Fotobiomodulação associada a cosméticos: percepção de profissionais sobre melhora de flacidez e hiperpigmentação genital / Photobiomodulation associated with cosmetics: perception of professionals on the improvement of flaccidity and genital hyperpigmentation

INTRODUÇÃO: A fotobiomodulação associada a cosméticos despigmentantes e rejuvenescedores tem mostrado benefícios na melhora da flacidez e hiperpigmentação genital em mulheres. OBJETIVO: O objetivo do estudo foi descrever a percepção de profissionais acerca da melhora de flacidez e hiperpigmentação genital tratados por fotobiomodulação associada a cosméticos. MÉTODO: O estudo evidenciou percepção de melhora no aspecto geral, flacidez e pigmentação genital com uso da terapêutica proposta. RESULTADOS: Amostra composta por dez mulheres submetidas a quatro sessões de tratamento. A análise dos profissionais foi mediante a comparação dos registos fotográficos de antes e depois do tratamento da região genital. CONCLUSÃO: No entanto, é necessário que novos modelos de avaliação para evidenciar a efetividade terapêutica para tratamentos de flacidez e discromias na região genital sejam desenvolvidos ampliando assim os métodos de avaliação para além da percepção de melhora do aspecto geral.

INTRODUCTION: Photobiomodulation associated with depigmenting and rejuvenating cosmetics has shown benefits in improving sagging and genital hyperpigmentation in women. OBJECTIVE: The aim of the study was to describe the perception of professionals about the improvement of sagging and genital hyperpigmentation treated by photobiomodulation associated with cosmetics. METHOD: The study showed a perception of improvement in the general appearance, sagging and genital pigmentation with the use of the proposed therapy. RESULTS: Sample composed of ten women submitted to four treatment sessions. The analysis of the professionals was by comparing the photographic records of before and after the treatment of the genital region. CONCLUSION: However, it is necessary that new evaluation models to evidence the therapeutic effectiveness for treatments of flaccidity and dyschromias in the genital region are developed, thus expanding the evaluation methods beyond the perception of improvement in the general aspect.

Reconstrucción estético - funcional de labios menores post amputación Iatrogénica amplia con colgajo de avance V - Y / Aesthetic-functional reconstruction of labia minora after extensive iatrogenic amputation with V-Y advancement flap

La hipertrofia de labios menores es la prolongación de estos más allá de los límites anatómicos de los labios mayores. La creencia de la simplicidad en la reducción de los labios menores y la falla en observar importantes aspectos de la técnica quirúrgica que llevan a la resección total del labio. En tales casos, la cirugía reconstructiva es la única forma posible de rectificar la situación. Presentamos el caso de una mujer de 36 años que acude por amputación de los labios menores secundario a cirugía de labioplastia por hipertrofia realizada por médico esteticista. Se realiza reconstrucción de labios menores en dos tiempos quirúrgicos. Los colgajos de avance en V-Y del capuchón del clítoris, con remanentes de tejido de la horquilla posterior, pueden lograr resultados satisfactorios y permitir la adaptación a la anatomía genital y los deseos estéticos únicos de cada mujer.

Labia minora hypertrophy is the prolongation of these beyond the anatomical limits of the labia majora. The belief in simplicity in the reduction of the labia minora and the failure to observe important aspects of the surgical technique that lead to total lip resection. In such cases, reconstructive surgery is the only possible way to rectify the situation. A 36-year-old woman with medical history of labia minora amputation secondary to labiaplasty surgery for hypertrophy of the labia minora performed by a beautician. The labia minora reconstruction is performed in two surgical stages. The V-Y advancement flaps of the clitoral hood with remnants of tissue from the posterior fork can be achieved with satisfactory results and allow adaptation to the genital anatomy and unique aesthetic wishes of each woman.

Impact of genital hair removal on female skin microenvironment: barrier disruption and risk of infection, a literature review / Impacto da depilação genital no microambiente da pele feminina: ruptura de barreira e risco de infecção, uma revisão da literatura / Impacto de la depilación genital en el microambiente de la piel femenina: interrupción de la barrera y riesgo de infección, una revisión de la literatura

Abstract Genital hair is one of the secondary sexual traits that marks the beginning of puberty; its removal has been part of human culture since ancient times. This practice may lead to modifications in vaginal microbiome with potential repercussions on skin health and balance. We conducted a narrative review with the purpose of describing normal skin microbiota, its impact under microenvironment changes and genital hair removal. Menses, pathological conditions and pubic hair removal may alter vaginal microbiota, being the latter of special relevance giving the risk of hair microtrauma, irritations and potential spread of infectious agents. MÉD.UIS.2019;32(3):27-33

Resumo O cabelo genital é um dos traços sexuais secundários que marcam o início da puberdade; sua remoção faz parte da cultura humana desde os tempos antigos. Essa prática pode levar a modificações no microbioma vaginal com possíveis repercussões na saúde e equilíbrio da pele. Realizamos uma revisão narrativa com o objetivo de descrever a microbiota normal da pele, seu impacto nas alterações do microambiente e na remoção de pelos genitais. A menstruação, as condições patológicas e a remoção de pelos pubianos podem alterar a microbiota vaginal, sendo esta última de especial relevância dando o risco de microtraumatismo capilar, irritações e potencial disseminação de agentes infecciosos. MÉD.UIS.2019;32(3): 27-33

Resumen El vello genital es uno de los rasgos sexuales secundarios que marca el comienzo de la pubertad; su eliminación ha sido parte de la cultura humana desde la antigüedad. Esta práctica puede conducir a modificaciones en el microbioma vaginal con posibles repercusiones potenciales en la salud y el equilibrio de la piel. Realizamos una revisión narrativa con el propósito de describir la microbiota cutánea normal, su impacto bajo los cambios del microambiente y la depilación genital. La menstruación, las condiciones patológicas y la depilación púbica pueden alterar la microbiota vaginal, siendo esta última de especial relevancia dado el riesgo de microtraumatismos, irritaciones y posible propagación de agentes infecciosos. MÉD.UIS.2019;32(3): 27-33

Nova classificação para hipertrofia dos pequenos lábios vaginais e correlação com as técnicas cirúrgicas indicadas / New classification of hypertrophy of the labia minora and correlation with indicated surgical techniques

Introdução: Primeira colocada entre as mais procuradas cirurgias plásticas genitais, a ninfoplastia ou labioplastia visa a correção da hipertrofia dos pequenos lábios vaginais e prepúcio, retirando seu excesso, sem interferir na sua função de proteção da vagina e auxílio na lubrificação genital. Diversos tipos de classificações foram propostos para facilitar a compreensão do grau de hipertrofia dos pequenos lábios vaginais e ajudar na escolha da técnica da labioplastia. Após analisar várias classificações, o autor propõe uma nova classificação, no intuito de facilitar a compreensão da hipertrofia das ninfas, capuz do clitóris e prepúcio e ajudar na escolha da técnica apropriada para labioplastia. Métodos: Foi feita uma busca na literatura médica PubMed/Medline com os termos hipertrofia lábios vaginais, labioplastia, labiaplasty, labioplasty, lábia minora hipertrophy, labial protrusion. Foram analisadas todas as classificações descritas nos trabalhos encontrados. Resultados: Uma nova classificação foi proposta. A hipertrofia dos pequenos lábios vaginais foi classificada em 4 graus: Grau 0 (≤ 1 cm), Grau 1 (> 1 cm e ≤ 3 cm), Grau 2 (> 3 cm e ≤ 5 cm) e Grau 3 (> 5 cm). Conclusões: A nova classificação, além de facilitar a compreensão do tamanho e extensão da hipertrofia das ninfas, também auxilia na escolha da técnica a ser escolhida para a labioplastia.

Introduction: Nymphoplasty or labioplasty is the most common genital plastic surgery. The objective of labioplasty is to correct hypertrophy of the labia minora and clitoral prepuce, removing excess tissue without affecting their function of protecting the vagina and aiding in genital lubrication. Several types of classifications have been proposed to facilitate the understanding of the degree of hypertrophy of the labia minora and assist in selecting the most suitable procedure in labioplasty. After analyzing several classifications, the author proposes a new classification to facilitate the understanding of hypertrophy of the labia minora, clitoral hood, and vaginal prepuce and help select the best labioplasty procedure. Methods: A literature search was conducted in PubMed/Medline using the following terms: hipertrofia lábios vaginais, labioplastia, labiaplasty, labioplasty, labia minora hypertrophy, and labial protrusion. All the classifications described in the identified studies were analyzed. Results: A new classification has been proposed. Hypertrophy of the labia minora was classified in four grades: grade 0 (≤ 1 cm), grade 1 (> 1 cm and ≤ 3 cm), grade 2 (> 3 cm and ≤ 5 cm), and grade 3 (> 5 cm). Conclusions: The new classification improves the understanding of the size and extent of hypertrophy of the labia minora and helps select the best procedure in labioplasty.

Vaginal sling implant misdiagnosed as rectal subepithelial tumor

As cosmetic procedures receive increasing attention from the media, female genital cosmetic surgery (FGCS) has become quite popular in Korea. The safety and efficacy of these surgeries and procedures have yet to be thoroughly documented. We report a case of a 47-year-old woman who underwent a vaginal sling implantation, which resulted in the misdiagnosis of a rectal subepithelial tumor during endoscopic mucosal resection (EMR). This patient suffered an iatrogenic rectal perforation during the EMR, which necessitated an exploratory operation. The sling implant was removed via the vaginal approach, and a primary repair of the vaginal and rectal walls was performed. The patient subsequently showed no sign of complication at her 6-month follow-up. Patients need to be educated about the importance of reporting a history of FGCS prior to undergoing surgical or endoscopic procedures. Also, physicians have to check the medical history of patient thoroughly to avoid misdiagnoses and unnecessary treatment.

Líquen escleroso e atrófico em criança com história de abuso sexual: relato de caso / Lichen sclerosus et atrophicus in a child with history of sexual abuse: case report

JUSTIFICATIVA E OBJETIVOS: O líquen escleroso e atrófico (LEA) é doença inflamatória crônica, caracterizada por máculase pápulas branco-nacaradas com espículas córneas, que podem confluir formando áreas homogêneas de hipopigmentação. Sua etiologia é desconhecida, porém há evidências de que esta seja multifatorial com base autoimune. Foram descritos como fatores desencadeantes: infecções genitais prévias, alterações hormonais e trauma local. Pode acometer todas as faixas etárias de ambos os sexos, sendo dez vezes mais comum no sexo feminino. O objetivo deste estudo foi apresentar caso de LEA em paciente pré-pubere com história de possível abuso sexual. RELATO DO CASO: Paciente do sexo feminino, 10 anos, branca, sem comorbidades, foi referenciada ao serviço de dermatologia do Hospital Naval Marcílio Dias para avaliação de lesão branco-nacarada, assintomática na região genital. A responsável pela menor relatou que havia observado a lesão há sete dias. Referia história de abuso sexual em investigação, há oito meses. Ausência de história pessoal e familiar de doença autoimune. Ao exame dermatológico: placas hipocrômico-atróficas, assintomáticas, de superfície apergaminhada, bem delimitadas, simétricas, localizadas nos grandes lábios. CONCLUSÃO: O LEA é doença inflamatória crônica, mais comum em nossa prática do que previamente reportado, cuja etiologia é desconhecida. Existem estudos que comprovam a associação entre LEA e o trauma. Seu reconhecimento nos estágios iniciais permite o tratamento precoce evitando evolução para craurose vulvar na mulher e balanite xerótica obliterante no homem, sendo estas, lesões pré-malignas. O LEA é um exemplo de afecção dermatológica que necessita de abordagem multidisciplinar. As lesões genitais em pacientes jovens devem ser avaliadas por urologistas, pediatras, cirurgiões gerais, ginecologistas, além dos dermatologistas...

BACKGROUND AND OBJECTIVES: Lichen sclerosous etatrophicus (LSA) is a chronic inflammatory disease characterized by pearly white macules and papules with horny spicules which can coalesce to form homogeneous areas of hypopigmentation.Its etiology is unknown, but there is evidence that it is multifactorial with an autoimmune basis. Triggering factors were described: hormonal changes, local trauma, and previous genitalin fections. LSA can affect all age groups and both genders, but its incidence is ten times higher in female than in male patients. The purpose of this study is to report a case of LSA in a prepubertal patient with history of possible sexual abuse. CASE REPORT: Female patient, ten years old, white, no comorbidities,was sent to the dermatology department of Hospital Naval Marcílio Dias for evaluation of ivory-white asymptomatic lesion located in genital area. The person responsible for the minor patient reported that the lesion was observed seven days before. There was referred history of sexual abuse under investigation,eight months before. There is no personal or family history of autoimmune disease. At dermatological examination: asymptomatic, parchment-like surface, well-defined, symmetrical, hypochromicatrophic plaques located in the labia majora. CONCLUSION: Lichen sclerosous et atrophicus (LSA) is a chronic inflammatory disease, more common in our practice than previously reported, whose etiology is unknown. There are studies showing the association between LSA and trauma. Its recognitionin the first stages allows an early treatment avoiding the progression to kraurosis vulvae in women, and balanitis xerotic aobliterans in men, which represent premalignant lesions. The LSA is an example of a dermatological condition that requires multidisciplinary approach. Along with the dermatologist examination,genital lesions in young patients should be evaluated by urologists, pediatricians, general surgeons, and gynecologists...

Acrocórdon de vulva: relato de dois casos / Vulvar acrochordon: a report of two cases

O acrocórdon é geralmente tumor benigno, peduncular, que acomete tanto o sexo feminino como o masculino e surge na idade adulta, sendo mais comum na meia idade. Alguns indivíduos podem ter mais probabilidade de serem acometidos, principalmente obesos e diabéticos. A maioria tem tamanho pequeno. Surgem mais facilmente em áreas de fricção, mas podem ocorrer em qualquer parte do corpo. Ocasionalmente pode exigir remoção devido a crescimento atípico, torção, irritação e dor, a depender do local acometido. Algumas condições comuns da pele podem imitar o acrocórdon ? a verruga de região genital é uma delas. Apesar de essa lesão ser acometida pelo papilomavírus humano, o acrocórdon algumas vezes pode estar associado a ela. Assim, é importante o exame histológico do material biopsiado.

Vulvar acrochordon: a report of two cases The acrochordon is usually a benign, stalk tumor, which affects both men and women. It is an adult-onset disease, being more common in middle-aged individuals. Some individuals may be more prone to the disease, especially those obese and diabetic. Most are small and develop more easily in areas of friction, but they may occur anywhere in the body. Occasionally removal may be required due to atypical growth, torsion, irritation or pain depending on the affected sites. Some common skin conditions may mimic acrochordon. Genital wart is one of these conditions, although it is affected by the human papiloma virus. The acrochordon may sometimes be associated with this infection. Therefore, histological examination of biopsy material is important.

Characterization of the external female genitalia of six species of Triatominae (Hemiptera: Reduviidade) by scanning electron microscopy

By macroscopic and microscopic dorsal side observation, it was noted that the IX and X segments of two species each of Panstrongylus and Triatoma terminate in an elongated way, whereas they terminate abruptly in the two species of Rhodnius. Scanning observation of the dorsal, ventral, lateral and posterior sides of the female genitalia of Panstrongylus herreri, Panstrongylus megistus, Rhodnius colombiensis, Rhodnius prolixus, Triatoma infestans and Triatoma vitticeps revealed that these six species are generally and specifically distinguished based on these elements. We describe several components that distinguish P. herreri from P. megistus: four on the dorsal side: the VII, VIII, IX and X segments, on the ventral view, three: VII sternite, VIII gonocoxite and VIII gonapophyse, on the lateral view one character, VIII gonocoxite and on the posterior view three characters: VIII and IX gonocoxite and XI gonopophyse. Comparing R. colombiensis and R. prolixus, there were three distinct characters on the dorsal side: the VII, VIII and X segments, on the ventral view three characters: the IX and X segments and VIII gonocoxite and on the posterior view four characters: the VIII, IX, X segments and VIII gonapophyse that distinguish the two species. T. infestans and T. vitticeps have four different characters on the dorsal side: the VII, VIII, IX and X segments, on the ventral view four characters: the VII and X segments, VIII gonocoxite and VIII gonapophyse, on the lateral view two characters, IX and X segments and on the posterior view four characters: the IX and X segments, VIII gonocoxite and VIII gonapophyse that distinguish the two species. Examination of the external female genitalia of six triatomine species by scanning suggests that these components are useful for taxonomical studies.

A Case of Embryonal Rhabdomyosarcoma of the External Female Genitalia / 대한피부과학회지

We report a case of embryonal rhabdomyosarcoma with palpable right inguinal lymph node in a 6-year-old girl which developed rapidly on the right labia minora over a period of 2 montha. Histopathological study showed characteristic findings of spindle shaped rhabdomyoblast with hyperchromatic nuclei and cytoplasmicprocesses. After a preoperative chemotherapy with vincristine, actinomycin D, and cytoxan, the size of the mass was reduced, and lymph nodes were not palpable. And then, simple vulvectomy. postoperhtive cheirnatherapy and radiotherapy were done.

A Case of Apocrine Hidrocystoma Occurring in the Female Genitalia / 대한피부과학회지

A 31-year-old female patient has had a translucent cystic papule on the genitalia since 2 years ago. The diagnosis was confirmed by clinical and histopathological findings. This is the rare case of apocrine hidrocystoma occring in the fernale genitalia in the literature.