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Vulvar Anatomy

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101. Imperforate Hymen (Diagnosis)

fimbriated, and the mucosal surfaces (ie, introitus, fossa navicularis, vaginal vestibule) are pale pink. Next: Problem Imperforate hymen has been diagnosed with prenatal ultrasound documentation of bladder outlet obstruction due to hydrocolpos or mucocolpos. However, in spite of the recommendations for inspection of the external genitalia during the neonatal and early childhood period, variations in hymenal anatomy commonly escape diagnosis until the time of menarche. See the image below. Imperforate (...) ) Previous Next: Epidemiology Frequency Imperforate hymen is likely the most frequent obstructive anomaly of the female genital tract, but estimates of its frequency vary from 1 case per 1000 population to 1 case per 10,000 population. A population-based study estimated the frequency at 0.5 case per 1000 women (95% confidence interval, 0.3-0.7). [ ] Heger et al examined 147 premenarchal girls with a mean age of 63 months to collect normative data on genital anatomy; an imperforate hymen was found in only

2014 eMedicine.com

102. Incontinence, Urinary: Nonsurgical Therapies (Diagnosis)

Incontinence, Urinary: Nonsurgical Therapies (Diagnosis) Urinary Incontinence: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDUyMjg5LW92ZXJ2aWV3 processing > Urinary (...) have interest or special expertise in these disorders. In the last decade, funding opportunities for incontinence research have increased vastly. Subspecialty professional organizations and journals are now active. Important contributions to the understanding of the structure and functioning of the lower urinary tract include an improved understanding of the anatomy and dynamic functioning of the pelvic floor and its contribution to continence. In addition, much study has been conducted to bolster

2014 eMedicine.com

103. Radiation Therapy in Gynecology (Overview)

to the pelvic sidewall and/or causing hydronephrosis or a nonfunctioning kidney Stage IVA - Invasion of the bladder or rectal mucosa Stage IVB - Distant metastasis (the para-aortic lymph nodes are considered a distant metastatic site) Vulvar cancer The current FIGO/AJCC staging guidelines for vulvar cancer are as follows: Stage IA - Tumor confined to the vulva or perineum and 2 cm or smaller with stromal invasion 1 mm or less, negative nodes Stage IB – Tumor confined to the vulva or perineum, larger than 2 (...) have significantly higher rates of regional lymph node metastases, locoregional and distant-site relapse, and poor outcome. Because direct extension of tumor into adjacent structures limits the ability of surgery to gain clear surgical margins, and the presence of the uterus is critical for the anatomy of brachytherapy insertion in this setting, primary chemoradiotherapy is generally indicated for the management of stage IIB-IVA locally advanced cervical cancer. Tumoral resection with anterior

2014 eMedicine.com

104. Nonneoplastic Epithelial Disorders of the Vulva (Overview)

Nonneoplastic Epithelial Disorders of the Vulva (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

2014 eMedicine.com

105. Normal and Abnormal Puerperium (Overview)

to the nonpregnant state. An overview of the relevant anatomy and physiology in the postpartum period follows. Uterus The pregnant term uterus (not including baby, placenta, fluids, etc) weighs approximately 1000 g. In the 6 weeks following delivery, the uterus recedes to a weight of 50-100 g. Immediately postpartum, the uterine fundus is palpable at or near the level of the maternal umbilicus. Thereafter, most of the reduction in size and weight occurs in the first 2 weeks, at which time the uterus has shrunk (...) sphincter complex as well as the anal epithelium. Any deep perineal laceration noted after a delivery warrants a thorough evaluation including a digital rectal exam to improve the diagnosis of OASIS. Approximately 4% of women have a clinically recognized OASIS immediately after time of vaginal delivery . [ ] Other tears after childbirth include periclitoral, periurethral, and labial lacerations; these should only be repaired to achieve hemostasis or to correct distorted anatomy. Additionally

2014 eMedicine.com

106. Incontinence, Urinary: Nonsurgical Therapies (Overview)

Incontinence, Urinary: Nonsurgical Therapies (Overview) Urinary Incontinence: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDUyMjg5LW92ZXJ2aWV3 processing > Urinary (...) have interest or special expertise in these disorders. In the last decade, funding opportunities for incontinence research have increased vastly. Subspecialty professional organizations and journals are now active. Important contributions to the understanding of the structure and functioning of the lower urinary tract include an improved understanding of the anatomy and dynamic functioning of the pelvic floor and its contribution to continence. In addition, much study has been conducted to bolster

2014 eMedicine.com

107. Vulvovaginitis (Overview)

Vulvovaginitis (Overview) Vulvovaginitis: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjE4ODkzMS1vdmVydmlldw== processing > Vulvovaginitis Updated: Jan 19, 2018 Author (...) : Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Vulvovaginitis Overview Practice Essentials Vulvovaginitis is a general term referring to many types of vaginal infection, although this article focuses on the following disorders, which affect the vulvar region: Vulvovaginal candidiasis Atrophic vaginitis Vulvar vestibulitis Contact dermatitis Signs and symptoms Acute vulvovaginal candidiasis Vulvar pruritus and burning - Primary symptoms

2014 eMedicine.com

108. Surgical Treatment of Vaginal Cancer (Overview)

approaches to the treatment of upper and lower vaginal cancer. According to the International Federation of Gynecology and Obstetrics (FIGO), a vaginal lesion involving the external os of the cervix should be considered and treated as such; a tumor involving both the vulva and the vagina should be considered vulvar cancer. About 80% of vaginal cancers are metastatic, primarily from the cervix or endometrium. Metastatic cancer from the vulva, ovaries, choriocarcinoma, rectosigmoid, and bladder are less (...) to prevent disease from HPV type 6, 11, 16, 18, 31, 33, 45, 52 and 58. Patient education For patient education information, see the and the , as well as , , , and . Relevant Anatomy The vagina is located in the true pelvis, which also contains the rest of the internal genital tract, the rectosigmoid, the bladder, the proximal urethra, and the pelvic portions of the ureters. The pelvic organs are partially covered by the peritoneum. The endopelvic fascia covers these organs and forms their supporting

2014 eMedicine.com

109. Surgical Management of Mullerian Duct Anomalies (Overview)

informed consent discussion with her gynecologic care provider and her respective parent(s) or guardian(s). Primary vaginal dilation is successful for more than 90–96% of patients, Referrals to centers with expertise should be offered regardless of the surgical technique chosen. The surgeon must be experienced 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 (...) of other tissues have been used as the graft source. Human amnion, not stripped from the chorion, has been used as a graft for vaginoplasties. [ ] Transposition flaps were described in 2 reports. In 1 method, a de-epithelialized vulvar transposition flap was used as the graft, and in the other, a pudendal thigh fasciocutaneous flap was described. Both authors reported good cosmetic and functional results. [ , ] Autologous buccal mucosa has also been used as a graft source. These approaches harvested

2014 eMedicine.com

110. Carbon Dioxide Laser Surgery for Cervical Dysplasia (Overview)

in 2012 updated consensus guidelines for the management of abnormal cervical screening tests, but continues to use the terminology CIN (cervical intraepithelial neoplasia), as delegates to the LAST project determined that the classification of LSIL and HSIL does not yet have enough evidence to allow clear risk-based management guidelines. [ ] White lesion is cervical intraepithelial neoplasm, grade I (CIN I). Cervical intraepithelial neoplasia, grades I and II (CIN I and II). Vulvar intraepithelial (...) , thus improving anatomic relationships by lysing adhesions and excising endometrial implants. When used in the pelvis for therapy of adhesions of other etiologies (eg, postoperative or postinfectious), the CO 2 laser allows precise incision of the adhesions, restoring local anatomy with a primary goal of reduced, repeat adhesion formation and decreased risk of damage to adjacent structures. Previous Next: Indications The carbon dioxide laser is customarily chosen over other ablative or excisional

2014 eMedicine.com

111. Carbon Dioxide Laser Surgery of the Lower Genital Tract (Overview)

in 2012 updated consensus guidelines for the management of abnormal cervical screening tests, but continues to use the terminology CIN (cervical intraepithelial neoplasia), as delegates to the LAST project determined that the classification of LSIL and HSIL does not yet have enough evidence to allow clear risk-based management guidelines. [ ] White lesion is cervical intraepithelial neoplasm, grade I (CIN I). Cervical intraepithelial neoplasia, grades I and II (CIN I and II). Vulvar intraepithelial (...) , thus improving anatomic relationships by lysing adhesions and excising endometrial implants. When used in the pelvis for therapy of adhesions of other etiologies (eg, postoperative or postinfectious), the CO 2 laser allows precise incision of the adhesions, restoring local anatomy with a primary goal of reduced, repeat adhesion formation and decreased risk of damage to adjacent structures. Previous Next: Indications The carbon dioxide laser is customarily chosen over other ablative or excisional

2014 eMedicine.com

112. Dermatologic Diseases of the Male Genitalia: Nonmalignant (Treatment)

Dermatologic Diseases of the Male Genitalia: Nonmalignant (Treatment) Nonmalignant Dermatologic Diseases of the Male Genitalia: Introduction, Definition of Terms, and Anatomy, Trichomycosis and Folliculitis, Balanoposthitis, Balanitis, and Candidiasis 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDU1MDIxLW92ZXJ2aWV3 processing > Nonmalignant Dermatologic Diseases of the Male Genitalia Updated: Feb 11, 2017 Author: Douglas C Parker, MD, DDS; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Nonmalignant Dermatologic Diseases of the Male Genitalia Introduction, Definition of Terms, and Anatomy Nonmalignant lesions account for most dermatologic disorders seen

2014 eMedicine.com

113. Carbon Dioxide Laser Surgery for Cervical Dysplasia (Treatment)

is positioned. Damp towels should be placed around the areas for laser therapy and around the vaginal introitus for cervical, vaginal or vulvar ablations to minimize damage from stray laser beams. Genital condylomata are ablated to the level of the skin surface and then to surgical plane 1 (see Table below). If fat is seen, the depth of ablation is too deep and destruction of skin structures or bleeding may result. Char should be removed via wiping with a damp gauze using sterile saline or acetic acid (...) of length and configuration. Dyspareunia may result and foreshortening may limit adequate future evaluation. Laser therapy of the vulva, perineum, or perirectal areas generally results in minimal scarring or loss of architecture, but excess depths of laser therapy increase the chance of alteration of anatomy due to scarring, dyspareunia, pain with defecation, or labial adhesions. Intra-abdominal laser therapy may result in a failure to eradicate adhesions or endometriosis, new adhesion formation

2014 eMedicine.com

114. Benign Cervical Lesions (Treatment)

Benign Cervical Lesions (Treatment) Benign Cervical Lesions: Embryology, Anatomy, Physiology 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjY0OTY2LW92ZXJ2aWV3 processing > Benign Cervical Lesions Updated: Oct 08 (...) , sinovaginal bulb). Through a process of squamous metaplasia, the vagina and a variable portion of the ectocervix become covered with squamous epithelium. This process is complete by the fifth month of pregnancy. Next: Anatomy The cervix (Latin for neck) is the inferior part of the uterus protruding into the vagina. Gross anatomy The cervix measures 2.5-3 cm in diameter and 3-5 cm in length. The normal anatomic position of the cervix is angulated slightly downward and backward. Inferiorly, the cervix

2014 eMedicine.com

115. Radiation Therapy in Gynecology (Treatment)

to the pelvic sidewall and/or causing hydronephrosis or a nonfunctioning kidney Stage IVA - Invasion of the bladder or rectal mucosa Stage IVB - Distant metastasis (the para-aortic lymph nodes are considered a distant metastatic site) Vulvar cancer The current FIGO/AJCC staging guidelines for vulvar cancer are as follows: Stage IA - Tumor confined to the vulva or perineum and 2 cm or smaller with stromal invasion 1 mm or less, negative nodes Stage IB – Tumor confined to the vulva or perineum, larger than 2 (...) have significantly higher rates of regional lymph node metastases, locoregional and distant-site relapse, and poor outcome. Because direct extension of tumor into adjacent structures limits the ability of surgery to gain clear surgical margins, and the presence of the uterus is critical for the anatomy of brachytherapy insertion in this setting, primary chemoradiotherapy is generally indicated for the management of stage IIB-IVA locally advanced cervical cancer. Tumoral resection with anterior

2014 eMedicine.com

116. Vulvovaginitis (Treatment)

Vulvovaginitis (Treatment) Vulvovaginitis: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjE4ODkzMS1vdmVydmlldw== processing > Vulvovaginitis Updated: Jan 19, 2018 Author (...) : Jill M Krapf, MD, FACOG; Chief Editor: Christine Isaacs, MD Share Email Print Feedback Close Sections Sections Vulvovaginitis Overview Practice Essentials Vulvovaginitis is a general term referring to many types of vaginal infection, although this article focuses on the following disorders, which affect the vulvar region: Vulvovaginal candidiasis Atrophic vaginitis Vulvar vestibulitis Contact dermatitis Signs and symptoms Acute vulvovaginal candidiasis Vulvar pruritus and burning - Primary symptoms

2014 eMedicine.com

117. Urethral Diverticulum (Treatment)

characterization of the lesions themselves. Knowledge of the size, location, adjacent anatomy, and other pertinent characteristics are important factors in choosing and executing a successful procedure. In 1993, Leach et al devised a classification system, in part, to aid surgeons in preoperative planning. [ ] The system was derived from their experience with evaluation and surgical treatment of 61 patients over 10 years. A secondary purpose of the classification system was to provide a standard means (...) pad is freed after the anterior branches of the internal pudendal artery are suture ligated. The suture around the freed superior end of the graft is left long. A tunnel is created connecting the vulvar and suburethral vaginal incisions using a clamp. The graft pedicle is pulled through the tunnel by grasping the long suture end at the superior pole. The fat pad then is fixed by suture to the area overlying the repaired urethra. The vagina is closed over the graft. The donor site is closed

2014 eMedicine.com

118. Uterine Prolapse (Treatment)

be offered pessaries for symptom relief. Topical estrogen is an important adjunct in the conservative management of patients with UP. When operative repair for prolapse of the uterus is chosen, a clear surgical plan must be formulated. The pelvic surgeon should consider surgical risks, coital activity, and normal vaginal anatomy. The correct operation must be tailored to the individual patient (see Indications). Other questions that must be answered include whether the operation is performed abdominally (...) uterosacral ligament fixation, and iliococcygeus fascia suspension. As originally described by Amreich and modified by Richter and Nichols, sacrospinous ligament fixation is usually performed on the patient's right side to avoid the rectosigmoid. [ ] The vaginal apex is attached, using permanent sutures, to the sacrospinous ligament. A thorough knowledge of pelvic anatomy is critical to avoid complications. Take care to place the sutures 1-2 cm medial to the ischial spine to avoid injury to the pudendal

2014 eMedicine.com

119. Nonneoplastic Epithelial Disorders of the Vulva (Treatment)

Nonneoplastic Epithelial Disorders of the Vulva (Treatment) 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

2014 eMedicine.com

120. Normal and Abnormal Puerperium (Treatment)

to the nonpregnant state. An overview of the relevant anatomy and physiology in the postpartum period follows. Uterus The pregnant term uterus (not including baby, placenta, fluids, etc) weighs approximately 1000 g. In the 6 weeks following delivery, the uterus recedes to a weight of 50-100 g. Immediately postpartum, the uterine fundus is palpable at or near the level of the maternal umbilicus. Thereafter, most of the reduction in size and weight occurs in the first 2 weeks, at which time the uterus has shrunk (...) sphincter complex as well as the anal epithelium. Any deep perineal laceration noted after a delivery warrants a thorough evaluation including a digital rectal exam to improve the diagnosis of OASIS. Approximately 4% of women have a clinically recognized OASIS immediately after time of vaginal delivery . [ ] Other tears after childbirth include periclitoral, periurethral, and labial lacerations; these should only be repaired to achieve hemostasis or to correct distorted anatomy. Additionally

2014 eMedicine.com

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