Treatment of vulvar vestibulitis syndrome with electromyographic biofeedback of pelvic floor musculature.

Thirty-three women diagnosed as suffering from vulvar vestibulitis syndrome, marked by a significant history of long-term moderate to severe chronic introital dyspareunia and tenderness of the vulvar vestibule, were selected for treatment. Patients were given a computerized electromyographic evaluation of the pelvic floor muscles and were then provided with portable electromyographic biofeedback instrumentation and instructions on the conduct of daily, at-home, biofeedback-assisted pelvic floor muscle rehabilitation exercises. They received intermittent evaluations of pelvic floor muscles to ensure compliance and monitor their progress and symptom changes. The results show that after an average of 16 weeks of practice, pelvic floor muscle contractions increased 95.4%, resting tension levels decreased 68%, and the instability of the muscle at rest decreased by 62%. Subjective reports of pain decreased an average of 83%. Twenty-eight patients had abstained from intercourse for an average of 13 months. Twenty-two of these 28 patients resumed intercourse by the end of the treatment period. Six month follow-up indicated maintenance of therapeutic benefits.

Malignant potential of mixed vulvar dystrophy (lichen sclerosus associated with squamous cell hyperplasia).

Fifty women whose clinical vulvar appearance was compatible with that of hyperplastic or mixed vulvar dystrophy were evaluated in the Vulvovaginal Referral Unit, University of Florida, from 1980 through 1986. Histologic material from biopsies performed on these patients was reviewed. The histologic picture was consistent with the clinical diagnosis in 33 cases. Fifteen patients had lichen sclerosus with various degrees of hyperkeratosis, while one had human papillomavirus-associated vulvar intraepithelial neoplasia and another had only mild chronic inflammation. Three patients in the mixed dystrophy group developed squamous carcinoma of the vulva. Women with squamous cell hyperplasia occurring in a background of lichen sclerosus (mixed dystrophy) constitute a distinct group at higher risk of developing invasive cancer and require histologic assessment.

A rapid colorimetric AFP monoclonal antibody test for the diagnosis of preterm rupture of the membranes.

Premature rupture of the membranes is a common and serious complication of pregnancy. Despite the prevalence and severity of sequelae, current diagnostic techniques are less than ideal. We studied 48 women with preterm rupture of the membranes with a rapid, colorimetric monoclonal alpha-fetoprotein (AFP) antibody test. Sensitivity was 98% for AFP testing compared to 77% for nitrazine and 62% for ferning. The differences in sensitivity were greater when membranes were ruptured for longer than 12 hours. In all 31 patients without rupture of the membranes, AFP testing was negative. Neither urine nor semen affected AFP testing, whereas blood did. Alpha-fetoprotein testing may be a significant addition to current methods in the diagnosis of preterm rupture of the membranes.