Treatment of Bartholin gland cyst with CO2laser / Tratamento do cisto da glândula de Bartholin comlaser de CO2

ABSTRACT Objective To describe the results of treatment with CO2 laser for Bartholin gland cysts. Methods Thirty-one women with Bartholin gland cysts were treated with CO2laser at an outpatient´s setting. Skin incision was performed with focused laser beam, the capsule was opened to drain mucoid content, followed by internal vaporization of impaired capsule. Results There were no complications. Five patients had recurrence of the cyst and were submitted to a second and successful session. Conclusion CO2 laser surgery was effective to treat Bartholin gland cysts with minimal or no complications, and can be performed at an outpatient´s setting.

RESUMO Objetivo Descrever os resultados do tratamento com laser de CO2 para o cisto da glândula de Bartholin. Métodos Foram tratadas 31 mulheres com cisto da glândula de Bartholin em regime ambulatorial com o laser de CO2. Foram realizados: incisão da pele com feixe de laser focalizado, abertura da cápsula com drenagem do conteúdo mucoide e vaporização interna da cápsula doente. Resultados Não ocorreram complicações. Cinco pacientes apresentaram recidiva do cisto, sendo submetidas à segunda sessão, com sucesso em todas. Conclusão A cirurgia com laser de CO2 foi efetiva para o tratamento do cisto da glândula de Bartholin, com mínima ou nenhuma complicação, podendo ser realizada em ambiente ambulatorial.

Vulvodínia: diagnóstico e tratamento / Vulvodynia: diagnosis and treatment

A vulvodínia é uma condição de desconforto vulvar crônico que afeta milhares de mulheres a cada ano. Trata-se de síndrome multifatorial com grande impacto na qualidade de vida das mulheres afetadas. Seu tratamento representa atualmente um desafio para o médico assistente que, apesar de estar mais atento ao seu diagnóstico, ainda não encontra evidências científicas para tratamento dessas pacientes. Ainda não é possível encontrar revisões sistemáticas ou metanálises pela heterogeneidade dos artigos. A abordagem multidisciplinar parece trazer melhores resultados. Habitualmente essas mulheres passam por vários especialistas à procura de alívio dos seus sintomas, na maioria das vezes sem sucesso. Este artigo objetiva fazer uma revisão atualizada do diagnóstico e tratamento da vulvodínia para orientar a prática clínica.(AU)

Vulvodynia is a vulvar discomfort and chronic condition that affects millions of women each year. It is a multifactorial syndrome with great impact on the quality of life of women affected by it. Its treatment is currently a challenge for the physician. Despite being closer to the diagnosis, scientific evidence for treating these patients has not yet been found. Systematic reviews and meta-analysis cannot be found due to the heterogeneity of the articles. A multidisciplinary approach seems to bring the best results. Usually these women consult several specialists seeking relief of their symptoms, most of the time without success. The aim of this article is to review the current diagnosis and treatment of vulvodynia to guide clinical practice.(AU)

Vulvodinia: un diagnóstico olvidado frente al dolor vulvar / Vulvodynia: unknown etiology of vulvar pain

La vulvodinia es una patología compleja y de difícil tratamiento. Se define como un dolor crónico de la vulva, que puede ser generalizado o localizado. La primera vez que se escribe sobre esta fue en 1889, por Skene. Sin embargo, es sólo hasta 1976, que los miembros de la International Society for Study of Vulvovaginal Diseases, reconocieron el dolor vulvar como una entidad patológica. Se estima una prevalencia de un 15 por ciento, con unas 14 millones de mujeres que lo padecen en EEUU. Generalmente consultan múltiples veces y a diferentes médicos, antes de llegar a un diagnóstico. No existen pruebas específicas, por lo que la clínica y el examen físico son las principales herramientas. Se deben excluir todas aquellas patologías que explican este dolor crónico vulvar. Su etiología es multifactorial, involucrando cambios a nivel de nociceptores, alteraciones de la inervación y la presencia de factores inflamatorios. Sin embargo, no podemos dejar de lado los aspectos psicosexuales, que pueden modular o desencadenar el dolor vulvar, al encontrar un sustrato alterado a nivel de estos tejidos. Basándose en estos aspectos, hoy existen diferentes tratamientos, que son efectivos si los utilizamos asociados y en forma gradual, ya que se potencian entre ellos.

Vulvodynia is a complex pathology and difficult to treat. In 1889 Skene was the first who write about this. However, only until 1976 the members of the International Society for Study of Vulvovaginal Diseases, recognized the vulvar pain as a disease entity. Prevalence estimated at 15 percent with an estimated 14 million women who suffer in the USA. A high number of gynaecologists do not know this diagnosis. For this reason women consult multiple times and to different doctors to reach a diagnosis. There are no specific tests for diagnosis. Finding in the clinical and physical examination are the main tools for this diagnosis. The different pathologies that could explain the presence of a chronic vulvar pain must be excluded. Undoubtedly its aetiology is multifactorial, involving changes in the number of nociceptors and alterations in the innervations, and the presence of inflammatory factors that may be the starting point of this pathology, as it seeks to explain the neuropathic theory. However we can not ignore the psychosomatic theory in explaining the psychosexual disorders as a trigger vulvar pain, in these altered tissues. Based on these aspects there are now treatments that are more or less effective when are gradually associated for better results.

Vulvodínia: aspectos atuais / Vulvodynia: an update

Vulvodínia é um termo utilizado para descrever dor crônica em queimação na vulva, sem achados físicos objetivos que justifiquem os sintomas. Sua etiologia é desconhecida. Mulheres brancas, sexualmente ativas e na pré-menopausa são as mais acometidas. Entre os possíveis fatores envolvidos na gênese, estão anormalidades de desenvolvimento embrionário, aumento da excreção urinária de oxalato, fatores genéticos e imunológicos, fatores hormonais, anormalidades no assoalho pélvico e neuropatias. O exame clínico detalhado, com caracterização da dor, pesquisa de irritantes locais, inspeção cuidadosa da vulva e busca de pontos dolorosos, além de avaliação do assoalho pélvico, orienta o diagnóstico e o tratamento. Existem vários tratamentos citados, porém pouca evidência científica que comprove a sua eficácia. Deve-se descontinuar a utilização de produtos que possam funcionar como irritantes. O uso de citrato de cálcio pode diminuir a excreção de oxalato na urina. A fisioterapia pode ser empregada nas pacientes com instabilidade do assoalho pélvico. Os antidepressivos tricíclicos e anticonvulsivantes foram utilizados com boa resposta em vários estudos. Além destes, podem ser aplicados, topicamente ou por injeção local, substâncias como anestésicos, corticoides, estrogênios e interferon-alfa. A cirurgia fica reservada para casos extremos, sendo que os resultados na literatura são conflitantes.

Vulvodynia is a term used to describe chronic vulvar pain or discomfort, without signs that explain such symptom. Its etiology is unknown. It is more likely to occur in sexually active, white women in pre-menopausal period. Many factors may be involved in the onset of this condition (anomalies in embrionary development, increased urinary oxalate excretion, genetic and immune factors, hormonal factors, pelvic floor problems and neuropathies). A thorough clinical history must be done, with special attention to the pain characteristics and use of local irritants. Careful vulvar inspection, research of trigger points and pelvic floor evaluation will increase the likelihood of an accurate diagnosis. Many treatment options are described, but there is not enough evidence on their effectiveness. Local irritants should be discontinued. Calcium citrate may decrease urinary oxalate excretion. Physical therapy can be used to treat pelvic floor instability. Tricyclic antidepressants and anticonvulsants showed a good response in some studies. Besides systemic drugs, topic substances or local injections can be applied (anesthetics, estrogens, corticosteroids and alpha-interferon). Surgery should be reserved to unresponsive cases and its effectiveness has been inconsistent in the scientific literature.

Clinicopathologic Characteristics and Treatment Modalities about Vulvar Vestibulitis Syndrome: A study of 30 Cases / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate and introduce the clinicopathologic characteristics and treatment modalities of vulvar vestibulitis, a subset of vulvodynia, may cause physical disabilities, phycological or emotional distress, sexual dysfunction and limitation of daily activities. But its etiologies and treatments are not defined yet. We want to summarize the diagnostic methods and treatments patients of vulvar vestibulitis syndrome, could be easily overlooked in your offices. METHODS: This retrospective study was based on medical records including pathologic reports of 30 patients who underwent skin biopsy among the patients who were diagnosed as vulvar vestibulitis syndrome from August 1999 to February 2002 at Kyung-Hee University Medical Center. Skin biopsy was taken at a most painful area of vestibule in Dermatology Department to improve the accuracy of diagnosis. We evaluated the clinicopathologic characteristics of patients RESULTS: The mean age of these patients was 53.4+/-10.4 years and the mean parity was 3.13+/-1.4 times. The mean duration from symptom onset to diagnosis was 26.2+/-24.1 months. The skin biopsies showed chronic inflammation in 21 cases (70.0%), chronic inflammation with koilocytosis in 5 cases (16.7%), subacute inflammation in 3 cases (10.0%), and acute inflammation in 1 case (3.3%). The most predominant painful area is right posterior vestibular site and all patients felt pain on that site with swab test. There were 70% improvement among 30 patients with non-surgical modalities. CONCLUSION: Vulvar vestibulitis syndrome is a syndrome of severe pain, burning, stinging, irritative or raw sensation within the vestibular area by vestibular touch or attempted vaginal entry such as tampon use or intercourse. It also has vestibular redness, urge to urinate frequently or suddenly and is confirmed by history, moistened cotton-tipped swab test and gentian violet staining on the lesions. Its prevalence is 15% and it is frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. Even though it could be seen frequently in our offices and has a tendency to become a chronic disease requiring long-term treatments, it has been being overlooked in offices due to lack of understanding of its etiologies, diagnostic criteria and treatments. Here we need more concerns and studies of vulvar vestibulitis syndrome.