15% first year, 31% second year, 23% third year, 11% fourth year, and 20% fifth year. Most (60%) never attended a VVD clinic during residency, with an increasing percentage of attendance in later residency years (15% at first year vs 65% at fifth).Participants reported low knowledge of vulvar precancerous lesions and vulvoscopy but better knowledge of vaginitis, vulvar self-examination, and lichen sclerosus. Of the respondents, 50% were not satisfied with the education provided during residency, and more than 60% lacked confidence in managing VVD.All participants expressed a strong desire to improve their knowledge and skills, with 100% agreeing that every gynecologist should know the "basics" and 98% wanting to improve their knowledge through webinars (45%), lessons (34%), newsletters, and videos (19%). CONCLUSION Our findings indicate a significant need to improve VVD knowledge among Italian Ob/Gyn residents. Further efforts are necessary to provide information about VVD and comprehensive training programs in Italian Universities.
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Affiliation(s)
| | - Amanda Selk
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tolu Adedipe
- Hull University Teaching Hospital NHS Trust, Hull, United Kingdom
| | - Tanja Bohl
- Vulva Clinic, Jean Hailes Medical Centre, Clayton, Victoria, Australia
| | - Luca Marozio
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Fulvio Borella
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Niccolò Gallio
- Department of Surgical Sciences University of Torino, Torino, Italy
| | | | - Eleonora Robba
- Department of Surgical Sciences University of Torino, Torino, Italy
| | | | - Chiara Benedetto
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Mario Preti
- Department of Surgical Sciences University of Torino, Torino, Italy
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2
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Selk A, Elangainesan P, Tannenbaum E, Wong K. "Check Your Vulva"-A Patient Education and Virtual Vulva Care Pilot Project. J Low Genit Tract Dis 2023; 27:390-394. [PMID: 37729049 DOI: 10.1097/lgt.0000000000000770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of the study is to identify whether vulvar self-examination learned from a web site could lead to a self-identification of vulvar lesions and the feasibility of virtual vulvar care with patient submitted photos. MATERIALS AND METHODS The study used a prospective cohort design in a tertiary academic hospital over a 1-year period. Eligible participants who self-identified a vulvar lesion/skin changes were invited to send vulvar photos through a secure patient portal and schedule a phone consult to discuss diagnosis/management. Clinical data, photo interpretability, and patient satisfaction measures were collected. Self-referral patients versus vulva clinic waitlist patients were analyzed separately. RESULTS Few people were interested in submitting vulvar photos online. Twenty-eight participants directly contacted the study, 8 consented, and 6 sent in vulvar photos. Forty four of 476 on the waitlist consented but only 24 of 44 sent in photos (5% of waitlist patients). The median time for a virtual assessment was 7 days for study participants while it was 18 months for the in-person usual care pathway. Most patient submitted photos were assessable. However, 60% participants needed help from another person to take the photos. More than 90% of patients required an in-person visit for their vulvar condition/concerns. While most patients were happy with the virtual process, 58% rated their satisfaction with the ease of taking photos of the genital region as "fair" or "poor." CONCLUSIONS Virtual care with photos/phone calls might be feasible, although most patients are unlikely to participate. Because of patient discomfort, unease with taking photos, and patient privacy concerns, vulvar care should continue to be in-person for most new consults.
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Affiliation(s)
| | | | | | - Karen Wong
- Department of Gynecology, Women's College Hospital, Toronto, Canada
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Improving Colposcopy Education Through Images: A Preliminary Assessment of an Image-Based Mobile App for Colposcopic Education. J Low Genit Tract Dis 2022; 27:78-82. [PMID: 36027576 DOI: 10.1097/lgt.0000000000000696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Colposcopy is an indispensable part of cervical cancer screening. However, in most training programs, there is little by way of a formalized curriculum. We created an image-based teaching tool and hypothesized that this tool, in a mobile app format, would increase resident comfort with colposcopic practice and quantitatively increase their ability to correlate colposcopic images with impressions. MATERIALS AND METHODS This was a pilot study conducted among ObGyn residents during March 2021. Thirty-eight residents participated and were randomized to either an app user or an independent study control group. Both groups were surveyed before and after their assigned training and completed a postintervention standardized cognitive examination. The primary end points were subjective improvements in comfort with colposcopy. The secondary end point was performance on a standardized image quiz. RESULTS Of the 46 targeted residents, 38 participated and 26 completed all elements of the study. On the image examination, app users performed slightly better when compared with the independent study group (mean score, 14.9/25 [SD = 2.15] vs 14.0/25 [SD = 3.27], p = .39). App users also were more likely to be confident in providing an overall colposcopic impression (73% vs 30%, p = .111). One hundred percent of the participants in the app user group said that they would recommend the tool to other residents and residency programs. CONCLUSIONS Image-based teaching tools, such as the ICE-TI app, are valued by learners and can be a useful adjunct to standardized colposcopy curricula. In addition, making use of a mobile platform facilitated convenience learning.
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Schneider A, Böhmer G, Petzel A, Schneider V, Stolte C, Weger V, Ludwig J, Killinger J, Welcker T. Kolposkopie: Können Online-Fortbildungen die Ausbildung sinnvoll unterstützen? Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1750-7464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Achim Schneider
- Institut für Zytologie und Dysplasie, MVZ Fürstenbergkarree, Berlin, Deutschland
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Dmytryshyn J, Selk A. Learning on the Go: Assessing Knowledge Gained From Medical Podcasts Created for Vulvovaginal Disease Education. J Low Genit Tract Dis 2022; 26:164-168. [PMID: 35067582 PMCID: PMC8936150 DOI: 10.1097/lgt.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effectiveness of "The Vulva Diaries" podcast as a novel learning tool for vulvovaginal disease education. MATERIALS AND METHODS Medical students and residents were invited to participate in the study using social media advertisements. Online pretests and posttests, one based on a podcast episode regarding genital herpes and the other on lichen sclerosus, were used to assess changes in knowledge level pre- and post-podcast listening in medical students and residents respectively. A second posttest was sent out 2 weeks after the first to assess knowledge retention. Results were analyzed using paired t tests comparing mean scores before and after podcast. RESULTS In medical students, the average test score increased by 20% (n = 56, p < .001). Similarly, in residents the average test score increased by 23.1% (n = 22, p < .001). Medical students and residents rated their average preference for using podcasts as compared with other resources at 3.6 and 3.7/5, respectively. Furthermore, in both groups, there was no significant difference between average scores for posttest 1 versus posttest 2 written 2 weeks later suggested excellent knowledge retention. CONCLUSIONS "The Vulva Diaries" podcast increases knowledge on vulvovaginal disease and is an effective learning tool for health care trainees in women's health. This study emphasizes the role of podcasts as a valuable educational resource within gynecology. The success of such initiatives will hopefully bolster the effort to correct the lack of provider knowledge in treating vulvovaginal diseases.
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Affiliation(s)
| | - Amanda Selk
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
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Song M, Day T, Kliman L, Otton G, Yap D, Pagano R, Tan Y, Scurry J. Desquamative Inflammatory Vaginitis and Plasma Cell Vulvitis Represent a Spectrum of Hemorrhagic Vestibulovaginitis. J Low Genit Tract Dis 2022; 26:60-67. [PMID: 34928254 PMCID: PMC8719513 DOI: 10.1097/lgt.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Myriarm Song
- Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Tania Day
- Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Len Kliman
- Epworth Freemasons Hospital, East Melbourne, Victoria, Australia
| | - Geoff Otton
- Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Desiree Yap
- Private practice, East Melbourne, Victoria, Australia
| | - Ross Pagano
- Vulvar Disorders and Dermatology Clinic, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Yasmin Tan
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - James Scurry
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- Pathology NSW, Hunter New England, Newcastle, New South Wales, Australia
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Erosive Lichen Sclerosus-A Clinicopathologic Subtype. J Low Genit Tract Dis 2021; 25:255-260. [PMID: 33859124 PMCID: PMC8231666 DOI: 10.1097/lgt.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of the study was to identify whether erosive lichen sclerosus (LS) is a distinct clinicopathologic subtype. Materials and Methods The pathology database was searched for “erosion,” “erosive,” “ulcer,” and “lichen sclerosus.” Inclusion criteria were histopathologic diagnosis of LS and erosion or ulcer overlying a band of hyalinization and/or fibrosis. Exclusions were concurrent neoplasia and insufficient tissue. Histopathologic review documented site, epithelial thickness, adjacent epidermal characteristics, infiltrate, and dermal collagen abnormality. Clinical data included demographics, comorbidities, examination findings, microbiologic results, treatment, and response. Results Ten examples of erosive LS and 15 of ulcerated LS occurred in 24 women with a mean age of 67 years. Ulcerated LS was associated with diabetes and nontreatment at time of biopsy. Clinicians identified red patches in all but 1 case of erosive LS. Ulcerated LS was documented as fissure, ulcer, or white plaque, with 8 (53%) described as lichenified LS with epidermal breaches. Erosive LS favored hairless skin with normal adjacent stratum corneum sloping gently into erosion, whereas most ulcers in LS had an abrupt slope from hair-bearing skin. All cases were treated with topical steroids; 2 patients with erosive LS and 10 with ulcerated LS also had oral antifungals, topical estrogen, antibiotics, and/or lesional excision. Treatment yielded complete resolution in 50%. Conclusions Erosive LS is an unusual clinicopathologic subtype characterized by red patches on hairless skin seen microscopically as eroded epithelium overlying a band of hyalinized or fibrotic collagen. In contrast, ulcerated LS is usually a traumatic secondary effect in an uncontrolled dermatosis.
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Four-decade trends in lymph node status of patients with vulvar squamous cell carcinoma in northern Italy. Sci Rep 2021; 11:5661. [PMID: 33707570 PMCID: PMC7952703 DOI: 10.1038/s41598-021-85030-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/16/2021] [Indexed: 01/25/2023] Open
Abstract
The 4-decade (1980–2017) trends in lymph node status of patients with vulvar squamous cell carcinoma (VSCC) in a province of northern Italy were investigated. Information was collected on lymph node dissection, number of lymph nodes dissected, lymph node involvement, and number of positive lymph nodes from a series of 760 patients admitted to a tertiary referral centre for vulvar disease. The adjusted odds ratios (ORs) for lymph node involvement, for ≥ 2 positive nodes, and for a lymph node ratio ≥ 20% were estimated from multiple logistic regression models. The adjusted OR for lymph node dissection was greater in the 2000s and 2010s versus the 1980s. The adjusted OR for lymph node involvement was 1.36 (95% confidence interval (CI), 0.72–2.60) in the 1990s, 1.31 (95% CI, 0.72–2.38) in the 2000s and 1.32 (95% CI, 0.73–2.41) in the 2010s versus the 1980s. The adjusted OR for ≥ 2 positive nodes was 1.36 (95% CI, 0.68–2.72), 0.86 (95% CI, 0.44–1.65) and 0.67 (95% CI, 0.34–1.31), respectively. The adjusted OR for lymph node ratio ≥ 20% was 1.45 (95% CI, 0.62–3.43), 1.21 (95% CI, 0.54–2.72) and 0.81 (95% CI, 0.35–1.89), respectively. This stagnation indicates the need for a serious rethink of the local model for the care of VSCC.
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Webber V, Miller ME, Gustafson DL, Bajzak K. Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives. Sex Med 2020; 8:757-766. [PMID: 32773263 PMCID: PMC7691876 DOI: 10.1016/j.esxm.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live. AIM We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions. METHODS For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia. MAIN OUTCOME MEASURES The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment. RESULTS Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients' inadequate knowledge of sexual functioning and sociocultural messages regarding "normal" sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments. CONCLUSION While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education. Webber V, Miller ME, Gustafson DL, et al. Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives. Sex Med 2020;8:757-766.
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Affiliation(s)
- Valerie Webber
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | - Michelle E Miller
- Discipline of Obstetrics and Gynecology, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | - Diana L Gustafson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland & Labrador, Canada
| | - Krisztina Bajzak
- Discipline of Obstetrics and Gynecology, Memorial University, St. John's, Newfoundland & Labrador, Canada.
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Adequacy of dermatology and ob-gyn graduate medical education for inflammatory vulvovaginal skin disease: A nationwide needs assessment survey. Int J Womens Dermatol 2020; 6:182-185. [PMID: 32637541 PMCID: PMC7330429 DOI: 10.1016/j.ijwd.2020.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Many patients with inflammatory vulvovaginal skin diseases, such as lichen planus and lichen sclerosus, experience a delay in diagnosis and lack of appropriate treatment. Unfortunately, patients experience significant morbidity with these conditions. Objective The aim of this study was to assess the adequacy of training in vulvar dermatoses for dermatology and obstetrics-gynecology residents (in the United States), with a secondary goal of identifying the most ideal modality to broadly reach these residents with high quality instruction. Methods We created a survey with questions relating to attitudes about training in vulvovaginal disease, quantity of current education on the subject, and opinions on ways to improve training. The survey was distributed to obstetrics-gynecology and dermatology residents and program directors nationwide. Results Most respondents reported that training was not adequate in this area and that additional education was needed. Conclusion We propose that online, interactive, case-based learning modules, created by vulvovaginal experts, could help improve graduate medical education and lead to better patient outcomes.
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Vieira-Baptista P, Lima-Silva J, Pérez-López FR, Preti M, Bornstein J. Vulvodynia: A disease commonly hidden in plain sight. Case Rep Womens Health 2018; 20:e00079. [PMID: 30245974 PMCID: PMC6142188 DOI: 10.1016/j.crwh.2018.e00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/16/2023] Open
Abstract
•Vulvodynia affects at least 6% of women, and can be found at any age and in all ethnic groups.•The diagnosis is one of exclusion but is very often missed.•Women with vulvodynia are frequently misdiagnosed as having vaginismus.•Failure to make the diagnosis often leads to irrelevant or deleterious examinations and treatments.
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Affiliation(s)
- Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Portugal
- Unidade de Tracto Genital Inferior, Serviço de Ginecologia e Obstetrícia, Centro Hospitalar de São João, Porto, Portugal
| | - Joana Lima-Silva
- Unidade de Tracto Genital Inferior, Serviço de Ginecologia e Obstetrícia, Centro Hospitalar de São João, Porto, Portugal
| | - Faustino R. Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine, Lozano-Blesa University Hospital, Zaragoza, Spain
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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