Vulva Anatomy Physiology and Pathology
Vulva Anatomy Physiology and Pathology
PART I. ANATOMY AND PHYSIOLOGY
1. Anatomy of the Vulva. 1
Aikaterini Deliveliotou and George Creatsas
Introduction. 1
Embryology of Vulva. 1
Anatomy of the Vulva. 2
Conclusion. 7
References. 7
2. Tissue Structure and Physiology of the Vulva. 9
Miranda A. Farage and Howard I. Maibach Introduction. 9
Variations in Epithelial Structure. 12
Blood Flow and Innervation. 14
Hormonal Responsiveness. 16
Immune Cell Populations. 16
Tissue Hydration and Barrier Function. 17
Permeability. 18
Skin Irritation. 19
Microbiology. 20
Conclusion. 22
References. 22
3. Changes in the Vulva and Vagina Throughout Life.
Miranda A. Farage, Howard I. Maibach, Aikaterini Deliveliotou, and George Creatsas Introduction. 27 Infancy and Early Childhood. 30 Puberty. 32 Reproductive Years. 34 Menopause and Older Age. 36 Conclusion. 39 References. 39
4. Microbial Ecology of the Vulva.
Ronald W. Berg and Catherine C. Davis Introduction. 43
Anatomical Structure of the Vulva. 43
Factors Controlling Microbial Growth and Diversity. 44
Microflora of the Vulva. 48
Conclusion. 53
References. 54
PART II. SYMPTOMS, DISEASES, AND THERAPIES
5. Are Vaginal Symptoms Ever Normal.
Matthew Anderson, Alison Karasz, and Sarah Friedland Introduction. 57
Characteristics of Normal Vaginal Discharge. 58 Characteristics of Normal Vaginal Odor. 59 Normalcy of Irritative Symptoms. 60 Conclusion. 60 References. 61
6. Common Diseases of the Vulva.
Diane Elas and Rudolph P. Galask
Introduction. 63
Assessment. 63
Physical Examination. 64
Diseases that Cause Vulvar Burning. 66
Diseases that Cause Vulvar Itching. 71
Diseases that Cause Vulvar Pain. 77
Diseases that Cause Vaginal Discharge. 80
Conclusion. 81
References. 81
7. Idiopathic Vulvodynia.
Lauren D. Arnold and Gloria A. Bachmann
Introduction. 85 Symptoms. 87 Etiology. 87 Prevalence. 88 Demographics. 89
Comorbid Conditions. 89
Gynecologic History. 90
Psychosocial and Sexual Aspects. 90
Diagnosis. 90
Treatment. 94
Conclusion. 96
References. 97
8. Vulvar Vestibulitis Syndrome.
Miranda A. Farage and Rudolph P. Galask Introduction. 101
Definition and Disease Characteristics. 101
Prevalence and Patient Demographics. 103
Differential Diagnosis. 104
Etiology. 105
Management. 107
Conclusion. 110
References. 111
9. Vulvar Therapies Evidence Vs. Testimony.
Natalie Moulton-Levy and Howard I. Maibach Introduction. 115 Vulvodynia. 115
Eczematous and Papulosquamous Vulvar Dermatoses. 117
Benign Vulvar Nodules or Tumors. 123
Infectious Diseases. 123
Vulvar Neoplasm. 138
Conclusion. 142
References. 143
PART III. MENSES, HYGIENE, AND PRODUCTS
10. The Menstrual Cycle, the Composition of Menses, and
the Effect of Menses on the Skin.
Miranda A. Farage, William H. Hood, and Paula J. Adams Hillard
Introduction. 151
The Menstrual Cycle. 152
Composition and Properties of Menses. 155
Effects of Menses and Venous Blood on the Skin. 160 Conclusion. 163 References. 164
11. The Menstrual Cycle and the Skin. 167
Birgit Drexler, Michael Landthaler, and Silvia Hohenleutner Introduction. 167 Hormonal Changes in the Course of the Menstrual Cycle. 167 Influence of the Sex Hormones on the Skin. 168 Premenstrual Syndrome. 171
Menstrual Cycle and Associated Skin Disorders. 172 Conclusion. 179 References. 179
12. Genital Hygiene Culture, Practices, and Health Impact. 183
Miranda A. Farage and Mario Bramante Introduction. 183 Genital Hygiene of Infants. 183 Genital Hygiene Among Premenarchal Girls. 184 Genital Hygiene Among Women of Reproductive Age. 188 Genital Hygiene Among Older Women. 204 Conclusion. 208 References. 208
13. Products for Vulvar Hygiene. 217
Miranda A. Farage and Lisa Lennon Introduction. 217
Cleanliness and Odor-Control Products. 217 Menstrual Protection Products. 223 Products for Incontinence Control. 227 Other Products Used on the Vulva. 228 Medications. 229 Conclusion. 230 References. 230
PART IV. ETHNICITY AND SOCIOLOGY
14. Vulva Ethnic Differences An Overview. 235
Marina Goldovsky and Howard I. Maibach Introduction. 235
Assessments of Variable Characteristics
of Ethnically Racially Different Skin. 236 Lipid Content. 247 Clinical Observations. 249 Conclusion. 249 References. 252
15. Female Genital Alterations A Sociological Perspective. 255
Samar A. Farage
Introduction. 255
The Management of Sexuality as a Problem
Postmasturbation Disease. 259 Types of Female Genital Alterations. 263 Procedures of the 19th and 20th Centuries. 264 Contemporary Female Genital Alterations in North America. 266 Conclusion. 267 References. 267
PART V. INVESTIGATIONAL METHODS
16. Bioengineering Methods for the Vulva. 271
Sibylle Schliemann, Britta Opper, and Peter Elsner Introduction. 271
Common Bioengineering Techniques. 272 Measuring Mechanical Properties. 277 Conclusion. 277 References. 277
17. Transepidermal Water Loss Dynamics of Human
Vulvar and Thigh Skin. 281
Raphael Warren, Michaelle B. Jones, and Peter Elsner Introduction. 281
Evaluation of Transepidermal Water Loss. 282 Transepidermal Water Loss Findings. 283 Conclusion. 284 References. 285
18. Vulvar Toxicology. 287
Christina Y. Wang and Howard I. Maibach Introduction. 287 Irritation of the Vulva. 288 Bioengineering Methods of Assessment. 290
Behind the Knee Test. 290 Vulvar Dermatitis. 291 Contact Urticaria. 294 Conclusion. 295 References. 295
19. Consumer Research and In-Market Comments. 297
Brigitte Nijs Introduction. 297
What Do Women Want from a Feminine Hygiene Pad. 297 Consumer Research Process for Feminine Hygiene Products. 298 Quality Assurance for Production of Feminine Hygiene Products. 300 Consumer Comments from Market Use. 301 Conclusion. 302 Reference. 302
1. Anatomy of the Vulva. 1
Aikaterini Deliveliotou and George Creatsas
Introduction. 1
Embryology of Vulva. 1
Anatomy of the Vulva. 2
Conclusion. 7
References. 7
2. Tissue Structure and Physiology of the Vulva. 9
Miranda A. Farage and Howard I. Maibach Introduction. 9
Variations in Epithelial Structure. 12
Blood Flow and Innervation. 14
Hormonal Responsiveness. 16
Immune Cell Populations. 16
Tissue Hydration and Barrier Function. 17
Permeability. 18
Skin Irritation. 19
Microbiology. 20
Conclusion. 22
References. 22
3. Changes in the Vulva and Vagina Throughout Life.
Miranda A. Farage, Howard I. Maibach, Aikaterini Deliveliotou, and George Creatsas Introduction. 27 Infancy and Early Childhood. 30 Puberty. 32 Reproductive Years. 34 Menopause and Older Age. 36 Conclusion. 39 References. 39
4. Microbial Ecology of the Vulva.
Ronald W. Berg and Catherine C. Davis Introduction. 43
Anatomical Structure of the Vulva. 43
Factors Controlling Microbial Growth and Diversity. 44
Microflora of the Vulva. 48
Conclusion. 53
References. 54
PART II. SYMPTOMS, DISEASES, AND THERAPIES
5. Are Vaginal Symptoms Ever Normal.
Matthew Anderson, Alison Karasz, and Sarah Friedland Introduction. 57
Characteristics of Normal Vaginal Discharge. 58 Characteristics of Normal Vaginal Odor. 59 Normalcy of Irritative Symptoms. 60 Conclusion. 60 References. 61
6. Common Diseases of the Vulva.
Diane Elas and Rudolph P. Galask
Introduction. 63
Assessment. 63
Physical Examination. 64
Diseases that Cause Vulvar Burning. 66
Diseases that Cause Vulvar Itching. 71
Diseases that Cause Vulvar Pain. 77
Diseases that Cause Vaginal Discharge. 80
Conclusion. 81
References. 81
7. Idiopathic Vulvodynia.
Lauren D. Arnold and Gloria A. Bachmann
Introduction. 85 Symptoms. 87 Etiology. 87 Prevalence. 88 Demographics. 89
Comorbid Conditions. 89
Gynecologic History. 90
Psychosocial and Sexual Aspects. 90
Diagnosis. 90
Treatment. 94
Conclusion. 96
References. 97
8. Vulvar Vestibulitis Syndrome.
Miranda A. Farage and Rudolph P. Galask Introduction. 101
Definition and Disease Characteristics. 101
Prevalence and Patient Demographics. 103
Differential Diagnosis. 104
Etiology. 105
Management. 107
Conclusion. 110
References. 111
9. Vulvar Therapies Evidence Vs. Testimony.
Natalie Moulton-Levy and Howard I. Maibach Introduction. 115 Vulvodynia. 115
Eczematous and Papulosquamous Vulvar Dermatoses. 117
Benign Vulvar Nodules or Tumors. 123
Infectious Diseases. 123
Vulvar Neoplasm. 138
Conclusion. 142
References. 143
PART III. MENSES, HYGIENE, AND PRODUCTS
10. The Menstrual Cycle, the Composition of Menses, and
the Effect of Menses on the Skin.
Miranda A. Farage, William H. Hood, and Paula J. Adams Hillard
Introduction. 151
The Menstrual Cycle. 152
Composition and Properties of Menses. 155
Effects of Menses and Venous Blood on the Skin. 160 Conclusion. 163 References. 164
11. The Menstrual Cycle and the Skin. 167
Birgit Drexler, Michael Landthaler, and Silvia Hohenleutner Introduction. 167 Hormonal Changes in the Course of the Menstrual Cycle. 167 Influence of the Sex Hormones on the Skin. 168 Premenstrual Syndrome. 171
Menstrual Cycle and Associated Skin Disorders. 172 Conclusion. 179 References. 179
12. Genital Hygiene Culture, Practices, and Health Impact. 183
Miranda A. Farage and Mario Bramante Introduction. 183 Genital Hygiene of Infants. 183 Genital Hygiene Among Premenarchal Girls. 184 Genital Hygiene Among Women of Reproductive Age. 188 Genital Hygiene Among Older Women. 204 Conclusion. 208 References. 208
13. Products for Vulvar Hygiene. 217
Miranda A. Farage and Lisa Lennon Introduction. 217
Cleanliness and Odor-Control Products. 217 Menstrual Protection Products. 223 Products for Incontinence Control. 227 Other Products Used on the Vulva. 228 Medications. 229 Conclusion. 230 References. 230
PART IV. ETHNICITY AND SOCIOLOGY
14. Vulva Ethnic Differences An Overview. 235
Marina Goldovsky and Howard I. Maibach Introduction. 235
Assessments of Variable Characteristics
of Ethnically Racially Different Skin. 236 Lipid Content. 247 Clinical Observations. 249 Conclusion. 249 References. 252
15. Female Genital Alterations A Sociological Perspective. 255
Samar A. Farage
Introduction. 255
The Management of Sexuality as a Problem
Postmasturbation Disease. 259 Types of Female Genital Alterations. 263 Procedures of the 19th and 20th Centuries. 264 Contemporary Female Genital Alterations in North America. 266 Conclusion. 267 References. 267
PART V. INVESTIGATIONAL METHODS
16. Bioengineering Methods for the Vulva. 271
Sibylle Schliemann, Britta Opper, and Peter Elsner Introduction. 271
Common Bioengineering Techniques. 272 Measuring Mechanical Properties. 277 Conclusion. 277 References. 277
17. Transepidermal Water Loss Dynamics of Human
Vulvar and Thigh Skin. 281
Raphael Warren, Michaelle B. Jones, and Peter Elsner Introduction. 281
Evaluation of Transepidermal Water Loss. 282 Transepidermal Water Loss Findings. 283 Conclusion. 284 References. 285
18. Vulvar Toxicology. 287
Christina Y. Wang and Howard I. Maibach Introduction. 287 Irritation of the Vulva. 288 Bioengineering Methods of Assessment. 290
Behind the Knee Test. 290 Vulvar Dermatitis. 291 Contact Urticaria. 294 Conclusion. 295 References. 295
19. Consumer Research and In-Market Comments. 297
Brigitte Nijs Introduction. 297
What Do Women Want from a Feminine Hygiene Pad. 297 Consumer Research Process for Feminine Hygiene Products. 298 Quality Assurance for Production of Feminine Hygiene Products. 300 Consumer Comments from Market Use. 301 Conclusion. 302 Reference. 302