- Medical Advisory Board – The National Vulvodynia Association
- Beware “The Great Mimicker” that can lurk in the vulva
- Vaginal-fluid transplants in the works for US women
- Vaginal Cancer
- What is vaginal cancer?
- Other Types of Vaginal Cancer
- Vaginal Cancer Prevention
- Vaginal Cancer Causes/Risk Factors
- Vaginal Cancer Symptoms
- Vaginal Cancer Diagnosis
- Treatment for Vaginal Cancer
Medical Advisory Board – The National Vulvodynia Association
Dr. Edwards is in private practice in Charlotte, N.C. She is also an Associate Clinical Professor of Dermatology at Wake Forest University School of Medicine, Winston-Salem. Dr. Edwards received her medical degree from Bowman Gray School of Medicine in 1976.
Her professional memberships include the American Academy of Dermatology and the Women’s Dermatologic Society. Dr.
Edwards is also currently the Secretary-General of the International Society for the Study of Vulvovaginal Disease (ISSVD) and was the program chairperson for the Fourth ISSVD World Congress.
Dr. Foster, Professor of Ob/Gyn at the University of Rochester, received his Medical Degree from the Thomas Jefferson University in 1976 and completed his residency in Obstetrics and Gynecology at the Johns Hopkins Hospital. Dr.
Foster completed a fellowship in Gynecologic Pathology at the Johns Hopkins Hospital and a Masters in Public Health in Epidemiology also at Hopkins. Dr. Foster directs the Colposcopy and Vulvovaginal Disease Unit at Strong Memorial Hospital and is an active member of the International Society for the Study of Vulvovaginal Disease.
Among a number of research projects focusing on diseases of the vulva, Dr. Foster was principal investigator for an NIH-funded trial concerning the medical treatment for vulvodynia.
Andrew Goldstein, M. D., a Board-certified ob/gyn, is the director of the Centers for Vulvovaginal Disorders in Washington, DC, Annapolis, MD and New York City. He specializes in the treatment of vulvodynia, vulvar dermatoses, and other disorders that cause sexual dysfunction and pain.
He is the immediate past-president of the International Society for the Study of Women’s Sexual Health and a member of the renowned International Society for the Study of Vulvovaginal Disease. Dr.
Goldstein has co-authored two books on female sexual pain and published numerous peer-reviewed articles and book chapters on this topic.
Dr. Harlow is Professor and Head of the Division of Epidemiology and Community Health at the University of Minnesota School of Public Health, and an Adjunct Professor of Epidemiology at the Harvard School of Public Health.
His recent research has focused on psychiatric disorders and their relation to reproductive function and gynecological morbidity.
He has a long history of NIH-funded research, including one of the first community-based studies to assess the prevalence and etiological predictors of vulvodynia.
Dr. Marinoff is professor emeritus of obstetrics and gynecology at the George Washington University of Medicine and Health Sciences in Washington, DC and is now retired from clinical practice. Formerly, Dr. Marinoff served as the medical director of the Center for Vulvovaginal Disorders and was a senior attending physician at Columbia Hospital for Women.
He received his medical degree from The Chicago Medical School and a Master’s degree in Public Health from Harvard University School of Public Health. Dr. Marinoff is a member of the American College of Obstetricians and Gynecologists, the International Society for the Study of Vulvovaginal Disease, and numerous other societies and committees.
He has published many articles on vulvodynia and pudendal neuralgia.
Dr. Nyirjesy is Professor of Obstetrics and Gynecology at Drexel University College of Medicine and the Director of the Drexel Vaginitis Center. After completing a residency in Obstetrics and Gynecology at Jefferson in 1989, Dr.
Nyirjesy completed a two-year fellowship in Infectious Diseases in the Department of Medicine at Temple University Hospital.
In 1991, he established the Temple Vaginitis Referral Center, a program whose goal is to evaluate and treat patients referred primarily by their gynecologists because of chronic vulvovaginal symptoms. This program moved to Drexel in 2003.
Because of the nature of his clinical practice, his academic interests have included vulvodynia. In addition to his many articles on chronic vulvar and vaginal diseases, he led the first double-blind randomized placebo-controlled trial of any therapy for vulvodynia.
Dr. Stewart works for Harvard Vanguard Medical Associates, a large multi-specialty medical group in Boston. She is also Assistant Professor of Obstetrics and Gynecology at Harvard Medical School. Dr.
Stewart graduated from George Washington University School of Medicine in 1981 and is a Fellow of the American College of Obstetrics and Gynecology. She is also a member of the International Society for the Study of Vulvovaginal Disease.
Her recent book on vulvovaginal health, The V Book, was released by Bantam in July 2002.
Dr. Justin Wasserman, M.D., F.A.A.P.M.R., is the Medical Director and President of The Pain Treatment Center of Greater Washington in Bethesda, Maryland. He graduated from the University of Cincinnati College of Medicine with a medical degree in 1993. Dr.
Wasserman interned at The Jewish Hospital of Cincinnati, and completed his residency in Physical Medicine and Rehabilitation at the University of Chicago/Schwab Rehabilitation Hospital in Chicago, Illinois in 1997. Since graduating from his residency, Dr.
Wasserman has been engaged in medical practice specializing exclusively in the treatment of chronic pain disorders. He has board certifications from both the American Board of Physical Medicine and Rehabilitation and The American Board of Pain Medicine.
He is also a member of several professional associations including the American Academy of Physical Medicine and Rehabilitation, the American Medical Association, the American Pain Society, the American Academy of Pain Medicine, the International Society for the Study of Pain, and the American Myopain Society. He has a specific expertise in the pharmacologic management of chronic pain, and is planning on participating in a variety of research projects.
Ursula Wesselmann received both MD and PhD (Physiology) degrees from the Christian-Albrechts-University in Kiel, Germany, in 1983 and 1987 respectively. She subsequently completed postdoctoral studies at the Medical College of Wisconsin in Milwaukee and at Northwestern University Medical School in Chicago.
She completed a residency in Neurology at the University of Chicago, and fellowship training in pain management at the Departments of Anesthesia and Neurology at the Massachusetts General Hospital/Harvard Medical School in Boston.
She joined the Departments of Neurology and Biomedical Engineering at The Johns Hopkins University in Baltimore in 1994, where she was an Attending Physician (Neurology) at Johns Hopkins Hospital and a member of the Johns Hopkins Blaustein Pain Treatment Center. In March 2008 Dr.
Wesselmann moved to the University of Alabama at Birmingham to join the Department of Anesthesiology/Division of Pain Management, where she is currently the Edward A. Ernst Endowed Professor of Anesthesiology, and a Senior Scientist at the Civitan International Research Center.
Her translational research laboratory focuses on the pathophysiological mechanisms of visceral and neuropathic pain syndromes in females and gender differences in the processing of nociceptive information with emphasis on pelvic pain and vulvodynia. Dr. Wesselmann’s research work is funded by grants from the National Institutes of Health. Her clinical practice centers on the treatment of chronic urogenital and pelvic pain syndromes.
Dr. Witkin has been in the Department of Obstetrics and Gynecology at Weill Medical College of Cornell University since 1981, where he is currently Professor of Immunology, Director of the Division of Immunology and Infectious Diseases. Dr. Witkin has over 240 peer reviewed publications in areas related to women’s health. In the past several years, the research in his Division has focused on genetic, immunologic, and infectious aspects of preterm birth, gynecologic infections and vulvar vestibulitis syndrome. His laboratory is also a New York State licensed clinical laboratory for genetic and immunological testing.
Beware “The Great Mimicker” that can lurk in the vulva
LAS VEGAS – Officially a type of precancerous lesion is known as vulvar intraepithelial neoplasia (VIN); unofficially, an obstetrician-gynecologist calls it something else: “The Great Mimicker.
” That’s because symptoms of VIN can fool physicians into thinking they’re seeing other vulvar conditions.
The good news: A biopsy can offer crucial insight and should be performed on any dysplastic or unusual lesion on the vulva.
Amanda Nickles Fader, MD, of Johns Hopkins Hospital in Baltimore, offered this advice and other tips about this type of precancerous vulvar lesion in a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium.
According to Dr. Nickles Fader, vulvar cancer accounts for 5% of all gynecologic malignancies, and it appears most in women aged 65-75 years.
However, about 15% of all vulvar cancers appear in women under the age of 40 years.
“We’re seeing a greater number of premenopausal women with this condition, probably due to HPV [human papillomavirus],” she said, adding that HPV vaccines are crucial to prevention.
The VIN form of precancerous lesion is most common in premenopausal women (75%) and – vulvar cancer – is linked to HPV infection, HIV infection, cigarette smoking, and weakened or suppressed immune systems, Dr. Nickles Faber said at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
VIN presents with symptoms such as pruritus, altered vulvar appearance at the site of the lesion, palpable abnormality, and perineal pain or burning. About 40% of cases do not show symptoms and are diagnosed by gynecologists at annual visits.
It’s important to biopsy these lesions, she said, because they can mimic other conditions such as vulvar cancer, condyloma acuminatum (genital warts), lichen sclerosus, lichen planus, and condyloma latum (a lesion linked to syphilis).
“Biopsy, biopsy, biopsy,” she urged.
In fact, one form of VIN – differentiated VIN – is associated with dermatologic conditions such as lichen sclerosus, and treatment of these conditions can prevent development of this VIN type.
As for treatment, Dr. Nickles Faber said surgery is the mainstay. About 90% of the time, wide local excision is the “go-to” approach, although the skinning vulvectomy procedure may be appropriate in lesions that are more extensive or multifocal and confluent. “It’s a lot more disfiguring.”
Laser ablation is a “very reasonable” option when cancer has been eliminated as a possibility, she said. It may be appropriate in multifocal or extensive lesions and can have important cosmetic advantages when excision would be inappropriate.
Off-label use of imiquimod 5%, a topical immune response modifier, can be appropriate in multifocal high-grade VINs, but it’s crucial to exclude invasive squamous cell carcinoma. As she noted, imiquimod is Food and Drug Administration–approved for anogenital warts but not for VIN. Beware of toxicity over the long term.
Dr. Nickles Fader reported no relevant financial disclosures.
Vaginal-fluid transplants in the works for US women
Good news for women with imbalanced nether regions.
US scientists are working to provide vaginal-fluid transplants to women suffering from bacterial vaginosis (BV), a condition characterized by “unusual discharge that has a strong fishy smell,” per the BBC. The Johns Hopkins University School of Medicine team working on the project was inspired by the success of fecal transplants used to combat chronic stomach ailments.
Along with treating BV, researchers say the vaginal microbiota transplant (VMT) “has the potential to revolutionize the way we view and treat conditions affecting the female reproductive tract,” per a new study published in the journal Frontiers in Cellular and Infection Microbiology.
BV is the most prevalent vaginal infection in people ages 15 to 44, affecting some 21.2 million Americans, according to the Centers for Disease Control and Prevention.
While it is unclear what triggers BV, the infection is caused by an imbalance in vaginal bacteria — and is usually found in women who are sexually active as well as those who douche, the CDC finds, although it has also been reported in those who’ve never had sex.
BV can heighten the risk of catching STIs, giving birth prematurely and spawning aberrant cells associated with cervical cancer. Sufferers often experience gray or white vaginal discharge, itching or burning and the aforementioned fishy odor emanating from the region — especially after sex. Although the infection can be knocked out with antibiotics, it often keeps coming back.
“We have very few treatment options available for BV, none of them fully curative or restorative,” Dr. Ethel Weld, a co-author of the study and an assistant professor of medicine at Johns Hopkins Medicine, said in a statement.
That’s where the VMT comes in, helping restore bacterial equilibrium after it’s been thrown off-kilter. More specifically, the vaginal-fluid infusion fosters the growth of good bacteria and depletes their bad, BV-causing counterparts, which thrive when the pH becomes too alkaline.
However, before the procedure could be made available to the public, the researchers needed to determine the ideal donor. So they developed a universal screening program, which they tested on 20 women. They found that ideal samples contained a high level of the bacterium Lactobacillus crispatus, with higher protective lactic acid content and a lower pH.
Before donating samples, women must forgo sex for a full month, and must undergo screening for any diseases, most notably HIV. Once cleared, they are then free to insert a flexible disc into their vagina to extract the fluid.
“The donation is a self-collection,” researcher Laura Ensign told the BBC. “It’s quick and easy and one sample collected that would be enough material to make one dose for transfer.”
Ensign said she hopes to receive funding soon so the public can start submitting samples, adding that even some members of the test group want to contribute for real.
Should the team get financing, they would ”give transplants to 40 recipients to begin with,” Ensign told the outlet. “Some would receive the real thing and others a placebo. All of them would get antibiotics for their BV too, though.”
“,”author”:”Ben Cost”,”date_published”:”2019-09-11T18:17:11.000Z”,”lead_image_url”:”https://thenypost.files.wordpress.com/2019/09/vaginal-fluid-transplant-953.jpg?quality=90&strip=all&w=1200″,”dek”:”US scientists are working to provide vaginal fluid transplants to women suffering from bacterial vaginosis (BV), a condition characterized by a “strong fishy smell” emanating from the vagina, the BBC reported. The Johns Hopkins University team working on the project were inspired by the success of poop transplants used to combat chronic stomach ailments.
Vaginal cancer happens when cancerous cells grow in your vagina.
A woman’s vagina — her birth canal — is a channel that goes from the opening of her uterus to the outside of her body. Many kinds of cancer can spread to the vagina from somewhere else, but cancer that starts here is rare. There are about 6,000 new cases in the U.S. each year.
There are a few main types of vaginal cancer:
Squamous cell carcinoma . This is by far the more common. It happens when cancer forms in the flat, thin cells that line your vagina. This type spreads slowly and tends to stay close to where it starts, but it can move into other places your liver, lungs, or bones. Older women are most ly to get this form. Nearly half of all new cases are in women ages 60 and up.
Adenocarcinoma . This type starts in glandular cells in the lining of your vagina, which make mucus and other fluids. It’s more ly to spread to other areas, including your lungs and the lymph nodes (small organs that filter out harmful things in your body) in your groin.
Clear cell carcinoma . This is an even rarer form of adenocarcinoma. It often affects women whose mothers took a hormone called diethylstilbestrol (DES) in the early months of pregnancy. Between 1938 and 1971, doctors often prescribed this medication to prevent miscarriage and other problems.
Even more rarely, vaginal cancer can form in connective tissue or muscle cells (sarcoma) or in cells that make pigments (melanoma).
Some cases of vaginal cancer don’t have a clear cause. But most are linked to infection with the human papillomavirus, or HPV. This is the most common sexually transmitted disease (STD). An HPV infection most often goes away on its own, but if it lingers, it can lead to cervical and vaginal cancer.
You also might be more ly to get vaginal cancer if you:
- Are 60 or older
- Were exposed to DES
- Drink alcohol
- Have cervical cancer or precancerous lesions
- Have HIV
- Have unusual cells in your vagina called vaginal intraepithelial neoplasia
Vaginal cancer often doesn’t cause symptoms. Your doctor might find it during a routine exam or Pap test.
If you have symptoms, they can include:
- Unusual bleeding from your vagina
- Watery or bad-smelling discharge from your vagina
- Pain in your pelvis
- Pain when having sex
- Pain when peeing
- Peeing more than usual
- A lump in your vagina
If you notice any of these things, it doesn’t mean you have vaginal cancer. You could just have an infection. But it’s important to get it checked out.
If a pelvic exam or a Pap test shows signs of a problem, your doctor may want to take a closer look by doing a colposcopy. They’ll use a lighted magnifying tool called a colposcope to check your vagina and cervix for anything unusual.
They might also take out a bit of tissue so a specialist can look at it under a microscope. This is called a biopsy.
After your doctor diagnoses vaginal cancer, they’ll do imaging tests and other exams to find out whether it’s spread to other parts of your body. This helps them decide the stage the cancer and how to treat it. The stages are:
- Stage I: The cancer is only in your vaginal wall.
- Stage II: It has spread to the tissue around your vagina.
- Stage III: Cancer is in the wall of your pelvis.
- Stage IVa: The cancer has reached the lining of your bladder, the lining of your rectum, or another area of your pelvis.
- Stage IVb: It has spread to farther parts of your body your lungs or bones.
You and your doctor will decide on treatment many things, including how close the cancer is to other organs, its stage, whether you’ve had radiation treatment in your pelvic area, and whether you’ve had a hysterectomy to remove your uterus.
Your doctor will probably recommend one or more of these treatments:
Surgery. This is the most common treatment. Your doctor may use a laser to cut out tissue or growths. In some cases, they might remove all or part of your vagina. You may need a hysterectomy to remove your cervix or other organs.
Many women can have a normal sex life after surgery. But sex can raise your chances of infection, and it can cause bleeding or strain the surgical site. Your doctor will tell you what’s safe to do and when it's safe.
Radiation therapy. This treatment uses high-powered X-rays or other forms of radiation to kill cancer. Your doctor might use a machine that sends X-rays into your body, or they could insert a radioactive substance inside your body, on or near the cancer.
Radiation treatments in your pelvic area can damage your ovaries. That can cause them to stop making estrogen, leading to menopause symptoms hot flashes and vaginal dryness. If you’ve been through menopause, you probably won’t have these problems.
This type of therapy also can irritate healthy tissue. Your vagina might get swollen and tender. Sex may be painful.
Chemotherapy (“chemo”). This uses medication to kill or stop the growth of cancer cells. You might take the medication by mouth or get it injected into a vein (intravenous or IV). In some cases, your doctor might give you a chemo in lotion or cream form.
You may lose your sex drive or have side effects nausea, hair loss, and changes in body weight. These will improve or go away after treatment.
Your recovery depends on many things. The most crucial is the stage at which your doctor found your cancer. At the earliest stages, doctors can often cure vaginal cancer.
Five-year survival rates are around 67% for women at stages I and II. This means that 5 years after they were diagnosed or treated, 67% of women are still alive. It's about 47% for all stages combined.
Your age, your overall health, whether your cancer is new or has come back, and whether it caused symptoms also play a role in recovery.
The best way to protect yourself is to avoid getting HPV. The FDA has approved the Gardasil 9 vaccine to prevent HPV-related diseases, including the seven most common types of HPV that cause cancer. The vaccine is for people ages 9 to 45. Younger patients need fewer shots for full protection.
Certain lifestyle changes can also help reduce your risk of vaginal cancer:
- Wait to have sex until your late teen years or beyond.
- Don’t have sex with more than one partner.
- Don’t have sex with someone who has more than one partner.
- Use condoms during sex.
- Get regular Pap exams.
- If you smoke, stop. If you don’t smoke, don’t start.
National Cancer Institute: “Vaginal Cancer Treatment.”
American Society of Clinical Oncology: “Vaginal Cancer: Risk Factors and Prevention.”
CDC: “Vaginal and Vulvar Cancers.”
American Cancer Society: “Vaginal Cancer.”
Mayo Clinic: “Cancer Treatment for Women: Possible Sexual Side Effects.”
FDA.gov: “FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old.”
Merck.com: “Gardasil 9.”
American Cancer Society: “Key Statistics for Vaginal Cancer,” “Survival Rates for Vaginal Cancer.”
Mayo Clinic: “Vaginal cancer.”
Johns Hopkins Medicine: “Vaginal Cancer.”
UpToDate: “Vaginal cancer.”
Obstetrics and Gynecology: “Factors Affecting Risk of Mortality in Women With Vaginal Cancer.”
Merck & Co.: “Gardasil 9 Prescribing Information.”
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What is vaginal cancer?
Cancer of the vagina, a rare kind of cancer in women, is a disease in which malignant (cancer) cells are found in the tissues of the vagina.
There are several types of cancer of the vagina. The two most common are:
Squamous cell cancer (squamous carcinoma):
Squamous carcinoma is most often found in women older than 60 and accounts for about 70 percent of all vaginal cancers.
Adenocarcinoma is more often found in women older than 50 and accounts for about 15 percent of all vaginal cancers.
A rare form of cancer called clear-cell adenocarcinoma results from the use of the drug diethylstilbestrol (DES) given to pregnant women between 1940 and 1971 to keep them from miscarrying. It occurs most often in the daughters of the women who took DES.
Other Types of Vaginal Cancer
Other, less common types of cancer that can be found in the vagina include:
Cancers that begin in other organs, such as the cervix and rectum, and spread to the vagina
Vaginal Cancer Prevention
The HPV vaccine can prevent the strains of HPV responsible for most cervical, vaginal and vulvar cancers.
HPV vaccines can only be used to prevent certain types of HPV. They cannot be used to treat an existing HPV infection. To be most effective, one of the vaccines should be given before a person becomes sexually active.
Vaginal Cancer Causes/Risk Factors
The following factors may increase a woman’s risk of developing vaginal cancer:
Age: Almost half of cases are in women 70 or older.
Exposure to diethylstilbestrol (DES) as a fetus (mother took DES during pregnancy)
History of cervical cancer
History of cervical precancerous conditions
Vaginal Cancer Symptoms
The following are the most common symptoms of vaginal cancer. However, each individual may experience symptoms differently. Symptoms may include:
Bleeding or discharge not related to menstrual periods
Difficult or painful urination
Pain during intercourse
Pain in the pelvic area
A mass that can be felt
Even if a woman has had a hysterectomy, she still has a chance of developing vaginal cancer. The symptoms of vaginal cancer may resemble other conditions or medical problems. Always consult a doctor for diagnosis.
Vaginal Cancer Diagnosis
There are several tests used to diagnose vaginal cancer, including:
Pelvic examination of the vagina, and other organs in the pelvis: This is done to check for tumors, lumps or masses.
Colposcopy: This procedure uses an instrument, called a colposcope, with magnifying lenses to examine the cervix and vagina for abnormalities. If abnormal tissue is found, a biopsy is usually performed; this is called a colposcopic biopsy.
Pap test (also called Pap smear): This test involves the microscopic exam of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation.
Computed tomography scan (CT or CAT scan): This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays.
Magnetic resonance imaging (MRI): This diagnostic procedure uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
Positron emission tomography (PET) scan: Radioactive- glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than most normal tissues, such as tumors, can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.
Biopsy: This procedure removes tissue samples from the vagina for examination under a microscope to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.
It is very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment and surveillance of female cancers, including vaginal cancer.
Treatment for Vaginal Cancer
Specific treatment for vaginal cancer will be determined by your doctor :
Your overall health and medical history
Extent of the disease
Your tolerance for specific medications, procedures or therapies
Expectations for the course of the disease
Generally, there are three kinds of treatment available for patients with cancerous or precancerous conditions of the vagina:
Laser surgery to remove the cancer, including LEEP (loop electroexcision procedure)
Local excision to remove the cancer
Vaginectomy to remove all or part of the vagina
Radiation therapy: the use of X-rays, gamma rays and charged particles to fight cancer
Chemotherapy (topical): the use of anticancer drugs to treat cancerous cells
Johns Hopkins researchers are hard at work developing new detection methods for gynecologic cancers. Learn more and discover how genetic testing for these cancers is saving lives.
Did you know that up to one-third of cancer deaths in women are attributed to excess body weight? Director of Gynecologic Oncology Amanda Fader and oncology dietitian Mary-Eve Brown discuss the correlation between the two. Learn what you can do to reduce your risk.