Desquamative Inflammatory Vaginitis and Plasma Cell Vulvitis Represent a Spectrum of Hemorrhagic Vestibulovaginitis.

OBJECTIVE: The aim of the study was to identify whether desquamative inflammatory vaginitis (DIV) and plasma cell vulvitis (PCV) are distinct clinicopathologic entities. MATERIALS AND METHODS: The pathology database identified biopsies described as "vaginitis" or "vulvitis" occurring in nonkeratinized epithelium or mucocutaneous junction. Exclusions were age less than 18 years, unavailable slides or records, concurrent neoplasia, or histopathology consistent with other entities. Clinical data included demographics, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, epithelial thickness and characteristics, infiltrate, and vascular abnormalities. Cases were analyzed according to histopathologic impression of DIV or PCV based on previous pathologic descriptions. RESULTS: There were 36 specimens classified as DIV and 18 as PCV from 51 women with mean age of 51 years; 3 (6%) had concurrent biopsies with both. Pain was more common in PCV, but rates of discharge, itch, and bleeding were comparable. Rates of petechiae or erythema were similar and vaginal examination was abnormal in 72% of PCV cases. All DIV and 33% of PCV occurred in squamous mucosa; the remaining PCV cases were from mucocutaneous junction. Mean epithelial thickness, rete ridge appearance, exocytosis, and spongiosis were similar in DIV and PCV. Epithelial erosion, wide-diameter lesions, plasma cells, and stromal hemosiderin occurred in both but were more common in PCV. Lymphocyte-obscured basal layer, narrow-diameter lesions, hemorrhage, and vascular congestion were seen in both, but more common and marked in DIV. CONCLUSIONS: Desquamative inflammatory vaginitis and PCV have overlapping symptoms, signs, and histopathologic features. They may represent a single condition of hemorrhagic vestibulovaginitis with varying manifestations according to location and severity.

Pain after vaginal prolapse repair surgery with mesh is a post-surgical neuropathy which needs to be treated - and can possibly be prevented in some cases.

Post-surgical neuropathy leading to chronic pain is a recognised complication. It also can occur after surgery for pelvic organ prolapse repair involving mesh. Post-surgical neuropathy needs to be identified and properly treated to minimise the occurrence of chronic pain. A treatment algorithm is put forward for discussion .

Interpretation of Nondiagnostic Vulvar Biopsies.

OBJECTIVE: The aim of the study was to assess clinical and histopathologic characteristics of symptomatic women who underwent a nondiagnostic biopsy of the inner vulva. MATERIALS AND METHODS: Consecutive nondiagnostic biopsies from medial labia minora, posterior fourchette, and vestibule obtained from symptomatic women between 2011 and 2015 were reviewed for this retrospective histopathologic case series. Histopathologic assessment included site, basal layer appearance, lymphocytic infiltrate, and presence of fibrosis or sclerosis. Examination findings, treatment, initial impression, and final clinical diagnosis were recorded. Descriptive statistics were performed; clinical and histopathologic characteristics were compared with Fisher exact test. RESULTS: There were 85 cases; mean age was 53 years. Most women presented with painful erythema and underwent biopsy to confirm (30, 35%) or exclude (43, 51%) lichen planus. After clinical follow-up and histopathologic review, most cases had persistent diagnostic discordance. Final clinical diagnoses were available in 70 women: lichen planus in 27 (38%), vulvodynia in 15 (21%), and the other 28 (40%) had LS (8), plasma cell vulvitis (5), psoriasis (4), dermatitis (4), candidosis (3), estrogen deficiency (3), and aphthosis (1). Histopathologic review highlighted the difficulty in distinguishing mucosa-associated lymphoid tissue from an inflammatory infiltrate in 23 (27%) of cases. Compared with other sites, biopsies from the mucocutaneous junction were more likely to be associated with a positive culture for Candida albicans. CONCLUSIONS: Nondiagnostic biopsies from the inner vulva should prompt thoughtful multidisciplinary review, but more research is required to resolve the problem of clinicopathologic discordance through better understanding of vulvar histology and pathophysiology.

Urinary catheter stent placement for treatment of cervical stenosis.

BACKGROUND: Cervical stenosis is an uncommon condition that may result in significant distress in premenopausal women. Those affected may present with amenorrhoea and associated cyclical, monthly pain, infertility and haematotrachelos/haematometra. AIM: To describe a safe, easy and effective treatment method for cervical stenosis. METHODS: The cervical canal is identified and dilated under ultrasound guidance. A urinary catheter stent is then placed in the cervical canal for two weeks. RESULTS: Of the five patients who underwent treatment for cervical stenosis, all had normal menstrual cycles restored. Four of these patients successfully became pregnant after treatment. Three of the four patients progressed to uncomplicated births at term (gestation). The fourth patient underwent a termination of pregnancy in the second trimester for a fetal abnormality. CONCLUSIONS: Cervical dilatation under ultrasound guidance with temporary urinary catheter stent placement appears to be both effective and safe in the treatment of cervical stenosis. Pregnancy outcomes after treatment were optimal in our case series.