1
|
Ostertag-Hill CA, Mulliken JB, Dickie BH, Fishman SJ. Surgical Resection of Vulvar Labial Venous Malformations: A Single Center Experience. J Pediatr Surg 2023; 58:2038-2042. [PMID: 37029024 DOI: 10.1016/j.jpedsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Venous malformations (VMs) involving the vulva are rare but often cause debilitating pain, aesthetic concern, and functional impairment. Treatment with medical therapy, sclerotherapy, operative resection, or a combination thereof may be considered. The optimal therapeutic approach remains unclear. We report our experience resecting labial VMs in a large cohort of patients. METHODS A retrospective review of patients who underwent partial or complete resection of a labial VM was conducted. RESULTS Thirty-one patients underwent forty-three resections of vulvar VMs between 1998 and 2022. Physical examination and imaging demonstrated: 16% of patients had focal labial lesions, 6% had multifocal labial lesions, and 77% had extensive labial lesions. Indications for intervention included pain (83%), appearance (21%), functional impairment (17%), bleeding (10%), and cellulitis (7%). Sixty-one percent of patients underwent a single resection, 13% multiple partial resections, and 26% a combination of sclerotherapy and operative resection(s). Median age was 16.3 years at first operation. All patients requiring multiple operations had extensive VMs. Median blood loss was 200 mL. Postoperative complications included wound infection/dehiscence (14%), hematoma (2%), and urinary tract infection (2%). The median follow-up assessment was 14 months: 88% of patients had no complaints and 3 patients were experiencing recurrent discomfort. CONCLUSIONS Surgical resection is a safe and effective approach to treating vulvar labial VMs. Patients with focal or multifocal VMs can be successfully treated with a single resection, whereas patients with an extensive VM may require multiple partial resections or combined sclerotherapy and resection(s) to achieve long-term control. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - John B Mulliken
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Belinda H Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Steven J Fishman
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
| |
Collapse
|
2
|
Laurian C, Bisdorff A, Toni F, Massoni C, Cerceau P, Paraskevas N. Surgical treatment of vulvar venous malformations without preoperative sclerotherapy: Outcomes of 18 patients. J Gynecol Obstet Hum Reprod 2020; 50:102007. [PMID: 33242680 DOI: 10.1016/j.jogoh.2020.102007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our aim was to evaluate the benefit of surgical resection of the venous malformations (VMs) of the external female genitalia. METHODS Over the period of 2009-2019, 18 consecutive females underwent surgical resection for vulvar VM. Evaluations included preoperative Doppler ultrasound, MRI, and pre-and postoperative photographic imaging. The main outcomes were: residual pain, cosmetic distortion, residual VM, and quality of life. RESULTS Over a 10 year periods, 18 females, mean age 35 years (range 9-71) were included in this study. All patients were symptomatic: 16 had intermittent pain or discomfort, 1 had bleeding and 2 requested cosmetic treatment. Of these cases, there were 5 isolated vulvar VM, 12 associated VM: 3 of the clitoral hood, 3 troncular pelvic vein insufficiency and 12 of the lower limb. Eight patients had undergone previous procedures: 2 sclerotherapy treatments (1-3 sessions), 4 partial surgical resections. There were 18 single resections in the vulva (7 focal, 11 complete), 2 partial resections in clitoral hood and 2 had resection of a VM in the perirtoneovaginal canal at the same time. The mean follow-up was 42. 9 months (range 6-120). Two patients were lost to followup at 6 months. For all patients, elimination of pain and soft tissue redundancy was achieved. Two patients had persistent discomfort and 2 requested cosmetic treatment. CONCLUSION Surgical resection of vulvar VM can be the best approach with few postoperative complications, good functional and cosmetic results. Appropriate preoperative evaluation is required to identify isolated VM or VM associated with ovarian vein or internal iliac vein insufficiency requiring to be treated before surgery.
Collapse
Affiliation(s)
- Claude Laurian
- Interdisciplinary Study Group for Vascular Malformations, Lariboisiere, Bichat, Saint-Joseph Hospitals, Alma Clinic, Paris, France; Department of Vascular Surgery - Saint Joseph Hospital, Clinic Alma Paris, 189 rue R. Losserand, Paris, 75014, France; Alma Clinic, 166 rue de l'Université, Paris 75007, France.
| | - Annouk Bisdorff
- Interdisciplinary Study Group for Vascular Malformations, Lariboisiere, Bichat, Saint-Joseph Hospitals, Alma Clinic, Paris, France; Department of Neuroradiology - Lariboisère Hospital, 2 rue Ambroise Pare, 75475 Paris Cedex 10, France.
| | - Francesca Toni
- Interdisciplinary Study Group for Vascular Malformations, Lariboisiere, Bichat, Saint-Joseph Hospitals, Alma Clinic, Paris, France; Alma Clinic, 166 rue de l'Université, Paris 75007, France.
| | - Claudine Massoni
- Interdisciplinary Study Group for Vascular Malformations, Lariboisiere, Bichat, Saint-Joseph Hospitals, Alma Clinic, Paris, France; Ultrasonography Center, 7 rue Chalgrin, Paris 75016, France.
| | - Pierre Cerceau
- Interdisciplinary Study Group for Vascular Malformations, Lariboisiere, Bichat, Saint-Joseph Hospitals, Alma Clinic, Paris, France; Department of Vascular Surgery - Bichat Hospital, 46 rue H. Huchard, Paris 75018, France.
| | - Nikos Paraskevas
- Interdisciplinary Study Group for Vascular Malformations, Lariboisiere, Bichat, Saint-Joseph Hospitals, Alma Clinic, Paris, France; Department of Vascular Surgery - Bichat Hospital, 46 rue H. Huchard, Paris 75018, France.
| |
Collapse
|
3
|
Ellibeş Kaya A, Doğan O, Yassa M, Başbuğ A, Özcan C, Çalışkan E. Do external female genital measurements affect genital perception and sexual function and orgasm? Turk J Obstet Gynecol 2020; 17:175-181. [PMID: 33072421 PMCID: PMC7538817 DOI: 10.4274/tjod.galenos.2020.89896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023] Open
Abstract
Objective: To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception. Materials and Methods: This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured. Results: The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores. Conclusion: The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes.
Collapse
Affiliation(s)
- Aşkı Ellibeş Kaya
- Düzce University Hospital, Clinic of Obstetrics and Gynecology, Düzce, Turkey
| | | | - Murat Yassa
- University of Health Sciences Turkey, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Alper Başbuğ
- Düzce University Hospital, Clinic of Obstetrics and Gynecology, Düzce, Turkey
| | | | - Eray Çalışkan
- Okan University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| |
Collapse
|
4
|
Vieiralves RR, Ribeiro GS, Alves EF, Sampaio FJ, Favorito LA. Are anogenital distance and external female genitalia development changed in neural tube defects? Study in human fetuses. J Pediatr Urol 2020; 16:654.e1-654.e8. [PMID: 32747310 DOI: 10.1016/j.jpurol.2020.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anogenital distance (AGD), the distance from the anus to the genitals, is a marker of normal genital development. AGD and other biometric parameters of external female genitalia are important as ultrasonographic markers that can determine fetal gender in the first trimester. Neural tube defects are one of the commonest congenital malformations of the central nervous system, with anencephaly being the most severe defect. Female genitalia development and their association with anencephaly have not been previously described. AIM The aim of this study was to compare the biometric parameters of external female genitalia in fetuses with anencephaly and compare it to the parameters of normocephalic fetuses at different gestational ages. STUDY DESIGN We studied 34 female fetuses, 22 normocephalic and 12 anencephalic, aged between 12 and 22 weeks post-conception. The fetuses were placed in the classic lithotomy position and before the fetal dissection, the external female genitalia were photographed with a digital camera. Biometric parameters were recorded and measurements were performed using the Image J software, version 1.46r. Clitoral length and width, clitoris to anus distance, vaginal opening length and width, vaginal opening to labia majora distance, and AGD were measured (Figure). For statistical analysis, the Wilcoxon-Mann-Whitney test was used (p < 0.05). RESULTS We observed a significant difference between some measurements of the groups: the vaginal opening width was significantly greater in anencephalic fetuses and the vaginal opening length, clitoris to anus distance and vaginal opening to labia majora distance were significantly greater in normocephalic fetuses. For the clitoris length and width, we did not find statistical differences. We also did not find statistical significance in AGD between groups (normocephalic 2.32 mm [2.46-6.42/SD = 2.17] vs. anencephalic 3.93 mm [1.15-6.65/SD = 1.93]; p = 0.499). The linear regression analysis indicated that AGD increased more with age in anencephalic than in the normocephalic group, but without significant differences (r2 = 0.01677; p < 0.318). DISCUSSION This article is the first to report the female external genitalia parameters in fetuses with anencephaly. In our study we observed some alterations in biometry of the external genitalia in anencephalic fetuses, with a pattern of morphological reduction in this group. The vaginal opening length, clitoris to anus distance and vaginal opening to labia majora distance were significantly lower in anencephalic fetuses but we did not find statistical significance in clitoris measurements and AGD. CONCLUSIONS Anencephalic fetuses had some alterations in external genitalia development, but the anogenital distances did vary significantly between the groups.
Collapse
Affiliation(s)
| | - Gisele S Ribeiro
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
| | - Edilaine F Alves
- Urogenital Research Unit, State University of Rio de Janeiro, Brazil
| | | | | |
Collapse
|
5
|
Özgüner G, Öztürk K, Bilkay C, Dursun A, Sulak O, Koyuncu E. Appearance of external genital organs and types of hymen in Turkish female foetal cadavers. J OBSTET GYNAECOL 2016; 37:215-222. [PMID: 27866459 DOI: 10.1080/01443615.2016.1233945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The present study's purpose was to determine the size and morphometric development of the female external genital organs on foetal cadavers. Dimensions of labia majora, labia minora and clitoris, bilabial diameter, vertical and horizontal diameters of hymenal opening, distance between the external urethral orifice and hymenal opening, distance between the clitoris and external urethral orifice and anogenital distance were measured. The hymenal types were determined. Mean values of parameters according to gestational weeks, months and trimesters were calculated. Imperforate hymen were determined in the first trimester. Twenty-eight foetuses with annular hymen, 25 foetuses with imperforate hymen, and 1 foetus with septated hymen were determined in the second trimester. Twenty-four foetuses with annular hymen, 3 foetuses with imperforate hymen, 1 foetus with fimbriated hymen, and 1 foetus with hymenal tag were determined in the third trimester. All foetuses in the full term were determined with annular hymen.
Collapse
Affiliation(s)
- Gülnur Özgüner
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Kenan Öztürk
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Cemil Bilkay
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Ahmet Dursun
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Osman Sulak
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| | - Esra Koyuncu
- a Department of Anatomy, Faculty of Medicine , Süleyman Demirel University , Isparta , Turkey
| |
Collapse
|
6
|
Yavagal S, de Farias TF, Medina CA, Takacs P. Normal vulvovaginal, perineal, and pelvic anatomy with reconstructive considerations. Semin Plast Surg 2012; 25:121-9. [PMID: 22547969 DOI: 10.1055/s-0031-1281481] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora, clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes, and ovaries with their visceral fascia. The visceral fascia also called the endopelvic fascia, surrounds the pelvic organs and connects them to the pelvic walls. It is continuous with the paraurethral and paravaginal fascia, which is attached to the perineal membrane. Thus, the internal and external genitalia are closely related to the muscles and fascia, and work as one functioning unit.
Collapse
|