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Vulvar Anatomy

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101. Carbon Dioxide Laser Surgery for Cervical Dysplasia (Diagnosis)

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

102. Surgical Treatment of Vaginal Cancer (Treatment)

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

103. Surgical Management of Mullerian Duct Anomalies (Treatment)

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

104. 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

105. 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

106. 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

107. 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

108. 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

109. 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

110. 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

111. 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

112. 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

113. Fournier Gangrene (Overview)

Fournier Gangrene (Overview) Fournier Gangrene: 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjAyODg5OS1vdmVydmlldw== processing > Fournier Gangrene Updated: Jan 10, 2018 (...) lover), placement of foreign bodies such as beans within the urethra, and excessive intercourse in diabetic and alcoholic persons. He calls upon physicians to be steadfast in obtaining confession from patients of “obscene practices.” Previous Next: Anatomy The complex anatomy of the male external genitalia influences the initiation and progression of Fournier gangrene. This infectious process involves the superficial and deep fascial planes of the genitalia. As the microorganisms responsible

2014 eMedicine.com

114. 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

115. 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

116. 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

117. 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

118. Benign Cervical Lesions (Overview)

Benign Cervical Lesions (Overview) 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

119. The Role of Sentinel Node Biopsy in Skin Cancer (Overview)

, vulvar carcinoma, penile cancer, pediatric soft tissue sarcoma, and clear cell sarcoma (melanoma of the soft parts). Previous Next: Relevant Anatomy The concept of sentinel lymph node biopsy is that a primary or sentinel lymph node (or nodes) exists through which tumor cells from a primary tumor in a particular location first must travel, via afferent lymphatics, to spread to a particular regional lymph node basin. The technique is well suited for application to cutaneous malignancies because (...) . Diagnosis and treatment of interval sentinel lymph nodes in patients with cutaneous melanoma. Plast Reconstr Surg . 2007 Mar. 119(3):907-13. . Thompson JF, Uren RF, Shaw HM, et al. Location of sentinel lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy. J Am Coll Surg . 1999 Aug. 189(2):195-204. . Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 1: sentinel node lymphoscintigraphy in malignant melanoma. Br

2014 eMedicine.com

120. Uterine Prolapse (Overview)

are available. When planning the appropriate approach, the surgeon must consider operative risk, coital activity, and vaginal canal anatomy. The following list illustrates variables that must be considered. Important considerations for nonsurgical or surgical decision making See the list below: Medical condition and age Severity of symptoms Patient's choice (ie, surgery or no surgery) Patient's suitability for surgery Presence of other pelvic conditions requiring simultaneous treatment, including urinary (...) or fecal incontinence Presence or absence of urethral hypermobility Presence or absence of pelvic floor neuropathy History of previous pelvic surgery Previous Next: Relevant Anatomy Knowledge of the anatomy of the pelvis is essential to understanding prolapse. Teleologic reasoning aids in the understanding of POP. The pelvic floor evolved in primates, particularly humans, who as bipeds, spend most of their waking hours in the upright position. As the name suggests, the floor of the pelvis is the lowest

2014 eMedicine.com

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