Bjog: An International Journal Of Obstetrics And Gynaecology, Jul 9, 2023
ObjectiveCharacterise VLS and obstetric considerations among women during pregnancy, parturition ... more ObjectiveCharacterise VLS and obstetric considerations among women during pregnancy, parturition and postpartum.DesignRetrospective cross‐sectional online survey, 2022.SettingInternational, English‐speakers.PopulationSelf‐identified individuals aged 18–50 diagnosed with VLS with symptom onset prior to pregnancy.MethodsParticipants recruited from social media support groups and accounts, completed a 47‐question survey including yes/no, multiple answer, and free‐text responses. Data were analysed with frequency, means and the Chi‐square test.Main outcome measuresVLS symptom severity, mode of delivery, perineal laceration, source and sufficiency of information provided about VLS and obstetrics, anxiety about delivery, and postpartum depression.ResultsOf 204 responses, 134 met inclusion criteria, encompassing 206 pregnancies. Mean respondent age was 35 years (SD 6) and mean age of VLS symptom onset, diagnosis and birth, was 22 (SD 8), 29 (SD 7) and 31 (SD 4) years, respectively. Symptoms decreased in 44% (n = 91) of pregnancies and increased during the postpartum period in 60% (n = 123). In all, 67% (n = 137) of pregnancies resulted in vaginal birth and 33% (n = 69) in caesarean birth. Anxiety for delivery due to VLS symptoms was reported by 50% (n = 103); 31% (n = 63) experienced postpartum depression. Of respondents previously diagnosed with VLS, 60% (n = 69) used topical steroids prior to pregnancy, 40% (n = 45) were treated during pregnancy and 65% (n = 75) postpartum. In all, 94% (n = 116) reported receiving an insufficient amount of information on the topic.ConclusionIn this online survey, we found reported symptom severity remained unchanged or decreased during pregnancy, but increased postpartum. Use of topical corticosteroids decreased during pregnancy compared with before and after pregnancy. Half of the respondents reported anxiety regarding VLS and delivery.
Introduction: Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affect... more Introduction: Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affecting the vulva. Studies have shown high rates of sexual dysfunction in patients with LS; however, the sexual effects of the condition are poorly acknowledged. Objectives: We sought to identify sexual health consequences among women with vulvar LS through systematic review of available literature. Methods: A systematic review of the literature was conducted to find reports on sexual health consequences among women with LS. PubMed, MEDLINE, and Scopus were queried. Included articles were observational studies evaluating women with LS and their sexual health and randomized controlled trials or comparative studies utilizing a validated sexual health measure before intervention among the same population. Articles must have been written in English and published from January 1991 to April 2022. Results: The search produced 683 references, including 32 articles that met criteria for full-text review and 20 reported studies that met inclusion criteria. Two studies investigated the impact of LS on interpersonal relationships, 6 studies evaluated sexual symptoms, 16%-60% reported sexual dysfunction, and 22%-56.7% reported dyspareunia. Also described were decreased sexual frequency and satisfaction, negative impact on sexual relationships, and feelings of inadequacy. Eight publications evaluated the Female Sexual Function Index (FSFI); all described studies that demonstrated a central tendency less than 26.55. Four publications evaluated the Female Sexual Distress Scale (FSDS); all demonstrated average scores greater than 12. Two publications evaluated the Female Genital Self-Image Scale (FGSIS), both found decreased scores compared to controls. Four publications evaluated the Dermatology Life Quality Index (DLQI); impact on quality of life was small to very large, with sexual difficulties affecting most study patients. One publication evaluated the Vulvar Quality of Life Index (VQLI); sexuality was the second highestscoring subgroup. Conclusions: Sexual health consequences of LS include sexual pain, dysfunction, and distress; negative genital self-image; and negative impact on sexual relationships. Women with LS experience a negative impact on quality of life, particularly related to sexual functioning.
Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective deli... more Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. Objective: The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. Methods: This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. Results: A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. Conclusions: The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction.
Journal of Lower Genital Tract Disease, Jun 26, 2021
Objective This systematic review aimed to present the available literature on plasma cell vulviti... more Objective This systematic review aimed to present the available literature on plasma cell vulvitis (PCV), a relatively uncommon form of inflammatory vulvovaginal dermatitis. Materials and Methods A literature search was performed in PubMed, Science Direct, and Google Scholar using the following key words: “plasma cell vulvitis,” “Zoon vulvitis,” and “vulvitis circumscripta plasmacellularis.” Specific variables were assessed in each article, including patient age, menopausal status, comorbidities, presenting symptoms, symptom duration, histological description, treatment, and treatment response. Results Thirty-nine articles met inclusion criteria, including 38 case reports and 1 observational study, with a total of 96 cases of PCV reported. The mean age of diagnosis was 52.9 years, with an age range of 8–76 years. Most common presenting symptoms included pruritis and vaginal discomfort, with average duration of symptoms 28.2 months (range = 2 months to 10 years). All reports demonstrated subepithelial plasma cell infiltrate on histology. Five percent of PCV cases reported concomitant autoimmune conditions and 6% sexually transmitted infections. Most common treatment modalities included topical corticosteroids (n = 41), tacrolimus (n = 6), and imiquimod (n = 6). In 53 reported outcomes, 88.7% of patients had resolution of symptoms with treatment. Conclusions Clinical research is needed to better determine the diagnostic criteria and to assess the efficacy of treatment options for PCV.
Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosu... more Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short-and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2021;XX:XXX−XXX
To estimate the efficacy of fractionated carbon dioxide (CO 2) laser therapy for vulvar lichen sc... more To estimate the efficacy of fractionated carbon dioxide (CO 2) laser therapy for vulvar lichen sclerosus. METHODS: We conducted a prospective, double-blind, randomized, sham-controlled, trial conducted in a clinic specializing in vulvar disorders. The study participants were 40 women with active vulvar lichen sclerosus confirmed with biopsy who were abstaining from topical and systemic treatments for at least 4 weeks before enrollment. Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five fractionated CO 2 treatments in a 24-week period. Study participants, treating clinicians, and the evaluating pathologist were blinded. The primary endpoint was the change in the histopathology scale score between pretreatment and posttreatment biopsies. We estimated 20 per group for 80% power to detect a 40% reduction in the histopathology scale score with up to 10% attrition. A secondary endpoint was the change in the validated CSS (Clinical Scoring System for Vulvar Lichen Sclerosus). RESULTS: From November 2018 to June 2020, 40 women were randomized to participate in the trial, and 37 women (19 fractionated CO 2 , 18 sham) were included in an intention-to-treat (ITT) analysis. Three women were excluded from the ITT analysis because they did not have posttreatment biopsies and, therefore, a posttreatment histopathology scale score could not be obtained. There was a 0.20 reduction (improvement) in histopathology scale score from baseline in the active treatment group (95% CI 21.1, 0.80, P5.74) and a 0.1 increase from baseline in the sham treatment group (95% CI 20.90, 1.0, P5.91). The change in histopathology scale score between the active and sham arm was not statistically significant (95% CI 21.14, 1.06, P5.76). CONCLUSION: Fractionated CO 2 is not an effective monotherapy treatment for vulvar lichen sclerosus.
Journal of Minimally Invasive Gynecology, Nov 1, 2013
and to address spikes in adverse surgical outcomes identified by our quality assurance committee.... more and to address spikes in adverse surgical outcomes identified by our quality assurance committee. Measurements and Main Results: After implementation of the MIS curriculum in the simulation lab, we observed a decline in the rate of abdominal hysterectomy from 51.9% (361/695) to 24.7% (186/751) and an increase in rate of laparoscopic hysterectomy from 46% (396/855) to 66.6% (500/751). 6/110 (5.4%) urinary thermal injuries occurred between 5/2012 and 9/2012 and this rate fell to 2/112(1.7%) following simulation lab workshops on anatomy and safe use of electrosurgical equipment. 235 multidisciplinary staff physicians and 120 residents have participated in skills labs. Fifteen staff gynecologic surgeons, with little or no formal laparoscopic residency training, became credentialed in advanced laparoscopic surgery since the opening of the center. Conclusion: An MIS skills lab in a community teaching hospital facilitates practice improvement and incorporation of new technology into surgical practice. Investment in a simulation lab offers the potential to decrease the rate of abdominal hysterectomy, to specifically address safety concerns, and to create a department-wide culture of practice adaptation and continual learning.
Objective: Characterize the presentation of vulvar lichen scleorsus (LS) among premenopausal wome... more Objective: Characterize the presentation of vulvar lichen scleorsus (LS) among premenopausal women. Design: Cross-sectional study. Setting: An international web-based survey distributed on social media support groups and in two urban gynecology offices specializing in LS. Population: A total of 503 premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50. Methods: Participants completed an anonymous 28-question web-based survey between January to March 2021. Main Outcome Measures: Symptoms, timing and accuracy of diagnosis, and presence of concomitant autoimmune conditions. Results: Symptoms reported to be most present and affect the individual were dyspareunia (68%; 44%) and tearing with intercourse or vaginal insertion (63%; 39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%), and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulv...
Background: Historically, most medical students began medical school right after completing their... more Background: Historically, most medical students began medical school right after completing their undergraduate degree. However, over the past 4 years, the average age of medical student matriculation was 24 years. Many students are taking a few years to pursue other opportunities before entering medical school, which has been shown to help in the transition to the clinical years of medical school. Methods: An anonymous online quantitative survey was sent from June 2017 through March 2018 to medical students enrolled in clinical rotations at four large medical schools representing different regions of the US. In this study, students 25 years or older were considered non-traditional, while students under the age of 25 were considered traditional. Survey questions were adapted from a qualitative study on the experiences of mature-aged medical students. Results: A total of 195 medical students responded to the survey, which was about a 14% participation rate. The average age upon enter...
Background/Theoretical Framework: Although the mean age of first year medical students is 24, an ... more Background/Theoretical Framework: Although the mean age of first year medical students is 24, an increasing number of “mature-aged” students, defined as over age 30, are entering medical school. Most studies of mature-aged medical students have examined academic performance using quantitative research design [1, 2]. Few studies have employed qualitative methodology to determine the experience of mature-aged medical students, especially in the clinical setting.
Samantha Ahle1, Jill Krapf MD2, Kirsten Brown PhD1, Juliet Lee MD3, Gisela Butera MLIS4, Ellen Go... more Samantha Ahle1, Jill Krapf MD2, Kirsten Brown PhD1, Juliet Lee MD3, Gisela Butera MLIS4, Ellen Goldman EdD5, Myriam Ferzli MD2, Rosalyn A. Jurjus MD PhD 1 1Department of Anatomy and Regenerative Biology, School of Medicine and Health Sciences, 2Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, 3Department of Surgery, School of Medicine and Health Sciences, 4Himmelfarb Health Sciences Library, School of Medicine and Health Sciences, 5Department of Human and Organizational Learning, Graduate School of Education and Human Development
Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affect... more Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet’s syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.
Bjog: An International Journal Of Obstetrics And Gynaecology, Jul 9, 2023
ObjectiveCharacterise VLS and obstetric considerations among women during pregnancy, parturition ... more ObjectiveCharacterise VLS and obstetric considerations among women during pregnancy, parturition and postpartum.DesignRetrospective cross‐sectional online survey, 2022.SettingInternational, English‐speakers.PopulationSelf‐identified individuals aged 18–50 diagnosed with VLS with symptom onset prior to pregnancy.MethodsParticipants recruited from social media support groups and accounts, completed a 47‐question survey including yes/no, multiple answer, and free‐text responses. Data were analysed with frequency, means and the Chi‐square test.Main outcome measuresVLS symptom severity, mode of delivery, perineal laceration, source and sufficiency of information provided about VLS and obstetrics, anxiety about delivery, and postpartum depression.ResultsOf 204 responses, 134 met inclusion criteria, encompassing 206 pregnancies. Mean respondent age was 35 years (SD 6) and mean age of VLS symptom onset, diagnosis and birth, was 22 (SD 8), 29 (SD 7) and 31 (SD 4) years, respectively. Symptoms decreased in 44% (n = 91) of pregnancies and increased during the postpartum period in 60% (n = 123). In all, 67% (n = 137) of pregnancies resulted in vaginal birth and 33% (n = 69) in caesarean birth. Anxiety for delivery due to VLS symptoms was reported by 50% (n = 103); 31% (n = 63) experienced postpartum depression. Of respondents previously diagnosed with VLS, 60% (n = 69) used topical steroids prior to pregnancy, 40% (n = 45) were treated during pregnancy and 65% (n = 75) postpartum. In all, 94% (n = 116) reported receiving an insufficient amount of information on the topic.ConclusionIn this online survey, we found reported symptom severity remained unchanged or decreased during pregnancy, but increased postpartum. Use of topical corticosteroids decreased during pregnancy compared with before and after pregnancy. Half of the respondents reported anxiety regarding VLS and delivery.
Introduction: Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affect... more Introduction: Lichen sclerosus (LS) is a chronic inflammatory skin condition predominantly affecting the vulva. Studies have shown high rates of sexual dysfunction in patients with LS; however, the sexual effects of the condition are poorly acknowledged. Objectives: We sought to identify sexual health consequences among women with vulvar LS through systematic review of available literature. Methods: A systematic review of the literature was conducted to find reports on sexual health consequences among women with LS. PubMed, MEDLINE, and Scopus were queried. Included articles were observational studies evaluating women with LS and their sexual health and randomized controlled trials or comparative studies utilizing a validated sexual health measure before intervention among the same population. Articles must have been written in English and published from January 1991 to April 2022. Results: The search produced 683 references, including 32 articles that met criteria for full-text review and 20 reported studies that met inclusion criteria. Two studies investigated the impact of LS on interpersonal relationships, 6 studies evaluated sexual symptoms, 16%-60% reported sexual dysfunction, and 22%-56.7% reported dyspareunia. Also described were decreased sexual frequency and satisfaction, negative impact on sexual relationships, and feelings of inadequacy. Eight publications evaluated the Female Sexual Function Index (FSFI); all described studies that demonstrated a central tendency less than 26.55. Four publications evaluated the Female Sexual Distress Scale (FSDS); all demonstrated average scores greater than 12. Two publications evaluated the Female Genital Self-Image Scale (FGSIS), both found decreased scores compared to controls. Four publications evaluated the Dermatology Life Quality Index (DLQI); impact on quality of life was small to very large, with sexual difficulties affecting most study patients. One publication evaluated the Vulvar Quality of Life Index (VQLI); sexuality was the second highestscoring subgroup. Conclusions: Sexual health consequences of LS include sexual pain, dysfunction, and distress; negative genital self-image; and negative impact on sexual relationships. Women with LS experience a negative impact on quality of life, particularly related to sexual functioning.
Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective deli... more Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. Objective: The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. Methods: This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. Results: A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. Conclusions: The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction.
Journal of Lower Genital Tract Disease, Jun 26, 2021
Objective This systematic review aimed to present the available literature on plasma cell vulviti... more Objective This systematic review aimed to present the available literature on plasma cell vulvitis (PCV), a relatively uncommon form of inflammatory vulvovaginal dermatitis. Materials and Methods A literature search was performed in PubMed, Science Direct, and Google Scholar using the following key words: “plasma cell vulvitis,” “Zoon vulvitis,” and “vulvitis circumscripta plasmacellularis.” Specific variables were assessed in each article, including patient age, menopausal status, comorbidities, presenting symptoms, symptom duration, histological description, treatment, and treatment response. Results Thirty-nine articles met inclusion criteria, including 38 case reports and 1 observational study, with a total of 96 cases of PCV reported. The mean age of diagnosis was 52.9 years, with an age range of 8–76 years. Most common presenting symptoms included pruritis and vaginal discomfort, with average duration of symptoms 28.2 months (range = 2 months to 10 years). All reports demonstrated subepithelial plasma cell infiltrate on histology. Five percent of PCV cases reported concomitant autoimmune conditions and 6% sexually transmitted infections. Most common treatment modalities included topical corticosteroids (n = 41), tacrolimus (n = 6), and imiquimod (n = 6). In 53 reported outcomes, 88.7% of patients had resolution of symptoms with treatment. Conclusions Clinical research is needed to better determine the diagnostic criteria and to assess the efficacy of treatment options for PCV.
Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosu... more Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short-and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2021;XX:XXX−XXX
To estimate the efficacy of fractionated carbon dioxide (CO 2) laser therapy for vulvar lichen sc... more To estimate the efficacy of fractionated carbon dioxide (CO 2) laser therapy for vulvar lichen sclerosus. METHODS: We conducted a prospective, double-blind, randomized, sham-controlled, trial conducted in a clinic specializing in vulvar disorders. The study participants were 40 women with active vulvar lichen sclerosus confirmed with biopsy who were abstaining from topical and systemic treatments for at least 4 weeks before enrollment. Women were randomized in a 1:1 ratio to receive either five sham laser treatments or five fractionated CO 2 treatments in a 24-week period. Study participants, treating clinicians, and the evaluating pathologist were blinded. The primary endpoint was the change in the histopathology scale score between pretreatment and posttreatment biopsies. We estimated 20 per group for 80% power to detect a 40% reduction in the histopathology scale score with up to 10% attrition. A secondary endpoint was the change in the validated CSS (Clinical Scoring System for Vulvar Lichen Sclerosus). RESULTS: From November 2018 to June 2020, 40 women were randomized to participate in the trial, and 37 women (19 fractionated CO 2 , 18 sham) were included in an intention-to-treat (ITT) analysis. Three women were excluded from the ITT analysis because they did not have posttreatment biopsies and, therefore, a posttreatment histopathology scale score could not be obtained. There was a 0.20 reduction (improvement) in histopathology scale score from baseline in the active treatment group (95% CI 21.1, 0.80, P5.74) and a 0.1 increase from baseline in the sham treatment group (95% CI 20.90, 1.0, P5.91). The change in histopathology scale score between the active and sham arm was not statistically significant (95% CI 21.14, 1.06, P5.76). CONCLUSION: Fractionated CO 2 is not an effective monotherapy treatment for vulvar lichen sclerosus.
Journal of Minimally Invasive Gynecology, Nov 1, 2013
and to address spikes in adverse surgical outcomes identified by our quality assurance committee.... more and to address spikes in adverse surgical outcomes identified by our quality assurance committee. Measurements and Main Results: After implementation of the MIS curriculum in the simulation lab, we observed a decline in the rate of abdominal hysterectomy from 51.9% (361/695) to 24.7% (186/751) and an increase in rate of laparoscopic hysterectomy from 46% (396/855) to 66.6% (500/751). 6/110 (5.4%) urinary thermal injuries occurred between 5/2012 and 9/2012 and this rate fell to 2/112(1.7%) following simulation lab workshops on anatomy and safe use of electrosurgical equipment. 235 multidisciplinary staff physicians and 120 residents have participated in skills labs. Fifteen staff gynecologic surgeons, with little or no formal laparoscopic residency training, became credentialed in advanced laparoscopic surgery since the opening of the center. Conclusion: An MIS skills lab in a community teaching hospital facilitates practice improvement and incorporation of new technology into surgical practice. Investment in a simulation lab offers the potential to decrease the rate of abdominal hysterectomy, to specifically address safety concerns, and to create a department-wide culture of practice adaptation and continual learning.
Objective: Characterize the presentation of vulvar lichen scleorsus (LS) among premenopausal wome... more Objective: Characterize the presentation of vulvar lichen scleorsus (LS) among premenopausal women. Design: Cross-sectional study. Setting: An international web-based survey distributed on social media support groups and in two urban gynecology offices specializing in LS. Population: A total of 503 premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50. Methods: Participants completed an anonymous 28-question web-based survey between January to March 2021. Main Outcome Measures: Symptoms, timing and accuracy of diagnosis, and presence of concomitant autoimmune conditions. Results: Symptoms reported to be most present and affect the individual were dyspareunia (68%; 44%) and tearing with intercourse or vaginal insertion (63%; 39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%), and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulv...
Background: Historically, most medical students began medical school right after completing their... more Background: Historically, most medical students began medical school right after completing their undergraduate degree. However, over the past 4 years, the average age of medical student matriculation was 24 years. Many students are taking a few years to pursue other opportunities before entering medical school, which has been shown to help in the transition to the clinical years of medical school. Methods: An anonymous online quantitative survey was sent from June 2017 through March 2018 to medical students enrolled in clinical rotations at four large medical schools representing different regions of the US. In this study, students 25 years or older were considered non-traditional, while students under the age of 25 were considered traditional. Survey questions were adapted from a qualitative study on the experiences of mature-aged medical students. Results: A total of 195 medical students responded to the survey, which was about a 14% participation rate. The average age upon enter...
Background/Theoretical Framework: Although the mean age of first year medical students is 24, an ... more Background/Theoretical Framework: Although the mean age of first year medical students is 24, an increasing number of “mature-aged” students, defined as over age 30, are entering medical school. Most studies of mature-aged medical students have examined academic performance using quantitative research design [1, 2]. Few studies have employed qualitative methodology to determine the experience of mature-aged medical students, especially in the clinical setting.
Samantha Ahle1, Jill Krapf MD2, Kirsten Brown PhD1, Juliet Lee MD3, Gisela Butera MLIS4, Ellen Go... more Samantha Ahle1, Jill Krapf MD2, Kirsten Brown PhD1, Juliet Lee MD3, Gisela Butera MLIS4, Ellen Goldman EdD5, Myriam Ferzli MD2, Rosalyn A. Jurjus MD PhD 1 1Department of Anatomy and Regenerative Biology, School of Medicine and Health Sciences, 2Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, 3Department of Surgery, School of Medicine and Health Sciences, 4Himmelfarb Health Sciences Library, School of Medicine and Health Sciences, 5Department of Human and Organizational Learning, Graduate School of Education and Human Development
Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affect... more Acute genital ulcers (AGU), known as Lipschütz ulcers, are painful vulvar ulcers typically affecting non-sexually active girls and women. AGU have been associated with viral infections, namely, Epstein-Barr virus (EBV). Here, we describe a case of AGU in the setting of SARS-CoV-2 in a non-sexually active adolescent girl hospitalised for pain control and urinary retention, who failed a course of oral corticosteroids and then improved with colchicine. Testing for herpes simplex virus, EBV and Behcet’s syndrome were all negative. Testing for SARS-CoV-2 was positive. COVID-19 increases cytokines such as tumour necrosis factor alpha, which has been shown to affect endothelial cell adhesion and neutrophil chemotaxis, leading to aphthosis.
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Papers by Jill Krapf