Ridley's The Vulva

15 Section 7: Intraepithelial Lesions 40 High‐Grade Squamous Intraepithelial Lesions Terminology Epidemiology Molecular genetics Pathophysiology Histological features Risk factors Clinical features Investigations Differential diagnosis Complications Associated disease Treatment Prognosis Follow‐up Resources References 41 Differentiated Vulval Epithelial Neoplasia Epidemiology Pathophysiology Histological features Other immunohistochemical stains Clinical features Differential diagnosis Complications Associated disease Treatment Prognosis Follow‐up References 42 Vulval Paget’s Disease Epidemiology Pathophysiology Classification Histological features Clinical features Differential diagnosis Complications Associated disease Treatment Prognosis Follow‐up Resources References

16 Section 8: Vulval Cancer 43 Vulval Squamous Cell Carcinoma Epidemiology Pathophysiology Clinical features Histology Variants of SCC Diagnosis Treatment of primary disease Sentinel lymph node biopsy Plastic surgical reconstruction Treatment of recurrent disease Complications Follow‐up Prognosis Prevention Resources References 44 Malignant Melanoma of the Vulva Epidemiology Genetics Pathophysiology Histological features Clinical features Investigations Differential diagnosis Staging Treatment Outcome predictors Prognosis Follow‐up Resources References 45 Other Malignant Vulval Tumours Tumours of epithelium Tumours of anogenital mammary glands Tumours of smooth muscle Tumours of striated muscle Tumours of fibroblastic tissue Malignant tumours of the adipose cells Tumours of vascular tissue Neural tumours Mesenchymal tumours of uncertain origin Tumours of Bartholin’s glands Miscellaneous malignant tumours Germ cell neoplasms Lymphoma and leukaemia References

17 Section 9: Surgical Procedures and Management of Other Conditions 46 Female Genital Mutilation Types of Female Genital Mutilation/Cutting (FGM/C) Human rights and FGM/C Impact of FGM/C Sexuality and FGM/C The motivation for and realities of clitoral reconstruction Benefits of the surgery Clinical examination Contraindications for surgery Surgical technique of clitoral reconstruction Post‐operative complications Post‐operative care Conclusion References 47 Transgender Surgery and the Neovulva Microbiology of the neovagina Cytology of the neovagina Problems in the neovagina Resources References

18 Section 10: Psychological Aspects of Vulval Disease 48 Psychological Aspects of Vulval Disorders The hypothalamic‐pituitary‐adrenal (HPA) axis Psychological symptoms and the vulva Psychiatric presentations Psychological aspects of specific conditions or events Sexual dysfunction Psychological assessment Psychological and psychiatric interventions Resources References

19 Section 11: Vulval Disease in Children 49 Inflammatory Dermatoses of the Vulva in Children Napkin (diaper) eruptions Resources Resources Immunobullous disease Dermatoses associated with systemic disease Drug eruptions Vulval pain in children References 50 Vulval Infection in Children Investigation of infection in children Common vulval infections in children Foreign bodies Bacterial infections Resources Viral infections Other infections Other infections Acute non‐sexually transmitted reactive genital ulcers (Lipschutz ulcers) References 51 Anatomical Abnormalities in Children Labial adhesions (labial agglutination) Infantile pyramidal perineal protrusion Clitoromegaly in children Childhood asymmetry labium majus enlargement (CALME) Urethral prolapse Abnormalities of the hymen Other developmental abnormalities Resources References 52 Vulval Trauma in Children Non‐thermal vulval trauma Thermal damage Chemical damage Hair tourniquet syndrome Bites Child sexual abuse Resources References 53 Vulval Lesions in Children Clitoral cysts Vulval naevi Infantile haemangiomas Vulval tumours Other lesions References

20 Section 12: Other Topics 54 Vulval Trauma Obstetric injury Trauma with consensual coitus Accidental injury Thermal injury Chemical injury Radiation injury Genital self‐mutilation The vulva and sport Cyclist’s vulva Other sporting injuries References 55 Cosmetic Procedures and Complications Procedures on vulval structures Perianal bleaching Pubic hair Piercing Tattoos Resources References

21 Glossary of Terms

22 Index

23 End User License Agreement

1 Chapter 1 Table 1.1 Carnegie stages in early embryogenesis. Table 1.2 Classification of disorders of sexual development (DSDs).

2 Chapter 2 Table 2.1 Normal measurements of vulval structures Table 2.2 Blood supply, innervation, and lymphatic drainage of the vulva.

3 Chapter 3 Table 3.1 Normal changes in the vulva through life

4 Chapter 5 Table 5.1 History taking in patients with vulval symptoms. Table 5.2 Equipment needed for vulval examination.

5 Chapter 6 Table 6.1 Common causes for vulval symptoms. Table 6.2 Types of cutaneous lesions.

6 Chapter 7 Table 7.1 Uses of Wood’s light in vulval disease. Table 7.2 Main indications for imaging in vulval disease

7 Chapter 8 Table 8.1 UK classification of topical steroids. Table 8.2 US classification of topical steroids.

8 Chapter 9 Table 9.1 Differential diagnosis of bacterial vaginosis

9 Chapter 10Table 10.1 Differential diagnosis of vulvovaginal candidiasisTable 10.2 Treatment schedules for anti‐candidal treatments [13]

10 Chapter 16Table 16.1 HPV protein functions.Table 16.2 Efficacy of treatments for genital warts.

11 Chapter 18Table 18.1 Other Rare Infections Affecting the Vulva..

12 Chapter 19Table 19.1 Other non‐sexually transmitted infections of the vulva.Table 19.2 Infections associated with acute genital ulcers.

13 Chapter 21Table 21.1 Summary of treatments in vulval psoriasis.

14 Chapter 22Table 22.1 Types of eczema affecting the vulva.Table 22.2 Common causes of allergic contact dermatitis on the vulva.

15 Chapter 23Table 23.1 Historical summary of terminology in lichen sclerosus.

16 Chapter 24Table 24.1 Main types of lichen planus affecting the vulva.

17 Chapter 25Table 25.1 Hurley staging system in hidradenitis suppurativa.

18 Chapter 26Table 26.1 Panel of antibodies against the basal membrane zone and intercel...

19 Chapter 29Table 29.1 Genetic Syndromes Associated with Genital Lentigines.

20 Chapter 31Table 31.1 Miscellaneous Drug Reactions and the Vulva

21 Chapter 33Table 33.1 Subtypes of primary lymphoedema.

22 Chapter 35Table 35.1 Vulvodynia – descriptorsTable 35.2 Associated factors in patients with vulvodynia

23 Chapter 36Table 36.1 Overlapping chronic pain conditions and vulvodynia.Table 36.2 Clinical findings and pain characteristics in the sub‐types of v...

24 Chapter 39Table 39.1 Other Types of Naevus Seen on the Vulva.

25 Chapter 40Table 40.1 2015 Terminology for squamous epithelial lesions.

26 Chapter 42Table 42.1 Current classification of VPD.

27 Chapter 43Table 43.1 FIGO staging for vulval cancer.Table 43.2 TNM staging system for vulval cancer.Table 43.3 Complications after surgery for VSCC.

28 Chapter 44Table 44.1 Poor prognostic features in vulval melanoma.

29 Chapter 48Table 48.1 Factors that can influence the psychological impact in a patient...Table 48.2 Questions to help in assessing psychological impact on vulval di...

30 Chapter 49Table 49.1 Causes of napkin/diaper eruptions.Table 49.2 Other dermatoses with vulval involvement in children.

31 Chapter 51Table 51.1 Causes of clitoromegaly in children

32 Chapter 52Table 52.1 Causes of accidental vulval trauma in children.Table 52.2 Vulval dermatoses that can mimic child sexual abuse.

1 Chapter 1 Figure 1.1 The conceptus is enclosed within an acellular envelope, the zona ... Figure 1.2 The conceptus continues to differentiate forming (a) the chorion,... Figure 1.3 (a) The floor of the amniotic cavity, the dorsal surface of the b... Figure 1.4 Migration of primordial germ cells into the genital ridge from th... Figure 1.5 (a) As the neural tube is enclosed within the intraembryonic meso... Figure 1.6 (a) Midline section of the embryo after formation of the head and... Figure 1.7 (a) The primitive hindgut is enclosed within the embryonic tail f... Figure 1.8 (a) The paired primordia of the genital tubercle lie immediately ... Figure 1.9 The indifferent human embryo possesses mesonephric and paramesone... Figure 1.10 (a) The mesonephric duct, within the urorectal septum, opens int... Figure 1.11 (a) The fused paramesonephric ducts form the genital canal, the ... Figure 1.12 (a) The genital and anal membranes rupture. (b) In the female fo...