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Vulvar Anatomy

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41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. Urological Trauma

41 Blunt scrotal trauma 41 Testicular dislocation 41 Haematocoele 41 Testicular rupture 41 Penetrating scrotal trauma 42 4.5.5 Genital trauma in females 42 Blunt vulvar injuries 42 4.5.6 Conclusion and recommendations for genital trauma 42 5. POLYTRAUMA, DAMAGE CONTROL AND MASS CASUALTY EVENTS 43 5.1 Introduction 43 5.1.1 The development of major trauma centres 43 Recommendations for polytrauma management 43 5.2 Damage control 43 5.3

2015 European Association of Urology

48. Chronic Pelvic Pain

Clinical examination 35 4.3.1 Investigations 35 4.4 Pain associated with well-defined conditions 35 4.4.1 Dysmenorrhoea 35 4.4.2 Infection 35 4.4.3 Endometriosis and adenomyosis 36 4.4.4 Gynaecological malignancy 36 4.4.5 Injuries related to childbirth 36 4.4.6 Pain associated with pelvic organ prolapse and prolapse surgery 36 4.5 Vaginal and vulvar pain syndromes 37 4.6 Managing chronic gynaecological pain in ill-defined conditions 37 4.7 Summary 37 4.7.1 Conclusions and recommendations (...) A in pelvic pain 41 5.4.3 Sacral neuromodulation and percutaneous tibial nerve stimulation in pelvic pain 41 5.4.4 Intermittent chronic anal pain syndrome 41 5.5 Summary 41 5.5.1 Conclusions and recommendations: anorectal pain syndrome 42 6. PERIPHERAL NERVE PAIN SYNDROMES 43 6.1 Neuropathic pain 43 6.2 Anatomy 44 6.2.1 The posterior subgluteal triangle nerves 44 6.2.2 Branches of the pudendal nerve 44 6.2.3 Anatomical relations of the pudendal nerve 44 6.2.4 Afferent nerves and the genitalia 45 6.2.5

2015 European Association of Urology

49. EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma ? SNMMI Endorsement

],andinadditionthereisasignificantcostreduc- tion [88]. SPECT/CTshould be performed in head and neck melanoma owing to the complex anatomy [83]. Moreover, SPECT/CT is highly recommended for the groin area and recommended for the axillary area because it facilitates the detection of in-transit nodes and aberrant lymphatic drainage stasisinlymph vesselsandconsequentlyfacilitatesthesurgi- cal procedure [2]. In pregnant patients, SPECTwithout a CT scanshouldbeperformedifaninguinaloraxillarynodalbase is to be imaged. However, for the head

2015 Society of Nuclear Medicine and Molecular Imaging

50. Vaginal Cancer Treatment (PDQ®): Health Professional Version

cancer in the United States in 2019:[ ] New cases: 5,350. Deaths: 1,430. Anatomy Normal female reproductive system anatomy. Risk Factors Increasing age is the most important risk factor for most cancers. Other risk factors for vaginal cancer include the following: Human papillomavirus (HPV) infection. SCC of the vagina is associated with a high rate of infection with oncogenic strains of HPV and has many risk factors in common with SCC of the cervix.[ - ] HPV infection has also been described (...) , 2019, pp 1171-1210. Daling JR, Madeleine MM, Schwartz SM, et al.: A population-based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol 84 (2): 263-70, 2002. [ ] Smith JS, Backes DM, Hoots BE, et al.: Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol 113 (4): 917-24, 2009. [ ] Wright VC, Chapman W: Intraepithelial neoplasia of the lower female genital tract: etiology, investigation, and management. Semin Surg

2017 PDQ - NCI's Comprehensive Cancer Database

51. Resection of a vulvar arteriovenous malformation in a premenarchal patient. (Abstract)

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

52. Intratreatment FDG-PET During Radiation Therapy for Gynecologic and Gastrointestinal Cancers

imaging in multiple types of cancers. The current focus will be more specific to certain types of gastrointestinal and gynecologic cancers treated with RT, identified from the prior study to warrant further research. Condition or disease Intervention/treatment Phase Cancer of the Cervix Vulvar Cancer Esophageal Cancer Anal Canal Cancer Other: FDG PET scan Phase 2 Detailed Description: Intra-treatment PETs have only recently been studied in small pilot series. In rectal cancer, a prospective trial from (...) procedures. Unlike CT or MRI (magnetic resonance imaging), techniques that look at anatomy or body form, PET studies metabolic activity or body function. Other Name: PET scan Outcome Measures Go to Primary Outcome Measures : The number of subjects with benefit from an intra-treatment PET-CT [ Time Frame: 4 years ] This benefit lies in the potential to adapt the treatment plan based on an intratreatment PET-CT. This may also be of significant prognostic utility, at an early enough time point

2018 Clinical Trials

53. Safety and Acceptability Study of a Non-Hormonal Ring

requirements including sexual activity/ abstinence and condom use requirements; and Can engage in vaginal intercourse with the participant, with and without condoms, as specified in protocol Vaginal and cervical anatomy that, in the opinion of the investigator, lends itself to easy colposcopy and genital tract sample collection Willing to give voluntary consent, sign an informed consent form and comply with study procedures as required by the protocol Exclusion Criteria: History of hysterectomy Vasectomy (...) STI or pelvic inflammatory disease. Note: Women or male partners with a history of genital herpes or condylomata who have been asymptomatic for at least six months may be considered for eligibility Positive test for Trichomonas vaginalis, Neisseria gonorrhea, Chlamydia trachomatis, or HIV Deep epithelial genital findings such as abrasions, ulcerations, and lacerations, or vesicles suspicious for a sexually transmitted infection Chronic or acute vulvar or vaginal symptoms (pain, irritation

2018 Clinical Trials

54. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society

be associated with VVA. 12,13,17,29,30 Lower urinary tract symptoms and urinary incontinence have beenassociatedwithbothsystemicagingandmenopause. 30,31 The urethra and the bladder trigone are derived embryolo- gically from the same estrogen receptorYdense primitive Menopause, Vol. 21, No. 10, 2014 1065 GENITOURINARY SYNDROME OF MENOPAUSE Copyright © 2014 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. urogenital sinus tissue, as are the vulvar vestibule (...) . 41,42 In the Clarifying Vaginal Atrophy_s Impact on Sex and Relation- ships(CLOSER)onlinesurvey,lessthanhalfofUSrespondents wereawareofavailabletreatments(nonhormonalorhormonal) to improve vaginal discomfort. 28 Collectively, these findings serve to highlight the lack of discussion, the underdiagnosis, and the undertreatment of vulvar, vaginal, sexual, and urinary symptoms associated with menopause. New Terminology After reviewing the clinical and basic science, diagnosis and therapy options

2014 The North American Menopause Society

55. Lymphoscintigraphy and Sentinel Node Localization in Gynecological Cancers ? SNMMI Endorsement

Lymphoscintigraphy and Sentinel Node Localization in Gynecological Cancers ? SNMMI Endorsement GUIDELINES TheEANMclinicalandtechnicalguidelines forlymphoscintigraphyandsentinelnodelocalization ingynaecologicalcancers FrancescoGiammarile &M.FaniBozkurt & DavidCibula &JaumePahisa & WimJ.Oyen & PilarParedes &RenatoValdesOlmos &SergiVidalSicart # Springer-VerlagBerlin Heidelberg 2014 Abstract The accurate harvesting of a sentinel node in gynaecologicalcancer(i.e.vaginal,vulvar,cervical,endome (...) of action based on current knowledge, available re- sources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective. Purpose The aim of this document is to provide general information about sentinel lymph node (SLN) detection in patients with gynaecological cancer. These guidelines describe the proto- cols currently used in clinical routine (vulvar and cervical cancers) and in investigational

2014 Society of Nuclear Medicine and Molecular Imaging

56. Anal Cancer

types 16 and 18. The quadrivalent HPV vaccine, when given prior to HPV exposure, has been shown to reduce the rates of AIN and should be considered in populations at high risk for anal cancer, which includes men who have sex with men, women with cervical or vulvar cancer, or individuals who are immunosuppressed [22]. Prognostic Factors The size of the primary tumor and the presence of nodal or distant metastases are determinates of outcome. Patients with de novo tumors >5 cm are at significantly (...) . Uncommon anal neoplasms. Surg Oncol Clin N Am. 2004;13(2):375-388. 11. Dujovny N, Quiros RM, Saclarides TJ. Anorectal anatomy and embryology. Surg Oncol Clin N Am. 2004;13(2):277-293. 12. Pineda CE, Welton ML. Management of anal dysplasia. In: Ben-Josef E, Koong A, ed. Radiation Medical Rounds: Lower Gastrointestinal Malignancies. Vol 1, Issue 2. New York, NY: Demos Medical Publishing; 2010:399-408. 13. Kuehn PG, Beckett R, Eisenberg H, Reed JF. Hematogenous Metastases from Epidermoid Carcinoma

2013 American College of Radiology

57. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society

on localestrogenaswellasonothermanagementoptionsavailable or in development for symptomatic VVA. If the evidence was contradictory or inadequateto form a conclusion, a consensus- based opinion wasestablished. Once the Panel completed its draft, the Position State- ment was submitted to the NAMS Board of Trustees for additional review, comments, and edits. The Board is com- posed of both clinicians and researchers from multiple spe- cialties and disciplines. The Board approved the Position Statementwithedits,andthePanelrevieweditonefinaltime. ANATOMY (...) neuronsinthevagina.Thisfunctionmayservetodecreasethe discomfort associated with VVA. 11 The term vulvovaginal atrophy refers specifically to the changes in the vaginal and vulvar surfaces that on examina- tion arethin,pale,anddry.Thevaginacannarrowandshorten, and the introitus may constrict, especially in the absence of penetrative sexual activity. The vaginal lining may exhibit petechiae and become thinner (often only a few cell layers thick),lesselastic,andprogressivelysmootherasrugalfolds decrease. Vaginal blood flow diminishes. Although

2013 The North American Menopause Society

58. 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

59. MonaLisa Touch Study

is the ability to demonstrate causality. Background: Genitourinary syndrome of Menopause is a condition of postmenopausal women due to estrogen deprivation which results in progressive worsening of the vaginal and vulvar anatomy with symptoms of vulvar itching or pain during intercourse, vaginal dryness, urinary urgency and frequency and frequent bladder infections. It could ultimately lead to vaginal bleeding, petechial hemorrhages, vaginal narrowing or stenosis and hypertonicity of the pelvic muscles due

2017 Clinical Trials

60. Tridimensional Pelvic Floor Ultrasound and Quality of Life Scores Questionnaires in Nulliparous or Parous Women

. The 3D ultrasound (3D UD) is a non-invasive method, reproductible, and technically easy of evaluate the pelvic floor. Different routes may be used, but the transperineal is the most common. By this route is possible to evaluate the pelvic floor anatomy, as well as its disfunction into deep planes, what we can not afford only with the physical exam. The objective was to evaluate the impact of the delivery on the pelvic floor, by the 3D ultrasound evaluation and to correlate it with the scores (...) (Adult) Sexes Eligible for Study: Female Accepts Healthy Volunteers: Yes Sampling Method: Non-Probability Sample Study Population Reproductive age women, followed in Family Planning Service and Urogynecology Service of Federal of São Paulo University recruited from May 2016 to June 2018. Criteria Inclusion Criteria: age between 18 and 50 reproductive age Exclusion Criteria: bad quality of 3D US images post- menopause vulvovaginitis urinary incontinence Human papillomavirus vulvar disease (condyloma

2017 Clinical Trials

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