DOCSLIB.ORG

Question Commentary By

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Question Commentary By Volume 12, Issue 2 (April 2016) This clinical e-newsletter from The North American Menopause Society (NAMS) presents questions and cases commonly seen in a menopause specialist’s practice. Recognized experts in the field provide their opinions and practical advice. Kathryn M. Macaulay, MD, NCMP, the Editor of Menopause e-Consult, encourages your suggestions for future topics. Note that the opinions expressed in the commentaries are those of the authors and are not necessarily endorsed by NAMS or by Dr. Macaulay. Question perimenopausal women report these 2 We often see patients start to complain about symptoms. vasomotor symptoms even though they are still having menses, albeit irregularly. What In a woman in her late 40s or early 50s who is the ideal hormone regimen for these reports characteristic VMS and has had patients? If their menses remain irregular, normal thyroid-stimulating hormone levels in should we be concerned? What regimen the last year or so, additional medical/ would best regulate their cycles? Do we need endocrine evaluation is not recommended. to more aggressively evaluate the patient for other medical issues that may cause hot If bleeding is heavy or prolonged, flashes? endometrial evaluation is appropriate. However, if menses are simply less regular Commentary by (or the patient reports a skipped/ oligomenorrheic menstrual pattern), endo- Andrew M Kaunitz, MD, FACOG, metrial evaluation is not indicated. NCMP Professor and Associate Chairman Medical Director and Director If the VMS are bothersome and disrupting of Menopause and Gynecologic normal activities, including sleep, treatment Ultrasound Services is appropriate. UF Southside Women’s Health Department of Obstetrics and Gynecology Whether birth control is needed, combination University of Florida College of Medicine (estrogen-progestin) hormone contraceptives Jacksonville, Florida (CHCs, including combination oral contra- ceptives [COCs]), suppress VMS, cause rregular menses and vasomotor symptoms regular withdrawal bleeding, and reduce the I (VMS) represent the hallmark of the amount of bleeding, as well as perimenopause transition, a time in a dysmenorrhea. woman’s life some have described as “hormonal chaos.”1 In addition, these agents carry additional health benefits, including prevention of Vasomotor symptoms are most prevalent ovarian and endometrial cancer and (when during the later stages of perimenopause; the used in women during the late Study of Women’s Health Across the Nation perimenopause transition) increased bone indicated that as many as 70% of mass. 2 On what appears to be a dose-related basis, As women age, the prevalence of use of CHCs increases risk of venous comorbidities, including obesity, hyper- thromboembolic events (VTEs). Although tension, and VTEs, which increase the their use has not been extensively studied in cardiovascular risks associated with CHC older reproductive-aged women, use of use, grows. In addition, CHC use is not CHCs does not appear to affect risk of breast appropriate for older reproductive-aged cancer. women who smoke or have migraine headaches. Almost all CHCs are formulated with the potent, synthetic estrogen ethinyl estradiol Combination hormone formulations indi- (EE)—5 μg of EE is approximately cated for use as HT have estrogen doses equivalent to 0.625 mg of conjugated lower than those used in CHCs and can be estrogens; therefore, a 20-μg COC delivers used off-label to treat VMS in about 4-fold more estrogen than standard- perimenopausal women who are not dose hormone therapy (HT). candidates for CHCs. A prior history of VTE would contraindicate both CHC and HT use. A COC containing 10 μg of EE and 1 mg norethindrone is available in the United Optimal symptom management in States (but not in Canada). In addition, an perimenopausal women likely requires oral contraceptive formulation with estradiol consistent ovulation suppression, because the valerate (most pills contain 2 mg) and the occurrence of sporadic ovulation in such women can aggravate irregular uterine progestin dienogest is available in the United 5 States and Canada. The estrogen dose of bleeding. these COC formulations is in the range of use in HT. Accordingly, it is important that HT formulations used to suppress perimenopause Other CHCs include a monthly vaginal ring symptoms are formulated with contraceptive (available in the United States and Canada) doses of progestins. Continuous oral HT and a weekly patch (generic in the United formulations with norethindrone acetate States; Evra in Canada), both worn for 3 of 0.5 mg (combined with 1.0 mg estradiol) or 4 weeks. norethindrone acetate 1.0 mg (combined with 5 μg EE) likely suppress ovulation and can In women who seek treatment for be used off-label to effectively treat VMS perimenopause symptoms and also need and suppress menstruation in perimenopausal contraception and who are appropriate women. Both formulations are available in candidates for combination contraceptives, Canada as well as in the United Sates. these agents can be continued until they are References in their mid-50s. At that time, the likelihood 1. Berga SL. Disordered folliculogenesis during the of menopause is high (meaning that future menopausal transition: explaining chaos. Menopause. ovulation is unlikely), and patients can 2009;16(1):11-12. discontinue combination contraceptives and 2. Gold EB, Colvin A, Avis N, et al. Longitudinal 3,4 analysis of the association between vasomotor transition to conventional HT, if desired. symptoms and race/ethnicity across the menopausal transition: Study of Women’s Health Across the Nation. Am J Public Health. 2006;96(7):1226-1235. Women using CHCs strictly for 3. Allen RH, Cwiak CA, Kaunitz AM. Contraception in noncontraceptive indications may consider women over 40 years of age. CMAJ. 2013;185(7): stopping these methods in their early 50s. 565-573. 3 4. Allen RH, Cwiak CA. Contraception for midlife educate and counsel women is necessary women. Menopause. 2016;23(1):111-113. 5. Santoro N, Teal S, Gavito C, Cano S, Chosich J, when caring for this population. Sheeder J. Use of a levonorgestrel-containing intrauterine system with supplemental estrogen Vaginal atrophy describes changes that occur improves symptoms in perimenopausal women: a pilot study. Menopause. 2015;22(12):1301-1307. to the vagina after estrogen levels decrease after or during the menopause transition, Disclosures: Dr. Kaunitz reports consultant/advisory either naturally or because of cancer board for Allergan, Bayer, Merck, Pfizer; grant/ therapies. Anatomic changes include thin- research support for Bayer, Merck, TherapeuticsMD; ning of the vaginal tissues, reduction in the and royalties/patents for UpToDate. size of the labia minora, and retraction of the vaginal introitus.4 Physiologically, vaginal Case pH may increase, vaginal epithelium may A woman who is 3 years postmenopausal become altered, and vaginal blood flow may comes in to your office with a chief be reduced. complaint of severe vaginal dryness. There are no visible signs of infection or lichen According to the 2013 North American sclerosis. She is severely atrophic and Menopause Society vulvovaginal atrophy frustrated. She has tried Estrace vaginal position statement, first-line treatment should cream, Vagifem, and Estring. Do you have include the use of vaginal moisturizers and any suggestions to help her severe dryness? lubricants.5 Vaginal moisturizers should be used on a regular basis every 3 days to Commentary by provide a moisture barrier within the vagina and reduce the symptoms of vaginal atrophy. Lisa Astalos Chism, DNP. APRN, NCMP, FAANP Clinical Director, Women’s Vaginal moisturizers typically do not cure Wellness Clinic vaginal atrophy; however, vaginal mois- Sexual Health Counselor turizers containing hyaluronic acid have been and Educator Karmanos Cancer Institute found to improve vaginal lubrication and Adjunct Assistant Professor, symptoms of vaginal atrophy, including Department of Surgery 6 Wayne State University School reducing pain with vaginal penetration. of Medicine Detroit, Michigan Vaginal lubricants are to be used at the time of vaginal penetration to reduce pain with tudies have shown that vaginal atrophy penetration. Clinicians counseling women S may significantly interfere with a about vaginal lubricants should include a woman’s quality of life, especially in regard discussion that reviews the difference to vaginal dryness and pain with vaginal between water-based and silicone-based penetration.1,2 products. Remarkably, 20% to 45% of women Oil- and petroleum-based lubricants should experience either decreased lubrication or be avoided because they can damage pain with penetration sometime during condoms and cause vaginal irritation. Water- midlife3; therefore, clinicians who care for based lubricants are safe for use with women during midlife will likely be asked to condoms but may dry out quickly and cause address these concerns. An understanding of more discomfort. Silicone-based lubricants vaginal atrophy as well as modalities to are safe with all condoms, do not absorb into 4 the skin, and may provide longer-lasting and arousal and reverse the physiologic signs comfort because of reduction in friction. of vaginal atrophy, including normalizing vaginal pH. Patients should be counseled that In addition to vaginal moisturizers and intravaginal DHEA has been studied in lubricants, clinicians should discuss vaginal phase 3 clinical trials but is not yet FDA stretching with their patients. Vaginal approved.
Load more

Recommended publications
  • Sexual Reproduction & the Reproductive System Visual
    Biology 202: Sexual Reproduction & the Reproductive System 1) Label the diagram below. Some terms may be used more than once. Spermatozoa (N) Mitosis Spermatogonium (2N) Spermatids (N) Primary Oocyte (2N) Polar bodies (N) Ootid (N) Second polar body (N) Meiosis I Primary spermatocyte (2N) Oogonium (2N) Secondary oocyte (2N) Ovum (N) Secondary spermatocytes (2N) First polar body Meiosis II Source Lesson: Gametogenesis & Meiosis: Process & Differences 2) Label the diagram of the male reproductive system below. Seminal vesicle Testis Scrotum Pubic bone Penis Prostate gland Urethra Epididymis Vas deferens Bladder Source Lesson: Male Reproductive System: Structures, Functions & Regulation 3) Label the image below. Rectum Testis Ureter Bulbourethral gland Urethra Urinary bladder Pubic bone Penis Seminal vesicle Ductus deferens Epididymis Prostate gland Anus Source Lesson: Semen: Composition & Production 4) Label the structures below. Inner and outer lips of the vagina Mons pubis Vaginal opening Clitoris Anus Urethral opening Perineum Vulva Source Lesson: Female Reproductive System: Structures & Functions 5) Label the diagram below. Some terms may be used more than once. Clitoris Vulva Labia majora Labia minora Perineum Clitoral hood Vaginal opening Source Lesson: Female Reproductive System: Structures & Functions 6) Label the internal organs that make up the female reproductive system. Uterus Fallopian tubes Ovaries Cervix Vagina Endometrium Source Lesson: Female Reproductive System: Structures & Functions 7) Label the diagram below. LH Follicular
    [Show full text]
  • Chapter 28 *Lecture Powepoint
    Chapter 28 *Lecture PowePoint The Female Reproductive System *See separate FlexArt PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Introduction • The female reproductive system is more complex than the male system because it serves more purposes – Produces and delivers gametes – Provides nutrition and safe harbor for fetal development – Gives birth – Nourishes infant • Female system is more cyclic, and the hormones are secreted in a more complex sequence than the relatively steady secretion in the male 28-2 Sexual Differentiation • The two sexes indistinguishable for first 8 to 10 weeks of development • Female reproductive tract develops from the paramesonephric ducts – Not because of the positive action of any hormone – Because of the absence of testosterone and müllerian-inhibiting factor (MIF) 28-3 Reproductive Anatomy • Expected Learning Outcomes – Describe the structure of the ovary – Trace the female reproductive tract and describe the gross anatomy and histology of each organ – Identify the ligaments that support the female reproductive organs – Describe the blood supply to the female reproductive tract – Identify the external genitalia of the female – Describe the structure of the nonlactating breast 28-4 Sexual Differentiation • Without testosterone: – Causes mesonephric ducts to degenerate – Genital tubercle becomes the glans clitoris – Urogenital folds become the labia minora – Labioscrotal folds
    [Show full text]
  • The Cyclist's Vulva
    The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al.
    [Show full text]
  • MR Imaging of Vaginal Morphology, Paravaginal Attachments and Ligaments
    MR imaging of vaginal morph:ingynious 05/06/15 10:09 Pagina 53 Original article MR imaging of vaginal morphology, paravaginal attachments and ligaments. Normal features VITTORIO PILONI Iniziativa Medica, Diagnostic Imaging Centre, Monselice (Padova), Italy Abstract: Aim: To define the MR appearance of the intact vaginal and paravaginal anatomy. Method: the pelvic MR examinations achieved with external coil of 25 nulliparous women (group A), mean age 31.3 range 28-35 years without pelvic floor dysfunctions, were compared with those of 8 women who had cesarean delivery (group B), mean age 34.1 range 31-40 years, for evidence of (a) vaginal morphology, length and axis inclination; (b) perineal body’s position with respect to the hymen plane; and (c) visibility of paravaginal attachments and lig- aments. Results: in both groups, axial MR images showed that the upper vagina had an horizontal, linear shape in over 91%; the middle vagi- na an H-shape or W-shape in 74% and 26%, respectively; and the lower vagina a U-shape in 82% of cases. Vaginal length, axis inclination and distance of perineal body to the hymen were not significantly different between the two groups (mean ± SD 77.3 ± 3.2 mm vs 74.3 ± 5.2 mm; 70.1 ± 4.8 degrees vs 74.04 ± 1.6 degrees; and +3.2 ± 2.4 mm vs + 2.4 ± 1.8 mm, in group A and B, respectively, P > 0.05). Overall, the lower third vaginal morphology was the less easily identifiable structure (visibility score, 2); the uterosacral ligaments and the parau- rethral ligaments were the most frequently depicted attachments (visibility score, 3 and 4, respectively); the distance of the perineal body to the hymen was the most consistent reference landmark (mean +3 mm, range -2 to + 5 mm, visibility score 4).
    [Show full text]
  • The Mythical G-Spot: Past, Present and Future by Dr
    Global Journal of Medical research: E Gynecology and Obstetrics Volume 14 Issue 2 Version 1.0 Year 2014 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Inc. (USA) Online ISSN: 2249-4618 & Print ISSN: 0975-5888 The Mythical G-Spot: Past, Present and Future By Dr. Franklin J. Espitia De La Hoz & Dra. Lilian Orozco Santiago Universidad Militar Nueva Granada, Colombia Summary- The so-called point Gräfenberg popularly known as "G-spot" corresponds to a vaginal area 1-2 cm wide, behind the pubis in intimate relationship with the anterior vaginal wall and around the urethra (complex clitoral) that when the woman is aroused becomes more sensitive than the rest of the vagina. Some women report that it is an erogenous area which, once stimulated, can lead to strong sexual arousal, intense orgasms and female ejaculation. Although the G-spot has been studied since the 40s, disagreement persists regarding the translation, localization and its existence as a distinct structure. Objective: Understand the operation and establish the anatomical points where the point G from embryology to adulthood. Methodology: A literature search in the electronic databases PubMed, Ovid, Elsevier, Interscience, EBSCO, Scopus, SciELO was performed. Results: descriptive articles and observational studies were reviewed which showed a significant number of patients. Conclusion: Sexual pleasure is a right we all have, and women must find a way to feel or experience orgasm as a possible experience of their sexuality, which necessitates effective stimulation. Keywords: G Spot; vaginal anatomy; clitoris; skene’s glands. GJMR-E Classification : NLMC Code: WP 250 TheMythicalG-SpotPastPresentandFuture Strictly as per the compliance and regulations of: © 2014.
    [Show full text]
  • Sexual Anatomy and Function in Women with and Without Genital Mutilation: a Cross-Sectional Study
    FEMALE SEXUAL FUNCTION Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study Jasmine Abdulcadir, MD,1,2 Diomidis Botsikas, MD,1,3 Mylène Bolmont, PhD Candidate,4 Aline Bilancioni, RN,1 Dahila Amal Djema, MD,3 Francesco Bianchi Demicheli, MD,1 Michal Yaron, MD,1 and Patrick Petignat, MD1 ABSTRACT Introduction: Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations. Aim: To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image. Methods: A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d’Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index). Main Outcome Measures: Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores. Results: Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs.
    [Show full text]
  • 1- Development of Female Genital System
    Development of female genital systems Reproductive block …………………………………………………………………. Objectives : ✓ Describe the development of gonads (indifferent& different stages) ✓ Describe the development of the female gonad (ovary). ✓ Describe the development of the internal genital organs (uterine tubes, uterus & vagina). ✓ Describe the development of the external genitalia. ✓ List the main congenital anomalies. Resources : ✓ 435 embryology (males & females) lectures. ✓ BRS embryology Book. ✓ The Developing Human Clinically Oriented Embryology book. Color Index: ✓ EXTRA ✓ Important ✓ Day, Week, Month Team leaders : Afnan AlMalki & Helmi M AlSwerki. Helpful video Focus on female genital system INTRODUCTION Sex Determination - Chromosomal and genetic sex is established at fertilization and depends upon the presence of Y or X chromosome of the sperm. - Development of female phenotype requires two X chromosomes. - The type of sex chromosomes complex established at fertilization determine the type of gonad differentiated from the indifferent gonad - The Y chromosome has testis determining factor (TDF) testis determining factor. One of the important result of fertilization is sex determination. - The primary female sexual differentiation is determined by the presence of the X chromosome , and the absence of Y chromosome and does not depend on hormonal effect. - The type of gonad determines the type of sexual differentiation in the Sexual Ducts and External Genitalia. - The Female reproductive system development comprises of : Gonad (Ovary) , Genital Ducts ( Both male and female embryo have two pair of genital ducts , They do not depend on ovaries or hormones ) and External genitalia. DEVELOPMENT OF THE GONADS (ovaries) - Is Derived From Three Sources (Male Slides) 1. Mesothelium 2. Mesenchyme 3. Primordial Germ cells (mesodermal epithelium ) lining underlying embryonic appear among the Endodermal the posterior abdominal wall connective tissue cell s in the wall of the yolk sac).
    [Show full text]
  • Skin Damage from Chronic Irritation Or Scratching
    Skin Damage from Chronic Irritation or Scratching Chronic irritation and scratching can cause skin damage to the vulva. Confusingly, this may be called many different things like Eczema, Lichen Simplex Chronicus (LSC), Chronic Dermatitis or Squamous Cell Hyperplasia. Some of these diagnoses require that a biopsy of the vulva has been performed; others are based just on clinical opinion after history and physical examination. Many things can trigger irritation of the vulva. For instance, scratching alone can lead to changes on the vulva that can be seen on physical exam or self-inspection. Often the original event that precipitated irritation and itching is unknown. Sometimes it is a vaginal infection, sometimes it is a contact irritant and sometimes it is a nervous itch. Regardless, the skin becomes irritated and inflamed, therefore beginning the “Scratch-Itch” cycle. Once this cycle is perpetuated, it is difficult for the vulvar skin to heal and the changes persist. When a biopsy is performed, it can greatly assist your practitioner in finding a diagnosis that can lead to successful treatment. Lichen simplex chronicus (LSC) and Squmous Cell Hyperplasia are 2 diagnoses that can be rendered after a skin biopsy. These are essentially similar entities and are defined as abnormal thickening of the skin of the vulva. Two thirds of patients who develop this condition are premenopausal. Moisture, chronic scratching, scrubbing, allergens, and medications may cause variations in the appearance of the lesions. The size of the lesions ranges from small to large, red to white, excoriated to eroded, and most frequently involve certain areas of the vulva like the hood of the clitoris, the labia majora, the interlabial sulcus (space between major and minor lips) outer aspect of the labia minora, and the perineal body (space between anus and vaginal opening).
    [Show full text]
  • Genital Variation
    Genital Variation People’s genitals are as unique as snowflakes! No two are alike... Our bodies, including our genitals, come in a variety of shapes, colors, and sizes. No two are exactly alike. Same bits & pieces, composed differently Did you know all human fetuses start out “female” unless hormones direct them differently? That’s why a fully-formed penis shares many characteristics with a clitoris, including a darker “underskin” and a thin “ridge” or seam” which runs from scrotum to anus. Basically, everyone’s sexual anatomy is arranged to accomplish the same few tasks: to produce steroid hormones for growth and development, to support reproduction, and to create pleasure during sex. Variations in anatomy simply reflect our unique abilities to accomplish these same tasks. Media paints an inaccurate picture The images of genitals shown in ads and in porn are commonly altered—subjected to airbrushing, makeup, fancy camera angles, photo editing and size-distorting techniques. The end result is a socially-constructed aesthetic, one which creates a false perception of conformity and reinforces a sex/gender binary. Real bodies are more interesting, varied, and nuanced. Vulvas, vaginas, & labia AA wide wide range r ofang variablese of existvariables in the look eofxis a vulvat in (the the external look genitalia). of a vulv Thesea include(the theex lengthternal and gwidthenit ofalia). a clitoris These or vagina, include as well as thethe color, leng length,th and rigidityand ofwidth labia. Typically, of a clit thereoris are twoor setsvagina, of labia, asthe labiawell majora as the (outer c labia)olor , andleng labiath, minora and (inner rigidity labia).
    [Show full text]
  • Colposcopy of the Vulva, Perineum and Anal Canal
    VESNA KESIC Colposcopy of the vulva, perineum and anal canal CHAPTER 14 Colposcopy of the vulva, perineum and anal canal VESNA KESIC INTRODUCTION of the female reproductive system. The vulva is responsive for Colposcopy of the vulva – vulvoscopy – is an important part the sex steroids. The alterations that are clinically recog- of gynaecological examination. However, it does not provide as nizable in the vulva throughout life and additional cyclic much information about the nature of vulvar lesions as col- changes, occurring during the reproductive period, are the poscopy of the cervix. This is due to the normal histology of this result of sequential variations of ovarian hormone secretion. area, which is covered by a keratinized, stratified squamous Significant changes happen during puberty, sexual inter- epithelium. The multifocal nature of vulvar intraepithelial dis- course, pregnancy, delivery, menopause and the postmeno- ease makes the examination more difficult. Nevertheless, col- pausal period, which alter the external appearance and func- poscopy should be performed in the examination of vulvar pa- tion of the vulva. Knowledge about this cyclical activity is im- thology because of its importance in identifying the individual portant in diagnosis and treatment of vulvar disorders. components of the lesions, both for biopsy and treatment pur- poses. Anatomically, the vulva, the term that designates exter- It should be remembered that the vestibule, as an endodermal nal female genital organs, consists of the mons pubis, the labia derivate, is less sensitive to sex hormones than adjacent struc- majora, the labia minora, the clitoris including frenulum and tures. This should be taken into consideration during the treat- prepuce, the vestibule (the vestibule, the introitus), glandular ment of certain vulvar conditions such as vestibulitis.
    [Show full text]
  • Labial Hypertrophy and Asymmetry
    Labial Hypertrophy and Asymmetry What are labial hypertrophy and labial asymmetry? Labial hypertrophy is an increase in the size of one or both of the “lips” of the vagina, called the labia. Labial hypertrophy can affect the inner labia, known as the labia minora, or the outer labia, called the labia majora. When only one side of the labia is enlarged, the condition is referred to as labial asymmetry. There is no definition of “normal” labia size, but sometimes the labia minora or majora are larger than another persons How is labial hypertrophy or asymmetry or larger on one side. treated? It is important to remember that your body is What causes labial hypertrophy? healthy and normal no matter the size of your Labia come in all different shapes and sizes and all labia. Everyone should practice good hygiene, are completely normal. The reason why some washing their genitalia once per day with mild, people have larger labia than others is unknown. scent-free, color-free, chemical-free soap. If you Sometimes labia have been enlarged since birth, have labial hypertrophy, you may consider but many times a person may first notice an avoiding wearing tight underwear and clothing, increase in size of their labia during puberty. and during your period, you might use chemical- free sanitary pads to prevent irritation or try tampons, menstrual underwear or the menstrual What are the symptoms of labial cup. Over the counter topical mild ointments can hypertrophy? be used to prevent irritation. Usually labial hypertrophy causes no problems or If you have pain that continues, irritation or symptoms.
    [Show full text]
  • Vulvas and Vaginas
    Vulvas and Vaginas 2 An Introduction to: Vulvas and Vaginas What is a Vulva? The Vulva is the entire external female genitalia – inner and outer labia, clitoris, clitoral hood, mons, vestibule and urethral and vagina openings. This part of the anatomy gets called lots of funny names: vajayjay, muff, coochie, crotch, “down there,” and often it gets confused with the vagina – the stretchable passage that leads to the cervix and uterus and is involved in menstruation, intercourse, pregnancy and delivery. Because the vulva and vagina are hidden, they can seem mysterious, confusing and even shameful. Let’s eliminate the mystery. Your vulva and vagina can be the source of much pleasure and it is a good idea to get to know them and all their wonders. Don’t be shy! Get to know your body! Look at your Vulva! Stand or sit over a mirror and take a good look. Examining the Vulva is healthy; it gets you familiar and comfortable with your unique body and all its parts. Labia: The word labia means lips in Latin. The outer labia are two folds of skin and fatty tissue which are the colour of your skin or a bit darker. They are covered in pubic hair after puberty and surround the rest of the vulva. They can be large or small, short or long and, like breasts, can be two different sizes. They swell during arousal and are often very sensitive. The inner labia are also sensitive and swell during arousal. These are the folds of skin that go from the clitoral hood to below the vaginal opening.
    [Show full text]