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Vulvar Anatomy

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21. Benign Vulvar Lesions (Overview)

Benign Vulvar Lesions (Overview) Benign Vulvar Lesions: Overview, Etiology and Pathophysiology, Clinical History and Physical Findings Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjY0NjQ4LW92ZXJ2aWV3 processing (...) > Benign Vulvar Lesions Updated: Apr 05, 2019 Author: Robert A Schwartz, MD, MPH; Chief Editor: Michel E Rivlin, MD Share Email Print Feedback Close Sections Sections Benign Vulvar Lesions Overview Overview In the last few years, interest in vulvar disease has greatly increased. However, the relevant material has been scattered throughout the literature of various specialties, including dermatology, genitourinary medicine, gynecology, and pathology. The spectrum of involved specialties reflects

2014 eMedicine.com

22. Vulvar-Vaginal Reconstruction (Overview)

fibers. In the nulliparous female, the sagittal dimension of both the vaginal introitus and the perineum is approximately 2 cm. An increase introitus:perineum ration may indicate perineal body disruption, especially in the nulliparous patient. Vulva surface anatomy. Superficial subcutaneous mons. The following image illustrates pertinent vulvar structures deep to the skin. Superficial perineal structures. Take special note of the following features: The perineum can be conveniently conceptualized (...) management of a patient who has sustained perineal trauma, except as necessary to achieve control of hemorrhage, until the patient is sufficiently stable to tolerate general or regional anesthesia. Previous References Propst AM, Thorp JM Jr. Traumatic vulvar hematomas: conservative versus surgical management. South Med J . 1998 Feb. 91(2):144-6. . DeLancey JOL. Surgical anatomy of the female pelvis. Rock JA, Jones HW III, eds. TeLinde's Operative Gynecology . 10th ed. Philadelphia: Lippincott Williams

2014 eMedicine.com

23. Vulvar-Vaginal Reconstruction (Follow-up)

revision may be considered after completion of the healing process but generally should be delayed 3-6 months. Previous References Propst AM, Thorp JM Jr. Traumatic vulvar hematomas: conservative versus surgical management. South Med J . 1998 Feb. 91(2):144-6. . DeLancey JOL. Surgical anatomy of the female pelvis. Rock JA, Jones HW III, eds. TeLinde's Operative Gynecology . 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. 82-112. Gianini GD, Method MW, Christman JE. Traumatic vulvar (...) at . June 24, 2016; Accessed: June 24, 2016. Grant JCB. Grant's Atlas of Anatomy . 6th ed. Philadelphia: Williams & Wilkins Co; 1972. 225. Grisoni ER, Hahn E, Marsh E, et al. Pediatric perineal impalement injuries. J Pediatr Surg . 2000 May. 35(5):702-4. . Negosanti L, Sgarzani R, Fabbri E, et al. Vulvar reconstruction by perforator flaps: algorithm for flap choice based on the topography of the defect. Int J Gynecol Cancer . 2015 Sep. 25(7):1322-7. . Kim SW, Lee WM, Kim JT, Kim YH. Vulvar and vaginal

2014 eMedicine.com

24. Vulvar Lichen Sclerosus

" paper") may be present Last and contiguous anatomy distorted Clitoris and Labia minora may not be visible (buried in surrounding tissue) V. Labs: Biopsy Biopsy especially indicated if squamous cell hyperplasia present Risk of developing of the vulva is 5% in Also biopsy vulvar lesions that fail to heal with management (see below) VI. Differential Diagnosis See Squamous Cell Hyperplasia VII. Associated Conditions: Autoimmune Conditions (present in >20% of cases) or VIII. Management s Initial (first 2 (...) Vulvar Lichen Sclerosus Vulvar Lichen Sclerosus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Vulvar Lichen Sclerosus Vulvar Lichen

2015 FP Notebook

25. The anterior Obturator Artery Perforator (aOAP) flap: Surgical anatomy and application of a method for vulvar reconstruction. (PubMed)

The anterior Obturator Artery Perforator (aOAP) flap: Surgical anatomy and application of a method for vulvar reconstruction. Vulvar reconstruction following oncologic resection is challenging. Some flaps used for reconstruction can show adverse characteristics such as excessive tissue bulk or increased distance to the defect. Region of the sulcus genitofemoralis is of thin and pliable tissue proximate to the vulva. Vasculature and suitability of that region used for vulvar reconstruction were (...) focused in this work.Vascular architecture of the region comprising the sulcus genitofemoralis was examined bilaterally on 10 female corpses (n = 20 specimens). In addition, tissue characteristics and suitability of that region to form a fasciocutaneous flap for vulvar reconstruction were anatomically examined and clinically proven.Vasculature of the sulcus genitofemoralis is reflected by either a musculocutaneous perforator (80%, 16/20) piercing the gracilis muscle or a septocutaneous perforator (20

2010 Gynecologic Oncology

26. Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations (PubMed)

Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations 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

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2011 Seminars in plastic surgery

27. Resection of a vulvar arteriovenous malformation in a premenarchal patient. (PubMed)

Resection of a vulvar arteriovenous malformation in a premenarchal patient. Arteriovenous malformation of the vulva is described in only a few case reports in the literature. Given the complex anatomy of the vulva, arteriovenous malformations in this location present a particularly challenging treatment dilemma.An 11-year-old premenarchal girl with a large vulvar arteriovenous malformation was monitored for several years. After three episodes of bleeding, despite conservative management

2010 Obstetrics and Gynecology

28. Oncologic imaging

Health. All Rights Reserved. 3 Pancreatic Cancer 72 Paraneoplastic Syndrome 74 Penile, Vaginal, and Vulvar Cancers 75 Prostate Cancer 77 Sarcoma of Bone and Soft Tissue 80 Thoracic Cancers – Pleura, Thymus, Heart and Mediastinum 83 Thyroid Cancer 85 Uterine Cancer 88 Codes 91 History 93 Oncologic Imaging Copyright © 2019. AIM Specialty Health. All Rights Reserved. 4 Description and Application of the Guidelines The AIM Clinical Appropriateness Guidelines (hereinafter “the AIM Clinical Appropriateness (...) Complications from prior fiberoptic colonoscopy o Diverticulitis with increased risk of perforation o Failed or incomplete fiberoptic colonoscopy of the entire colon, due to inability to pass the colonoscope proximally (may be secondary to obstructing neoplasm, spasm, redundant colon, altered anatomy or scarring from previous surgery, stricture, or extrinsic compression) o Increased sedation risk, such as chronic obstructive pulmonary disease or previous adverse reaction to anesthesia o Known colonic

2019 AIM Specialty Health

29. Urological Trauma

of Transvaginal Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: Tips for Prevention, Recognition, and Management. Eur Urol Focus, 2016. 2: 260. 201. Inaba, K., et al. Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury. J Trauma Acute Care Surg, 2013. 75: 1019. 202. Latini, J.M., et al. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral (...) fracture urethral injuries. Urology, 2014. 83: S48. 214. Barratt, R.C., et al. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol, 2018. 7: S29. 215. Mundy, A.R., et al. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int, 2011. 108: 310. 216. Mundy, A.R., et al. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int, 2010

2019 European Association of Urology

30. Chronic Pelvic Pain

cystitis. Urology, 2007. 70: 16. 153. Reissing, E.D., et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol, 2005. 26: 107. 154. Nickel , J., et al. Management of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome who have failed traditional management. Rev Urol, 2007. 9: 63. 155. Nickel, J.C., et al. Chronic Prostate Inflammation Predicts Symptom Progression in Patients with Chronic Prostatitis/Chronic Pelvic Pain. J Urol, 2017 (...) colpopexy: management of postoperative pudendal nerve entrapment. Obstet Gynecol, 1996. 88: 713. 218. Fisher, H.W., et al. Nerve injury locations during retropubic sling procedures. Int Urogynecol J, 2011. 22: 439. 219. Moszkowicz, D., et al. Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis, 2011. 13: 1326. 220. Ashton-Miller, J.A., et al. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci, 2007. 1101: 266. 221. Amarenco, G., et al. [Perineal neuropathy

2019 European Association of Urology

31. Appropriate Use Criteria: Imaging of the Chest

features is present: ¦ Lymphatic or venous invasion ¦ Lymph node involvement ¦ Perineural invasion ¦ Poorly differentiated tumor ¦ T4 tumor ¦ Associated with bowel obstruction ¦ Close, indeterminate or positive margins ¦ Fewer than 12 nodes examined at surgery ¦ Localized perforation ? Gynecologic malignancies ? Surveillance imaging in patients with previously treated gynecologic malignancies including ovarian, endometrial, cervical, vaginal or vulvar cancer (Note: This exclusion does not apply (...) al. Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation–initial experience. Radiology. 2005; 234(3): 702-709. 33. Kanne JP, Jensen LE, Mohammed TL, et al.; American College of Radiology Expert Panel on Thoracic Imaging. ACR appropriateness Criteria® radiographically detected solitary pulmonary nodule. J Thorac Imaging. 2013;28(1):W1-W3. 34. Kazerooni EA. High-resolution CT of the lungs. AJR Am J Roentgenol. 2001;177(3):501-519. 35

2018 AIM Specialty Health

32. Müllerian Agenesis: Diagnosis, Management, and Treatment

with the procedure because the initial procedure is more likely to succeed than follow-up procedures. Although vulvar and vaginal intraepithelial neoplasia are possible, routine cytology testing is not regularly recommended because of the lack of a cervix. Sexually active women with müllerian agenesis should be aware that they are at risk of sexually transmitted infections and, thus, condoms should be used for intercourse. Patients should be appropriately screened for sexually transmitted infections according (...) dilation. Cognitive issues that affect adherence to dilation may include the following: limited comprehension of the diagnosis and anatomy, young age, underlying learning disability, and inadequate knowledge of the dilation process. Logistical barriers to successful dilation include lack of privacy and limited ability to travel to clinic for close follow-up. In a study of adolescent girls and women in whom müllerian agenesis was diagnosed, respondents reported lack of motivation, uncertainty

2018 American College of Obstetricians and Gynecologists

33. Appropriate Use Criteria: Imaging of the Abdomen & Pelvis

? Surveillance imaging in patients with previously treated gynecologic malignancies including ovarian, endometrial, cervical, vaginal or vulvar cancer (Note: This exclusion does not apply to sarcoma or other rare histologies not typically associated with these structures). ? Non-Hodgkin’s lymphoma ? Surveillance imaging of non-Hodgkin’s lymphoma for a patient in remission and there has been at least two (2) years since the most recent course of chemotherapy ? Prostate cancer ? Staging of low risk prostate (...) . 2013;19(1):3-26. 36. Mandeville JA, Gnessin E, Lingeman JE. Imaging evaluation in the patient with renal stone disease. Semin Nephrol. 2011 May;31(3):254-258. 37. Marrero JA, Ahn J, Rajender Reddy K. American College of Gastroenterology clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014;109(9):1328-1347. 38. Matsuki M, Kani H, Tatsugami F, et al. Preoperative assessment of vascular anatomy around the stomach by 3D imaging using MDCT before laparoscopy

2018 AIM Specialty Health

34. Clinical Appropriateness Guidelines: Radiation Oncology Brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) treatment guidelines

treatment to a higher dose, the IGRT group was noted to have similar genitourinary and gastrointestinal toxicities. Pre-treatment corrective left-right, anteroposterior and superoinferior shifts were required in 15%, 6% and 19% of cases respectively supporting the use of pre- treatment imaging. The ACR-ASTRO practice parameter for IGRT indicates that “when the target is not clearly visible and bony anatomy is not sufficient for adequate target alignment, fiducial markers may be needed.” For soft tissue (...) bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys. 2005;63(3):800-811. 31. Shah A, Aird E, Shekhdar J. Contribution to normal tissue dose from concomitant radiation for two common kV-CBCT systems and one MVCT system used in radiotherapy. Radiother Oncol. 2012;105(1):139-144. 32. Singh J, Greer PB, White MA, et. al. Treatment-related morbidity in prostate cancer: A comparison of 3-dimensional conformal radiation therapy with and without

2018 AIM Specialty Health

35. Postmenopausal Subacute or Chronic Pelvic Pain

, including pelvic venous disorders (commonly termed pelvic congestion syndrome), intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis versus chronic pain localized to the perineum, vulva, or vagina that arises from suspected vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain. Special Imaging Considerations When there is suspected local pathology in the vulva, perineum, or vaginal wall, translabial/transperineal ultrasound (US (...) of diagnosis for most conditions localized to the vulvar skin [31]. Perineal and vaginal cysts are subcutaneous but often palpable and are appropriately evaluated with either translabial or transvaginal US, or both [8]. As with pelvic pain localized to the deep pelvis, US is widely regarded as the initial imaging study of choice for pelvic pain localized to the perineum, vulva, or vagina, but there is little high-quality evidence specifically supporting its use. US Pelvis Transabdominal As above

2018 American College of Radiology

36. The Utility of and Indications for Routine Pelvic Examination

are needed. Potential Benefits of the Screening Pelvic Examination for Asymptomatic Women Based on expert opinion, potential benefits of the pelvic examination include early detection of treatable gynecologic conditions before symptoms occurring (eg, vulvar or vaginal cancer), as well as incidental findings such as dermatologic changes and foreign bodies. Additionally, screening pelvic examinations in the context of a well-woman visit ( ) may allow gynecologists to explain a patient’s anatomy, reassure

2018 American College of Obstetricians and Gynecologists

37. HTA of extending the HPV vaccination to boys

45 2.5 Detection of HPV 46 2.6 Vaccines 47 2.7 HPV immunisation programmes 51 2.8 Discussion 55 Key points 57 3 Epidemiology 58 3.1 Introduction 58 3.2 Prevalence and natural history of HPV infection 60 3.3 Cervical cancer and precancerous lesions 67 3.4 Vulvar cancer and precancerous lesions 81 3.5 Vaginal cancer and precancerous lesions 85 Health Technology Assessment (HTA) of HPV vaccination of boys Health Information and Quality Authority Page 4 of 450 3.6 Anal and rectal cancer (...) Neoplasia VIN Vulvar Intraepithelial Neoplasia VSD Vaccine Safety Datalink VTE Venous Thromboembolism WHO World Health Organization Health Technology Assessment (HTA) of HPV vaccination of boys Health Information and Quality Authority Page 15 of 450 Advice to the Minister for Health The Health Information and Quality Authority (HIQA) has completed a health technology assessment (HTA) in relation to proposed changes to the national HPV immunisation programme, to offer the vaccine to boys. HIQA agreed

2018 Health Information and Quality Authority

38. The 2017 hormone therapy position statement of The North American Menopause Society

therapy has been shown in RCTs to effectively restore genitourinary tract anatomy, increase superficial vag- inal cells, reduce vaginal pH, and treat symptoms of vulvo- vaginal atrophy (VVA). 32 Key point HormonetherapyisapprovedbyFDAforfourindications: bothersome VMS; prevention of bone loss; hypoestrogen- ism caused by hypogonadism, castration, or POI; and genitourinary symptoms. NAMS POSITION STATEMENT Menopause, Vol. 24, No. 7, 2017 731Copyright @ 2017 The North American Menopause Society

2017 The North American Menopause Society

39. WHO guidelines on the management of health complications from female genital mutilation

practitioner who has little knowledge of female anatomy or how to manage possible adverse events (6) . Moreover, the removal of or damage to healthy genital tissue interferes with the natural 2 WHO guidelines on the management of health complications from female genital mutilation Box 1.1: Types of FGM * Unaltered female genitalia Type I Partial or total removal of the clitoris (clitoridectomy) and/or the prepuce bartholin glands clitoris urethra vaginal introitus perineum anus labia minora labia majora (...) , scarring of the vulvar area may result in pain, including during sexual intercourse (6, 11) (see Box 1.2). In addition to these health risks, a number of procedures and day-to-day activities may be hindered due to anatomical distortions, including gynaecological examinations, cytology testing, post-abortion evacuation of the uterus, intrauterine device (IUD) placement and tampon usage, especially in the case of type III FGM. Providing exact data regarding the direct health impacts of FGM has been

2016 World Health Organisation Guidelines

40. Tropical Travel Trouble 005 RUQ Pain and Jaundice

fistulas, rectovaginal fistulas, and vulvar and penile skin ulcerations can occur as a result of intestinal disease or secondary to sexual transmission. Surgical wounds can become infected if invaded by a nearby or internal amoebic lesion. Trophozoites can be seen under microscopy in fresh ulcer discharge or scrapings of the ulcer edge. Q5. What is the differential diagnosis for Amoebic liver abscess? Answer and interpretation Pyogenic abscess. Primary hepatocellular carcinoma or metastasis to liver (...) abscess (especially if multiple lesions), as adjunct to medical therapy (no response in 72 hours). If rupture is imminent. If the abscess is >/= 10cm, or if the abscess is in left lobe (increased potential to rupture with critical complications). Surgery should be performed for abscess rupture, bacterial superinfection, or if abscess needs aspiration but percutaneous access limited by anatomy. Perforation, toxic megacolon or abscesses that fail medical treatment, all need surgical intervention

2018 Life in the Fast Lane Blog

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