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Carcinoma of the Vagina and Vulva
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Sadaf Ghaem-Maghami, Kostas Lathouras
Vaginal stenosis may occur and is more likely when advanced tumors are treated. The overall prevalence of vaginal stenosis is approximately 30% and is an undoubted problem for sexually active patients. Mucosal ulceration, either immediate or delayed, can be a distressing complication, but conservative therapy is usually effective. Vesicovaginal and rectovaginal fistulas and small bowel complications can occur but are rare. The risk of fistula formation is higher in advanced disease.
Common vulvar and vaginal complaints
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
RMS is sensitive to chemotherapy. Most treatment involves wide local resection and chemotherapy. Neoadjuvant chemotherapy reduces tumor burden and can allow resection with better preservation of reproductive function. The tumors are very responsive to VAC (vincristine, dactinomycin, plus cyclophosphamide). The use of radiation therapy did not improve survival in the SEER data analysis, but its use may have been limited to high-risk patients. While it may be useful to treat tumors difficult to resect, radiation therapy also carries long-term risks of vaginal stenosis, ovarian insufficiency, and increased risk of primary tumors. Long-term follow-up of girls treated for genital RMS is important, as both disease recurrence and second primary tumors can occur.33
Problems with Female Orgasm
Published in Philipa A Brough, Margaret Denman, Introduction to Psychosexual Medicine, 2019
Sexual activity and the ability to orgasm can be detrimentally affected by dermatological conditions of the vulva. These can include vulvovaginitis caused by candidiasis, herpes, trichomonas, atrophic vaginitis, vulvar dermatosis such as lichen sclerosus, lichen planus or eczema that can sometimes be a chemical irritation due to soap, washing powder or perfumes. There can also be provoked vulvodynia, hymenal abnormalities, pelvic radiotherapy causing vaginal stenosis or trauma and scarring such as from previous vaginal surgery or episiotomy (11). Lichen sclerosus gives a classic ‘figure-of-eight’ pattern of white patches surrounding the vulva and anus which can be itchy and sore. Often there is a loss of normal architecture and the clitoris may become buried by affected skin leading to a loss of sensation. Both lichen sclerosus and planus can lead to vulval and vaginal adhesions also affecting function. A detailed history and genital examination must be taken to rule out an organic cause, however there is often a combination of physical and psychological factors for failure to orgasm.
All of Me
Published in Oncology Issues, 2022
Though it took eight years (2008 to 2016), Sullivan-Wagner eventually received closure. “I remember the appointment where the specialist held my hand and told me in a soft, consoling voice that too much time had passed between the end of my cancer treatment and the evaluation and treatment to address my radiation and menopausal damage,” she recalls. “They said, ‘You waited too long. I am sorry.’” An examination showed that it was not the vaginal stenosis that was the main problem; instead, it was tissue scarring at the hymenal ring. The dilator size Sullivan-Wagner could tolerate did not stretch the opening of her vagina enough to comfortably accommodate penetration, as her skin was repeatedly torn open during intercourse. “The elasticity at my vaginal entrance was gone and no amount of estrogen was going to help me,” she says. “My problem was irreversible. I needed to grieve and finally had been given permission to move on.”
Vaginal mucositis in patients with gynaecological cancer undergoing (chemo-)radiotherapy: a retrospective analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Jolien Robijns, Sandrine Censabella, Heleen Bollen, Stefan Claes, Leen Van Bever, Jindra Becker, Luc Pannekoeke, Paul Bulens, Evelyn Van de Werf
Secondly, in the current study, the patients performed vaginal washes with a povidone-iodine solution once a day during RT, which is included in our institutional standard of care for patients who undergo (C)RT for gynaecological cancers. This measure was introduced based on two main principles. First, it has been proven that iodine solutions are effective in managing vaginitis caused by yeast infections (Ratzan 1969; Yu and Tak-Yin, 1993). Second, during vaginal washes, patients are dilating their vagina with a vaginal irrigator, which will reduce vaginal adhesion. Vaginal dilatation is a proven measure to prevent vaginal stenosis (Bahng et al. 2012; Kirchheiner et al. 2016a; Akbaba et al. 2019). Yet, there is no data about the efficacy of vaginal washes during pelvic RT included in the clinical guidelines published by Denton et al (Denton and Maher 2003). Therefore, it is hard to compare the results of our trial with other clinical trials, as our supportive care approach could have led to the weakening of the VM symptoms. Likewise, our institute does not have a reference value before the introduction of the vaginal washes.
Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria
Published in Journal of Obstetrics and Gynaecology, 2022
Oluwasomidoyin Olukemi Bello, Imran Oludare Morhason-Bello, Olatunji Okikiola Lawal, Rukiyat Adeola Abdus-Salam, Ayodele Olukayode Iyun, Oladosu Akanbi Ojengbede
AG was successfully treated with dissection and excision of fibrotic tissue with or without skin graft, flaps, and colon neovagina. Dissection and serial dilation was the most performed surgical procedure but the choice of surgery depends on patient’s clinical characteristics and findings, previous unsuccessful surgeries, having a close to natural vaginal anatomical axis without need for lifelong dilation and severity of the vaginal stenosis (Arowojolu et al. 2001; Ugburo et al. 2011; Ugburo et al. 2012; Kölle et al. 2019). Postoperative complications were reported in 9(29.0%) of the patients, which is lower than those reported in previous studies (Unuigbe et al. 1984; Arowojolu et al. 2001; Okunlola et al. 2001). This might be due to the availability of more potent antibiotics for post-operative care, more expertise and an improved multidisciplinary approach to care.