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van der Meijden WI, Boffa MJ, Ter Harmsel B, Kirtschig G, Lewis F, Moyal-Barracco M, Tiplica GS, Sherrard J. 2021 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2022; 36:952-972. [PMID: 35411963 DOI: 10.1111/jdv.18102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 12/27/2022]
Affiliation(s)
- W I van der Meijden
- Department of Dermatology, Betsi Cadwaladr University Health Board, Bangor, UK
| | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - B Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- Gesundheitszentrum Frauenfeld, Frauenfeld, Switzerland
| | - F Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G-S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Wycombe General Hospital, Bucks, UK
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2
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Kanneganti A, Ismail-Pratt I, Yasin N, Low JJH. Surgical management of recurrent vaginal obliteration due to severe erosive lichen planus. Int J Gynaecol Obstet 2021; 154:368-369. [PMID: 34013977 DOI: 10.1002/ijgo.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Nooraishah Yasin
- Department of Gynaecology Oncology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jeffrey J H Low
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Division of Gynaecologic Oncology, National University Cancer Institute, Singapore
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Spring A, Griffiths D, Nirmal D, Jing G, Marrouche N, Skellett A. Identification and management of vulval problems of the postmenopausal woman - Tips and tricks. Post Reprod Health 2020; 26:155-161. [PMID: 32997591 DOI: 10.1177/2053369120924166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vulval irritation and discomfort can be a common presentation to both primary and secondary care. These symptoms can become increasingly prevalent due to physiological changes, which occur to the female genitalia following menopausal transition or due to inflammatory conditions. The correct diagnosis and management can have a huge impact on the patients' quality of life. However, due to the nature of the symptoms, there can be delayed presentation to healthcare professionals. This article gives an overview of the most common benign vulval conditions in the post-menopausal woman, their clinical features and the diagnosis and initial management.
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Affiliation(s)
- Abigail Spring
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - David Griffiths
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - Daisy Nirmal
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - Gao Jing
- Department of Dermatology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - Nadine Marrouche
- Department of Dermatology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - Anne Skellett
- Department of Dermatology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
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van der Meijden WI, Boffa MJ, Ter Harmsel WA, Kirtschig G, Lewis FM, Moyal-Barracco M, Tiplica GS, Sherrard J. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol 2017; 31:925-941. [PMID: 28164373 DOI: 10.1111/jdv.14096] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022]
Abstract
Vulval conditions may present to a variety of clinicians, such as dermatologists, gynaecologists and general practitioners. Women with these conditions are best managed by a multidisciplinary approach, which includes clear referral pathways between disciplines or access to a specialist multidisciplinary vulval service. Informed consent is a prerequisite for all examinations, investigations and treatments. Consent is particularly important for intimate examinations of the anogenital area, and a chaperone should be offered in all cases. All efforts should be made to maintain a patient's dignity. Depending on symptoms and risk factors, screening for sexually transmitted infections (STI) should be considered. If the patient presents with vulval itch, particularly if also complaining of increased vaginal discharge, vulvaginal candidiasis should be excluded. Sexual dysfunction should be considered in all patients with vulval complaints, either as the cause of the symptoms or secondary to symptoms, and assessed if appropriate. This guideline covers several aspects, such as diagnosis and treatment, of the more common vulval conditions (relatively) often encountered at vulval clinics, i.e. vulval dermatitis (eczema), psoriasis, lichen simplex chronicus, lichen sclerosus, lichen planus, vulvodynia and vulval intraepithelial neoplasia (VIN).
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - W A Ter Harmsel
- Department of Gynaecology, Roosevelt kliniek, Leiden, The Netherlands
| | - G Kirtschig
- University Hospital of Tübingen, Tübingen, Germany
| | - F M Lewis
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London and Frimley Health NHS Trust, London, UK
| | - M Moyal-Barracco
- Department of Dermatology, Tarnier-Cochin Hospital, Paris, France
| | - G S Tiplica
- Dermatology 2, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - J Sherrard
- Department of Sexual Health, Churchill Hospital, Oxford, UK
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Roth TM. Surgical management of vulvovaginal agglutination due to lichen planus. Am J Obstet Gynecol 2016; 215:251. [PMID: 27094966 DOI: 10.1016/j.ajog.2016.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ted M Roth
- Central Maine Urogynecology/The Bladder Control Center, Central Maine Medical Center, Lewiston, ME.
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Fairchild PS, Haefner HK. Reply. Am J Obstet Gynecol 2016; 215:251-2. [PMID: 27085515 DOI: 10.1016/j.ajog.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Pamela S Fairchild
- Female Pelvic Medicine and Reconstructive Surgery, University of Michigan, Ann Arbor, MI.
| | - Hope K Haefner
- Center for Vulvar Diseases, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Krapf JM, Goldstein AT. Vulvar Dermatoses: Diagnosis, Management, and Impact on Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0090-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Fairchild PS, Haefner HK. Surgical management of vulvovaginal agglutination due to lichen planus. Am J Obstet Gynecol 2016; 214:289.e1-289.e2. [PMID: 26348378 DOI: 10.1016/j.ajog.2015.08.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022]
Abstract
Lichen planus is a rare dermatological disorder that is often associated with painful and disfiguring vulvovaginal effects. At the University of Michigan Center for Vulvar Diseases, we see many women with vulvovaginal lichen planus each year, with marked scarring and vulvovaginal agglutination that precludes vaginal intercourse and causes difficulty with urination. Through our experience, we developed a protocol for the operative management and postoperative care for severe vulvovaginal agglutination. Our objective is to share this protocol with a wider audience so that providers who see patients with these devastating effects of lichen planus can benefit from our experience to better serve this patient population. The figure represents a case of erosive lichen planus with early vaginal agglutination. The video reviews the pathophysiology and presentation of lichen planus. We then present a case of scarring and agglutination in a young woman, including our surgical management and postoperative care recommendations.
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Affiliation(s)
- Pamela S Fairchild
- Department of Obstetrics and Gynecology, Female Pelvic Medicine, and Reconstructive Surgery, University of Michigan, Ann Arbor, MI.
| | - Hope K Haefner
- Department of Obstetrics and Gynecology, Center for Vulvar Diseases, University of Michigan, Ann Arbor, MI
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Postoperative Sexual Concerns and Functioning in Patients Who Underwent Lysis of Vulvovaginal Adhesions. J Low Genit Tract Dis 2013; 17:33-7. [DOI: 10.1097/lgt.0b013e318252d347] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A retrospective study of 95 women with a clinical diagnosis of genital lichen planus. J Low Genit Tract Dis 2011; 14:323-8. [PMID: 20885160 DOI: 10.1097/lgt.0b013e3181d73622] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this retrospective clinical study was to evaluate clinical features, histopathology, treatment regimen, and follow-up in 95 patients with genital lichen planus. MATERIALS AND METHODS We retrospectively analyzed data of 95 women diagnosed with genital lichen planus and visiting the vulvar clinic at Erasmus MC, Rotterdam, the Netherlands. RESULTS All patients were symptomatic, most often complaining of vulvar soreness and burning (31.6%). Of all women, 34% had persistent symptoms for more than 5 years. On physical examination, 81.1% showed sharply demarcated erythematous lesions, usually located at the vestibule, and 56.8% had oral lesions. Treatment usually consisted of potent topical corticosteroids. Seventeen women (17.9%) were referred to the gynecology department for additional surgical treatment. In two of them, a vulvar squamous cell carcinoma was detected, followed by radical surgery. CONCLUSIONS In cases with vulvar soreness and burning, sharply demarcated erythematous vulvar lesions, and the concomitant presence of oral lesions, the diagnosis of lichen planus should be considered and treatment must be initiated accordingly, even when histopathology is discordant.
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Abstract
Vaginal strictures are generally difficult to manage and tend to reccur despite appropriate initial therapy. Vaginal dilation with or without surgery is the main stay of treatment. Causes, diagnosis and management of the vulvovaginal strictures are presented.
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