Vulvar vestibulitis is rarely associated with human papillomavirus infection types 6, 11, 16, or 18.

Vulvar vestibular biopsy specimens from 31 women with clinical and pathologic findings of vulvar vestibulitis were studied using polymerase chain reaction (PCR) for the identification of human papilloma virus (HPV). The PCR technique specifically probed for HPV types 6, 11, 16, and 18. Of the 31 subjects, three were found to have HPV within the biopsy specimens; two had HPV type 11 and one had HPV 16. Five of the 31 cases had histopathologic features of koilocytosis consistent with HPV effect; three of these five were found to have HPV. The findings support the hypothesis that HPV types 6, 11, 16, and 18 are rarely associated with vulvar vestibulitis. The frequencies identified were similar to those seen with control patients. True koilocytosis is the most useful pathologic feature distinguishing HPV-related cases; it is rarely identified in typical vulvar vestibulitis. Nonspecific changes in the vestibular epithelium associated with glycogen effect should not be interpreted as koilocytosis.

Two distinct pathologic types of giant cell tumor of the vulva. A report of two cases.

Giant cell carcinoma of the vulva has been described as a distinctive primary tumor of the vulva associated with multinucleated tumor giant cells and nuclear pleomorphism. These tumors have been reported to have a poorer prognosis than does squamous cell carcinoma, to which they are thought to be related. Two women were treated for primary vulvar malignancies possessing the morphologic features of giant cell tumor. Electron microscopy was not beneficial in distinguishing the tumors. A panel of immunoperoxidase procedures, including AE 1/3, 35 beta H-11, carcinoembryonic antigen, epithelial membrane antigen, HMB-45, S-100, leukocyte common antigen, placentalike alkaline phosphatase, alpha-1-antichymotrypsin and vimentin made it possible to distinguish the two tumors and characterized one as a nodular amelanotic melanoma with multinucleate tumor giant cells and the second as a squamous cell carcinoma with tumor giant cells. The latter term should replace the term giant cell carcinoma. Histologic criteria can help define this tumor.

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.

Desquamative vaginitis: lichen planus in disguise.

A principal cause of desquamative vaginitis is erosive lichen planus. We report five cases to illustrate the classic oral and vaginal findings, describe the histology, and relate the therapeutic response of the disease. Early recognition of the disorder and prompt use of corticosteroids and vaginal dilators may prevent the common sequelae of adhesion formation and vaginal stenosis.

Therapeutic studies on vulvar vestibulitis.

Established drugs that could logically be hoped to have a beneficial effect on vulvar vestibulitis were evaluated empirically in small, uncontrolled, pilot studies. A small number of spontaneous remissions occurred in the groups using oral isotretinoin or progesterone cream. Apparent therapeutic responses were observed in women using oral dapsone, oral acyclovir or topical capsaicin. A further investigation of the last two drugs is warranted.

Microwave sterilization of Candida on underwear fabric. A preliminary report.

Candida-contaminated underwear might not be sterilized by ordinary laundering. The effectiveness of microwaving against Candida albicans on fabric was therefore determined. Swatches of Candida-impregnated cotton underpants fabric were subjected to domestic microwaving at the high setting for up to 30 minutes. If the fabric was microwaved dry, the Candida organisms survived. If the fabric was moistened, sterilization occurred within five minutes. Microwaving wet, freshly laundered cotton underpants should sterilize residual Candida and reduce the risk of reinfection.

The histopathology of vulvar vestibulitis syndrome.

Forty-one cases of vulvar vestibulitis syndrome are presented. All cases were studied to provide a histopathological description of this condition in terms of location, intensity, and characterization of the inflammatory response. Alterations of the normal histology of minor vestibular glands forming vestibular clefts are described. The association of this condition with other disease processes, and special studies done to elucidate an etiology, are discussed.

Vulvar vestibulitis syndrome.

Eighty-six patients were treated for vulvar vestibulitis syndrome. Prospective history forms and retrospective questionnaires were used to identify the frequency of various features of this condition and to assess the subjective responses of the patients to various methods of therapy. The term vulvar vestibulitis syndrome should be adopted as the standard description of this disorder.

A new technique for alcohol injection in the vulva.

The technique of alcohol injection in the vulva is reserved for the attempted relief of pruritus vulvae in patients who have failed to respond to a conscientious trial of medical therapy. The procedure is time-consuming, but the operative time can be shortened significantly if a transparent adhesive drape with a grid drawn on it is applied to the vulva before injection.

Vaginitis.

Vaginitis is one of the most common complaints of women in the United States today. About 90% of patients with this problem suffer from infection of the vagina caused by Candida, Gardnerella, or Trichomonas. The diagnosis and effective treatment of these common infections depend on accurate identification of the entity, effective specific therapy, and restoration of the normal ecosystem of the vagina. At the same time women should be made aware that not all discharge means infection and that any attempts at self-treatment may only worsen their condition. Proper hygiene habits, dietary control, and management of stress are all helpful factors in the control of recurrent vaginal infections.

The carbon dioxide laser in the treatment of vulvar disease.

Our review of the current use of the carbon dioxide laser in treating vulvar disease reveals that it holds significant promise in the treatment of vulvar intraepithelial carcinoma, condylomata acuminata, and focal vestibular adenitis. The long-range results of such treatment, however, are not yet known. Until sufficient data are accumulated to demonstrate the efficacy of the laser in treating the vulvar dystrophies and herpes genitalis, it should be used with caution, and the results should be carefully evaluated and reported.

The vestibule.

The vestibule, or introitus, is a unique area in the lower genital canal. Of major importance is the understanding of the embryology of the area if the lesions are to be interpreted adequately. It is a "collision zone" formed at the junction of different germ layers. The newly recognized syndrome of severe dyspareunia caused by inflammation of the minor vestibular glands affects many women. At present, ablative therapy is all that can be offered to these patients. While excisional surgery is highly successful, medical therapy awaits the elucidation of the true cause of this disorder. Vestibular mucous cysts and vestibular papillae are common benign conditions which must be recognized as such, lest inappropriate therapy be recommended.

Vulvar surgery for neurofibromatosis.

Von Recklinghausen's neurofibromatosis is an unusual disorder with a wide variety of manifestations. The initial findings may at times involve the female genitalia. When the vulva is affected, the obstetrician-gynecologist has an opportunity for the establishment of an accurate diagnosis as well as for cosmetic correction. Two cases are presented which illustrate these concepts.

Genetic aspects of vulvar lichen sclerosus.

Thirteen instances of familial lichen sclerosus have been recorded in the literature. This report documents the disease in two additional families and adds genetic data on their HLA characteristics. The relationship of these factors to a possible autoimmune mechanism for the disease is discussed.

Association of Fanconi's anemia and squamous-cell carcinoma of the lower female genital tract with condyloma acuminatum. A report of two cases.

Two young women had Fanconi's anemia and genital human papillomavirus infection associated with multicentric genital neoplasia. One of these women represented the first documented case of death from vaginal squamous carcinoma associated with Fanconi's anemia. In these two women an apparent biologic compression of the natural history of vulvar and vaginal carcinoma was observed. The finding of condyloma acuminatum in both of them prior to the onset of carcinoma suggests a partial causal association. Involvement of the cervix, vagina, vulva and perianal epithelium by the oncogenic process implies that a field effect occurred in those areas.

Serum levels of sex hormones in vulvar lichen sclerosus, and the effect of topical testosterone.

Lichen sclerosus is a chronic cutaneous disorder of unknown cause that most commonly occurs on the vulva in postmenopausal women. Earlier investigations suggested that the affected tissue is reversibly atrophic and that it has normal metabolic potential. The present study was designed to determine whether levels of sex steroid hormones in serum are altered in this disease and how they are affected by topical testosterone, a recognized form of therapy. As compared with normal values for age, serum levels of dihydrotestosterone, free testosterone, and androstenedione were significantly decreased in patients with untreated vulvar lichen sclerosus. Dihydrotestosterone and testosterone levels rose and exceeded normal values after therapy. These results suggest that abnormal enzymatic activity (5 alpha-reductase) may be responsible for this disease and indicate a need for similar studies of the disorder in other locations.