A randomized prospective trial of the cutaneous and sensory effects of feminine hygiene wet wipes.

OBJECTIVE: To assess the effects of feminine hygiene wet wipes on vulvar skin. STUDY DESIGN: An examiner-blind, randomized, prospective clinical trial of prototype wet wipes (treatment group) and dry toilet tissue (comparison group) in 120 premenopausal and 60 postmenopausal women was conducted in which the wipes or toilet tissues were for approximately 28 consecutive days. RESULTS: Use of wet wipes in lieu of toilet tissue caused no significant impact on erythema of the external genitalia. Mean vulvar erythema scores after 28 days of product use were lower than baseline scores for both wipes and toilet tissue. In postmenopausal women, wet wipes were associated with increased labial and perineal skin moisture. A minority of premenopausal participants found skin wetness from wipes less appealing and sometimes associated with slight sensory irritation; however, wet wipes were favored for personal cleansing by postmenopausal women. CONCLUSION: Four weeks of using wet wipes caused negligible clinical effects on vulvar skin irritation and appeared to contribute to skin moisture in postmenopausal women. This subgroup preferred using wet wipes, possibly due to the skin atrophy and dryness that accompany estrogen depletion. An opportunity exists to tailor the lotion level on the wipes m to the genital skin condition and preferences of younger and older Women.

Local relapse in patients treated for squamous cell vulvar carcinoma: incidence and prognostic value.

To evaluate the risk factors for local relapse in vulvar cancer patients and its impact on survival as a function of its different patterns, which include local recurrences at the primary tumor site, recurrences remote from the primary tumor, and skin bridge recurrences. Between January 1978 and June 1999, 215 patients were treated for vulvar squamous cell carcinoma. The median follow-up was 38 months. To evaluate the role of local relapse in survival, a Cox regression multivariable analysis was performed using local relapse as a time-dependent covariate. The local relapse-free survival rate was 78.6% (+/- 7.1%) at 5 years. Multivariable analyses showed that the local relapse was increased by the factors margin status and depth of invasion. Pathologic nodal status, tumor size, margin status, and depth of invasion were predictors of cancer-related death in the Cox multivariable model with fixed covariates. The contribution of local relapse for disease-specific survival at the site of the primary tumor (relative risk [RR] 6.35; 95% confidence interval [CI] 2.07, 15.76) or skin bridge recurrence (RR 6.48; 95% CI 2.54, 16.49) was highly significant, whereas the contribution of local relapse at the other sites was not (RR 2.29; 95% CI 0.53, 9.91). In this model, margin status was not significant. The risk of cancer-related death after local relapse was 58.4% (+/- 18.3%) at 1 year and 70.9% (+/- 17.6%) at 3 years.Local relapses at the site of the primary tumor or skin bridge recurrences are strong predictors for cancer-related death, but not local relapse at a distant site.

Anti-HPV16 E2 protein T-cell responses and viral control in women with usual vulvar intraepithelial neoplasia and their healthy partners.

T-cell responses (proliferation, intracellular cytokine synthesis and IFNγ ELISPOT) against human papillomavirus 16 (HPV16) E2 peptides were tested during 18 months in a longitudinal study in eight women presenting with HPV16-related usual vulvar intraepithelial neoplasia (VIN) and their healthy male partners. In six women, anti-E2 proliferative responses and cytokine production (single IFNγ and/or dual IFNγ/IL2 and/or single IL2) by CD4+ T lymphocytes became detectable after treating and healing of the usual VIN. In the women presenting with persistent lesions despite therapy, no proliferation was observed. Anti-E2 proliferative responses were also observed with dual IFNγ/IL2 production by CD4+ T-cells in six male partners who did not exhibit any genital HPV-related diseases. Ex vivo IFNγ ELISPOT showed numerous effector T-cells producing IFNγ after stimulation by a dominant E2 peptide in all men and women. Since the E2 protein is absent from the viral particles but is required for viral DNA replication, these results suggest a recent infection with replicative HPV16 in male partners. The presence of polyfunctional anti-E2 T-cell responses in the blood of asymptomatic men unambiguously establishes HPV infection even without detectable lesions. These results, despite the small size of the studied group, provide an argument in favor of prophylactic HPV vaccination of young men in order to prevent HPV16 infection and viral transmission from men to women.

Non-sexually related acute genital ulcers in 13 pubertal girls: a clinical and microbiological study.

OBJECTIVE: To describe the clinical and microbiological features of acute genital ulcers (AGU), which have been reported in virgin adolescents, predominantly in girls. DESIGN: Descriptive study. We collected data on the clinical features, sexual history, blood cell count, biochemistry, microbiological workup, and 1-year follow-up. SETTING: Departments of dermatology of 3 university hospitals in Paris. Patients Thirteen immunocompetent female patients with a first flare of non-sexually transmitted AGU. MAIN OUTCOME MEASURES: Clinical and microbiological data, using a standardized form. RESULTS: Mean age was 16.6 years (range, 11-19 years). Eleven patients denied previous sexual contact. A fever or flulike symptoms preceded AGU in 10 of the 13 patients (77%), with a mean delay of 3.8 days before the AGU onset (range, 0-10 days). The genital ulcers were bilateral in 10 patients. The final diagnosis was Epstein-Barr virus primary infection in 4 patients (31%) and Behçet disease in 1 patient (8%). No other infectious agents were detected in this series. CONCLUSIONS: We recommend serologic testing for Epstein-Barr virus with IgM antibodies to viral capsid antigens in non-sexually related AGU in immunocompetent patients. Further microbiological studies are required to identify other causative agents.

Perineoplasty for the treatment of introital stenosis related to vulvar lichen sclerosus.

OBJECTIVE: The objective of this study is to assess the usefulness of perineoplasty for introital stenosis related to vulvar lichen sclerosus. STUDY DESIGN: The records of 64 patients who underwent perineoplasty for this indication were reviewed retrospectively. The median age of patients was 49 years, and the median duration of lichen sclerosus was 60 months. Ninety percent of patients complained of dyspareunia. Patient satisfaction with the outcome was assessed by means of a questionnaire. Persistence of dyspareunia and impaired quality of sexual intercourse were considered as treatment failure. Risk factors of failure that were evaluated included duration of lichen sclerosus, age, previous topical steroid therapy, previous perineotomy, time since surgery, and histologic stage. Statistical analysis was performed by use of Fisher exact test. RESULTS: Of the 64 patients, 12 were lost to follow-up and 2 patients did not respond to the questionnaire. Perineoplasty improved dyspareunia in 45 of the 50 patients (90%) and quality of sexual intercourse in 43 of 50 patients (86%). None of the risk factors evaluated were associated with failure of perineoplasty. CONCLUSION: Perineoplasty provides good functional results for women with introital stenosis related to vulvar lichen sclerosus.