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Vulvar Anatomy

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141. Child Abuse and Neglect: Sexual Abuse (Treatment)

):1319-22. . Berenson AB. Normal anogenital anatomy. Child Abuse Negl . 1998 Jun. 22(6):589-96; discussion 597-603. . Berkowitz CD. Medical consequences of child sexual abuse. Child Abuse Negl . 1998 Jun. 22(6):541-50; discussion 551-4. . Briere JN, Elliott DM. Immediate and long-term impacts of child sexual abuse. Future Child . 1994 Summer-Fall. 4(2):54-69. . Burgess AW, Groth AN, Holmstrom LL, Sgroi SM. Sexual Assault of Children and Adolescents . New York, NY: Lexington Books; 1978. CDC. Sexually (...) girl presented with significant bruising that involved labia minora and labia majora, hymenal trauma with disruption of hymen, and fresh blood. Bruising on vulvar structure is nearly resolved. Hymen is healing and no blood is observed. Courtesy of Carol D. Berkowitz, MD. Genital examination of girl in frog-leg supine position after genital trauma. Examination reveals suture in place at 6-o'clock position to stop bleeding from injury. Hymenal edge is irregular and asymmetric. Courtesy of Carol D

2014 eMedicine Pediatrics

142. Drainage, Bartholin Abscess (Follow-up)

of the vulvar soft tissue are very uncommon. When localized in the Bartholin gland area, these tumors can be mistaken for benign lesions, leading to a delayed diagnosis. [ ] This rare form of carcinoma has an approximate incidence of 0.1 cases per 100,000 women. Women older than 40 years should be referred to a gynecologist for diagnosis and treatment. [ ] Progressive infection and sepsis Patients with compromised immune systems may exhibit rare complications of progressive infection and sepsis. Treat all (...) of Bartholin gland abscesses. Obstet Gynecol . 2013 Oct. 122(4):794-9. . Reif P, Ulrich D, Bjelic-Radisic V, Hausler M, Schnedl-Lamprecht E, Tamussino K. Management of Bartholin's cyst and abscess using the Word catheter: implementation, recurrence rates and costs. Eur J Obstet Gynecol Reprod Biol . 2015 Jul. 190:81-4. . Mayeaux EJ Jr, Cooper D. Vulvar procedures: biopsy, Bartholin abscess treatment, and condyloma treatment. Obstet Gynecol Clin North Am . 2013 Dec. 40 (4):759-72. . Marzano DA, Haefner HK

2014 eMedicine Emergency Medicine

143. Vulvovaginitis (Follow-up)

Vulvovaginitis (Follow-up) 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 Emergency Medicine

144. Bartholin Gland Diseases (Overview)

to the hymen. Their function is to maintain the moisture of the vaginal mucosa's vestibular surface. This article focuses on the most common Bartholin gland diseases, cysts and abscesses (see the image below). Although rare, carcinoma of the gland should be considered in women with an atypical presentation. Primary carcinoma of the Bartholin gland accounts for approximately 5% of vulvar carcinomas. [ , , , , ] Patients typically have an exquisitely tender, fluctuant labial mass with surrounding erythema (...) obstructed, leading to distention of the gland or duct with fluid. Obstruction is usually secondary to nonspecific inflammation or trauma. The cyst is usually 1-3 cm in diameter and often asymptomatic, although larger cysts may be associated with pain and dyspareunia. [ , , , ] Bartholin abscesses result from either primary gland infection or infected cyst. Patients with abscesses complain of acute, rapidly progressive vulvar pain. Studies have shown that these abscesses are usually polymicrobial

2014 eMedicine Emergency Medicine

145. 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 Emergency Medicine

146. Urinary Incontinence (Diagnosis)

Urinary Incontinence (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 Incontinence Updated: Mar 19 (...) 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 the understanding of the neurophysiology

2014 eMedicine Emergency Medicine

147. Vulvovaginitis (Diagnosis)

Vulvovaginitis (Diagnosis) 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 Emergency Medicine

148. Renal Calculi (Diagnosis)

Renal Calculi (Diagnosis) Nephrolithiasis: 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM3MDk2LW92ZXJ2aWV3 processing > Nephrolithiasis Updated: Jun 21, 2018 Author (...) in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate to flank or lumbar areas

2014 eMedicine Emergency Medicine

149. Nonneoplastic Epithelial Disorders of the Vulva (Diagnosis)

Nonneoplastic Epithelial Disorders of the Vulva (Diagnosis) 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

150. Normal and Abnormal Puerperium (Diagnosis)

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

151. Nephrolithiasis (Diagnosis)

Nephrolithiasis (Diagnosis) Nephrolithiasis: 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM3MDk2LW92ZXJ2aWV3 processing > Nephrolithiasis Updated: Jun 21, 2018 Author (...) in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate to flank or lumbar areas

2014 eMedicine.com

152. Nephrolithiasis: Acute Renal Colic (Diagnosis)

Nephrolithiasis: Acute Renal Colic (Diagnosis) Nephrolithiasis: 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM3MDk2LW92ZXJ2aWV3 processing > Nephrolithiasis Updated (...) and characteristics of pain in nephrolithiasis include the following: Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting Upper ureteral stones: Radiate

2014 eMedicine.com

153. Radiation Therapy in Gynecology (Diagnosis)

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

154. Surgical Treatment of Vaginal Cancer (Diagnosis)

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

155. Surgical Management of Mullerian Duct Anomalies (Diagnosis)

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

156. 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

157. 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

158. Labiaplasty and Labia Minora Reduction

such as exercise and increase insecurities when wearing tight clothing. Previous Next: Relevant Anatomy A diagram of vulvar anatomy is shown below. Anatomical diagram of the vulva. The typical external female genitalia include the labia majora, labia minora, clitoris, clitoral hood, mons pubis, labial commissure, urethra opening, and vaginal opening. Collectively, the external female genitalia are referred to as the vulva. Female genital plastic surgery can be performed on the labia minora, labia majora, mons (...) problem of not feeling “normal” in comparison with the perceived ideal anatomy cannot be underestimated. [ ] Previous Next: Epidemiology Frequency Labiaplasty surgeries are expected to continue increasing in frequency as the techniques and procedures become more defined. Popularity of the procedure is expected to increase as knowledge of the benefits increase. According to a 2000 study of 163 labia minora reductions, 87% of patients had labiaplasty surgery for aesthetic reasons, while 64% desired

2014 eMedicine Surgery

159. Drainage, Bartholin Abscess (Treatment)

of the vulvar soft tissue are very uncommon. When localized in the Bartholin gland area, these tumors can be mistaken for benign lesions, leading to a delayed diagnosis. [ ] This rare form of carcinoma has an approximate incidence of 0.1 cases per 100,000 women. Women older than 40 years should be referred to a gynecologist for diagnosis and treatment. [ ] Progressive infection and sepsis Patients with compromised immune systems may exhibit rare complications of progressive infection and sepsis. Treat all (...) of Bartholin gland abscesses. Obstet Gynecol . 2013 Oct. 122(4):794-9. . Reif P, Ulrich D, Bjelic-Radisic V, Hausler M, Schnedl-Lamprecht E, Tamussino K. Management of Bartholin's cyst and abscess using the Word catheter: implementation, recurrence rates and costs. Eur J Obstet Gynecol Reprod Biol . 2015 Jul. 190:81-4. . Mayeaux EJ Jr, Cooper D. Vulvar procedures: biopsy, Bartholin abscess treatment, and condyloma treatment. Obstet Gynecol Clin North Am . 2013 Dec. 40 (4):759-72. . Marzano DA, Haefner HK

2014 eMedicine Emergency Medicine

160. 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 Emergency Medicine

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