An analysis of vulvar necrotizing fasciitis in the unique and ethnically diverse Hawaiian population.

Vulvar necrotizing fasciitis is a surgical emergency with a high rate of morbidity and mortality. Our case series adds seven patients to the literature and presents the first group that is predominantly of Pacific-Islander origin. This study not only confirms traditional risk factors such as diabetes mellitus, obesity and hypertension but investigates ethnicity and socioeconomic status as risk factors. Also presented is a case of recurrent necrotizing fasciitis initially involving the vulva, then the back. In any patient for which there is suspicion of vulvar necrotizing fasciitis, surgical diagnosis remains the gold standard and facilitates rapid debridement of all necrotic tissues. Aggressive surgical debridement with broad spectrum antibiotic coverage is required to minimize mortality.

Prepubertal unilateral fibrous hyperplasia of the labium majus: report of eight cases and review of the literature.

OBJECTIVE: To report and propose a consensus term for eight cases of a newly recognized, asymptomatic, rapidly growing unilateral labium majus mass without palpable borders in prepubertal girls, appearing to be temporally associated with the physiologic increase of adrenal hormones. METHODS: Histologic examination, special stains, and immunohistochemistry were performed on all cases. In our personal cases, electron microscopy and chromosomal analysis were also performed, together with pelvic magnetic resonance imaging (MRI), inguinal exploration, vaginoscopy with biopsies, and adrenal hormone levels. RESULTS: Of the eight cases, seven were Ashkenazi Jewish girls from the same area in New York City. The unilateral masses were asymptomatic, soft, without palpable borders. The overlying skin had a slightly tan peau d'orange surface. The masses could not be completely excised because they extended into the contiguous pelvic floor. Histologically, the masses were composed of bland hypocellular fibrous tissue extending into the deep subcutaneous tissue. The masses blended into the surrounding tissue and adjacent pelvic floor as shown by MRI preoperatively and postoperatively. Residual tissue did not progress after incomplete resection. CONCLUSION: These fibrous lesions develop in months at the time of physiologic increase in adrenal hormone secretion just before puberty and subsequently appear to stop growing. The surgeon should not attempt a complete removal but simply excise sufficient tissue for a reasonable cosmetic result and to confirm the diagnosis. The lesions reflect fibroblastic hyperplasia, which is possibly hormone-driven. The ethnic and geographic clustering of cases raises consideration of environmental exposures or genetic predisposition.

Use of the McGill Pain Questionnaire to compare women with vulvar pain, pelvic pain and headaches.

OBJECTIVE: To assess differences between women with three distinct types of chronic pain conditions using a modified McGill Pain Questionnaire. STUDY DESIGN: Data by self-administered questionnaire were collected on patients presenting to the University of Michigan Medical Center with chronic vulvar pain (144 patients), pelvic pain (198 patients) or headaches (130 patients). Data for analysis included: patient demographics, duration of pain and modified McGill Pain Questionnaire scores. Univariate and multivariate analyses were performed. RESULTS: Patients with vulvar pain had more formal education (P < .001), were more likely to be married (P < .001) and were less likely to be African American (P = .003) as compared to those with chronic pelvic pain and headaches. Chronic pelvic pain patients were younger than those in the other two groups (P = .002), and headache patients were likely to have had their chronic pain for a shorter duration than those with vulvar or pelvic pain (P < .001). Patients with vulvar pain had lower total scores on the McGill Pain Questionnaire as well as on the four subsets of variables: affective, sensory, cognitive and miscellaneous indexes (P < .001). They also chose fewer words to describe their symptoms from the 20-word lists (P < .001) and had lower average scores in each of the 20 categories as compared to the other two groups (P < .0001). Controlling for age, ethnicity and marital status did not alter this significance. CONCLUSION: Patients with vulvar pain were a unique groups when compared to other chronic pain populations. Evaluation of the demographics and McGill Pain Questionnaire scores confirmed the distinct qualities of women with vulvar pain.