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PubMed1990

Histological changes in the genital tract of female veal calves implanted with naturally occurring anabolic steroids.

The influence of implants composed of estradiol and testosterone on the genital tract of female veal calves was studied. Striking results were the metaplastic and hyperplastic lesions seen in Bartholin's glands (an estrogenic effect) and a preputial-like separation of the clitoral epithelium (an androgenic effect). Other changes were less pronounced or resembled those found in estrous animals. Similar though less distinct histological changes were observed in the genital tract of animals from a farm with a history of illegal administration of anabolic steroids suggesting illegal treatment. From these findings it is concluded that histological screening of Bartholin's glands for estrogenic influences and of the clitoris for androgenic activity can be useful in tracing illegal anabolic treatment of female veal calves with combination preparations.

Animals↗
PubMed1997

A case of ambiguous genitalia with unilateral amelia and unilateral peromelia of the upper limbs.

A 7-year-old patient is reported with a 46,XY karyotype, ambiguous genitalia and unilateral amelia and unilateral peromelia of the upper limbs. The external genitalia had essentially a female configuration with labia majora, large clitoris, and narrow vaginal opening. Gonadal tissue was not palpable on either side. The levels of 17-OH progesterone dehydroepiandrosterone sulfate (DHEA-S), androstenedione and luteinizing hormone (LH) were normal, but the level of follicle stimulating hormone (FSH) was elevated minimally. Abdominal ultrasonography (USG) was normal. On pelvic USG, neither uterus nor ovaries were seen. Genitography showed a blind vagina. Gonads, Müllerian and/or Wolffian structures were not observed at laparotomy. Clitoral recession and cut-back vaginoplasty were performed. The occurrence of these findings suggests embryonic testicular regression syndrome with bilateral transverse defect of the upper limbs. The case has been presented because the pattern of the birth defects, including both ambiguous genitalia and unilateral amelia on one side of the upper limbs and unilateral peromelia on the other, have not been described previously.

Abnormalities, Multiple↗
PubMed2004

Successful bladder management for a pure urogenital sinus anomaly.

We report on a case of a pure urogenital sinus anomaly presented with bladder distention. A seven-day-old girl with an abdominal distension was referred to the Division of Urology, Hakodate Central Hospital, Hakodate, Japan. A common urogenital sinus without abnormalities in the labium, clitoris or anus was found. A computed tomography (CT) scan documented a distended bladder without hydrometrocolpos or hydroureteronephrosis. Cystography performed at 44 days revealed a large flaccid bladder without ureteral reflux. Urinary management by an indwelling urethral catheter was maintained until 3 months, when an endoscopic examination was performed and a stenotic urethral-type urogenital sinus with low confluence was diagnosed. Parents successfully instituted clean intermittent catheterization as a temporary urinary management, and postvoid residual urine gradually decreased. At 2 years of age, flap vaginoplasty was performed. In an urodynamic study performed postoperatively, the detrusor pressure during voiding was 40-50 cmH(2)O. The patient maintained spontaneous voiding without consequences. Appropriate urinary care is essential to prevent urological complications in cases with a pure urogenital sinus anomaly.

Female↗
PubMed2006

Sexually responsive vascular tissue of the vulva.

OBJECTIVE: To better understand the genital changes that occur during the female sexual response, using a gross anatomical and histological study of the vascular tissue of the vulva, supplemented with magnetic resonance imaging (MRI). MATERIALS AND METHODS: Seven cadaveric vulvectomy specimens were used; they were serially sectioned in coronal, sagittal, and axial planes, and stained with haematoxylin and eosin. Selected blocks were stained with elastic Masson's trichrome. Axial MR images were taken of two healthy women with intact sexual functioning using a gadolinium-based blood-pool contrast agent. A 1.5 T system was used for all MRI studies, with images taken at baseline and during sexual arousal while viewing an erotic videotape. RESULTS: There are five vascular compartments of the female external genitalia, found in the clitoris, clitoral bulbs, labia minora, urethra, and vestibule/vagina. Of these five compartments, two distinct types of vascular tissue were identified, i.e. erectile and non-erectile/specialized genital. The erectile tissue compartments had the greatest change in blood volume during sexual arousal, as assessed by MRI. CONCLUSIONS: The vulva contains a substantial amount of vascular tissue. These specialized tissues show a variable, but unified response to sexual arousal.

Arousal↗
PubMed1998

The C fibre reflex of the cat urinary bladder.

1. Reflexes evoked in bladder parasympathetic neurones by electrical stimulation of bladder C afferent fibres were studied in cats anaesthetized with alpha-chloralose. The responses were compared with the ordinary micturition reflex evoked by low-threshold Adelta afferents from bladder mechanoreceptors and mediated by a spino-ponto-spinal reflex pathway. 2. The bladder was catheterized for fluid instillations and pressure recordings. Efferent reflex discharges were recorded from the cut central end of a small distal bladder branch of the pelvic nerve. The remaining bladder pelvic nerve branches were stimulated electrically close to the bladder. 3. Stimulation at C afferent intensity evoked a late reflex discharge in bladder pelvic efferents in all animals. The response was centrally mediated, had a latency of 150-250 ms, and was much weaker after stimulation on the contralateral nerve. 4. The bladder C fibre reflex differed in several functional aspects from the ordinary Adelta micturition reflex. It could be evoked at a low rate of stimulation, with an empty bladder and no background activity from bladder mechanoreceptors. In this situation, the normal Adelta micturition reflex is not elicited. The C fibre reflex also survived an acute spinalization at a low thoracic level. 5. The C fibre reflex was strongly inhibited by dorsal clitoris or dorsal penis nerve stimulation, an effect that was maintained after spinalization. It was facilitated by bladder or urethra exposure to cold and menthol, stimuli that activate specific cold-sensitive receptors associated with unmyelinated C afferents. 6. It is concluded that the central pathway of the C fibre reflex is spinal and partly separate from that of the ordinary micturition reflex. These observations are in keeping with the clinical finding that a bladder cooling reflex can be elicited in patients with disturbed descending control of the bladder.

Animals↗
PubMed1977

Male intersexuality presenting at puberty.

A 15-year-old girl was referred to the Endocrine Unit because of a deep voice and the absence of menstruation. Secondary sex hair showed a male pattern of distribution and there was a phallic clitoris 4 cm long, with the urethral orifice posterior. Plasma testosterone was within the normal male range. The karyotype was 46XY. Gonadectomy and clitoridectomy were performed. Histology suggested a diagnosis of anatomical testicular failure, which, in view of the imperfect attempt at masculinization, was thought to be only partial. Possible causes are discussed.

Adolescent↗
PubMed1984

Treatment of condylomata acuminata with the carbon dioxide laser.

Extensive and/or recurrent condylomata acuminata in 78 women were treated with the CO2 laser. Urethra, clitoris or the anal canal were involved in about one-fourth of the cases. Most were treated as outpatients with the more extensive lesions staged for multiple treatments. After a follow-up period of 6-33 months, 91% of women were free from disease and treatment failures occurred in 9%, some of which may have been new infections. No serological investigations were performed.

Adolescent↗
PubMed1988

Neurophysiological abnormalities in genuine female stress urinary incontinence.

Perineal sensory and motor function was investigated in 28 women with genuine stress incontinence of urine and compared with a matched control group. Electrosensitivity of the dorsal nerve of the clitoris and of the urethral mucosa was significantly diminished in these patients (eight measurements 'insensitive'). Three different reflex latency measurements (dorsal nerve to external anal sphincter, dorsal nerve to urethral sphincter, urethral mucosa to external anal sphincter) were prolonged in incontinence (14 absent reflexes). Mean motor unit potential duration of the external anal sphincter was also prolonged, reflecting an early neuropathy. Anorectal manometry detected significantly weaker squeeze pressures in stress incontinence although other variables were unaffected.

Adult↗
PubMed2002

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria.

OBJECTIVE: To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria. DESIGN: Cross sectional study. SETTING: Women attending family planning and antenatal clinics at three hospitals in Edo State, South-south Nigeria. POPULATION: 1836 healthy premenopausal women. METHODS: The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women's sociodemographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models. MAIN OUTCOME MEASURES: Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections. RESULTS: Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26-0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51-2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11-2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54-5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09-2.49) and genital ulcers (OR = 4.38, 95% CI 1.13-17.00). CONCLUSION: Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

Adolescent↗
PubMed2005

Female genital appearance: "normality" unfolds.

OBJECTIVE: To describe variations in genital dimensions of normal women. DESIGN: Observational cross-sectional study. SETTING: Elizabeth Garrett Anderson Hospital, University College Hospital NHS Trust, London, UK. POPULATION: Fifty premenopausal women having gynaecological procedures not involving the external genitalia under general anaesthetic. METHODS: A cross sectional study using digital photography and measurements of the external genitalia. MAIN OUTCOME MEASURES: Clitoral size, labial length and width, colour and rugosity, vaginal length, distance from clitoris to urethral orifice, distance from posterior fourchette to anterior anal margin. RESULTS: A wide range of values were noted for each measurement. There was no statistically significant association with age, parity, ethnicity, hormonal use or history of sexual activity. CONCLUSION: Women vary widely in genital dimensions. This information should be made available to women when considering surgical procedures on the genitals, decisions for which must be carefully considered between surgeon and woman.

Adolescent↗
PubMedDate not supplied

Malignant eccrine spiradenoma of the vulva: a case report and review of the literature.

Malignant eccrine spiradenoma is a rare skin tumor of sweat gland origin. We present the first reported case of this tumor in the female genitalia. Due to the rarity of this tumor, there has yet to be an established standard of care. The present case is that of a 41-year-old woman with malignant eccrine spiradenoma of the periclitoral region. She had an 18-month history of a recurrent, painful mass adjacent to the clitoris. Her diagnosis was made after excision of the cystic tumor. The patient then underwent a partial radical vulvectomy with bilateral sentinel lymph node sampling. As malignant eccrine spiradenoma is a rare tumor, no standard care exists for treatment and postoperative management. Based on our review of the literature, wide local excision appears to be the preferred initial treatment. Furthermore, adjuvant chemotherapy and/or radiation does not seem to improve survival in patients with advanced or recurrent cancer. Although lymph node sampling and/or lymphadenectomy is frequently reported in the treatment of this tumor, hematogenous metastasis can also occur. Therefore, these patients require close postoperative follow-up for recurrent disease.

Acrospiroma↗
PubMedDate not supplied

Vulvar keratoacanthoma.

A keratoacanthoma of the vulva in a 33-year-old woman is described. The patient presented with a rapidly growing exophytic lesion of 1 cm in diameter over the clitoris that had been present for a couple of months. An excisional biopsy was performed. Pathologic examination of the exophytic nodule showed squamous proliferation with a characteristic central keratin- filled crater. There were pushing margins. High power microscopy showed squamous cells of cytologically bland appearance with glassy cytoplasm. There were few mitotic figures. Less than 10% Ki-67-positive staining nuclei were seen. There was no p53 oncoprotein overexpression. Keratoacanthoma of the vulva is rare with only five cases having been reviewed in the English literature since 1985. Keratoacanthomas are rapidly growing crateriform lesions on the sun-exposed skin of the elderly. Because of its rarity in the vulva, the lesion can be misinterpreted as a malignant lesion such as squamous cell carcinoma. Awareness of vulvar occurrence of keratoacanthoma and its characteristic histopathologic features will help avoid misdiagnosis of a squamous cell carcinoma leading to radical surgery.

Adult↗
PubMed1982

Insulin resistance in a child with Acanthosis nigricans type A.

The patient, a female 6 years 4 months old, diagnosed as affected by Acanthosis nigricans and diabetes mellitus was referred to our Clinic for further investigation of her glucose metabolism. She had a typical face with hypertelorism, prognathism, macroglossia and large auricles. The skin was hyperpigmented, verrucous, hyperkeratotic especially in the folds and flexural areas with small papillomatous or nodular growth; diffused hypertrichosis and hypertrophic clitoris were also present. Biochemical and hormonal investigations revealed no major abnormalities apart from glucose metabolism. After an unsuccessful trial with conventional insulin therapy, endovenous continuous insulin infusion was started: even with 32 U/kg/h it was not possible to achieve normoglycemia. Insulin receptors were studied on erythrocytes: 125I-insulin binding (specific) was clearly lower than normal. The concentration of insulin receptors was reduced, while the average affinity profile was normal. The study of erythrocyte insulin receptors has demonstrated that insulin resistance in this patient is due to a decrease in the number of receptors, i.e. Acanthosis nigricans type A.

Acanthosis Nigricans↗
PubMed1993

Sertoli-Leydig cell tumour of the ovary--a rare cause of virilization after menopause.

A case of Sertoli-Leydig cell tumour of the ovary causing virilization in a postmenopausal woman is presented. The patient had increasing facial hair growth, deepening of the voice, a dull pain in the lower part of the abdomen and enlargement of the clitoris. Laboratory investigations showed an elevated level of plasma testosterone. Considering an ovarian tumour the most likely cause of the above-mentioned findings, hysterectomy with bilateral salpingo-oophorectomy was performed. Both ovaries were macroscopically normal at operation, but pathological examination revealed a small well-differentiated Sertoli-Leydig cell tumour in the left ovary. Follow-up 3 months later showed decreasing signs of virilization and normalization of the hormone levels.

Dehydroepiandrosterone↗
PubMed2006

Psychiatric illness presenting with a sexual complaint and management by psychotropic medications: a case report.

INTRODUCTION: Sexual medicine healthcare professionals, who do not normally examine men and women with psychiatric disorders, need to be aware that those with psychiatric disorders can and do present with sexual medicine problems. In particular, psychiatric individuals may present with a variety of delusions including those that have sexual content or sexual implications. The rare disorder of reverse delusional misidentification syndrome may be encountered in schizophrenic patients and may be best managed by the combined team effort of a sexual medicine specialist and psychiatrist. AIM: To report a case study that reiterates the assessment and sexual medicine management of a female with sexual dysfunction who believed she was transforming into a male. METHODS: Case report of a woman who attended an outpatient clinic in an academic medical center. RESULTS: A 60-year-old woman with a history of paranoid schizophrenia presented to a gynecologist for ovarian cancer screening. Evaluation revealed complaints that the patient's ovaries were testes that produced sperm and her clitoris was a penis capable of erection and ejaculation. Gynecological examination revealed only atrophic vaginitis. The patient was treated with local minimally absorbed vaginal estrogens and referred for psychological assessment and counseling. Psychotropic medication compliance was encouraged, weekly psychotherapy was continued, and delusional symptoms were minimized. CONCLUSION: Sexual medicine healthcare providers should be prepared to manage sex health concerns of men and women with psychiatric disorders, including delusional misidentification syndrome, in conjunction with a psychiatrist.

Delusions↗
PubMed1997

Male pseudohermaphroditism in a cat.

A seven-month-old male pedigree cat was brought to the Norwegian College of Veterinary Medicine for routine castration. Visual examination of the external genitalia revealed a wide genital cleft with non-fused bilaterally located testicular pouches. A large clitoris, which was penis-like with small penile spines, was seen protruding dorsally from the ventral commissure of the genital cleft. During an exploratory coeliotomy, no intra-abdominal genital structures of müllerian origin were found. The skin pouches on either side of the vulvar cleft were incised and grossly normal testicles were removed. Histology of the removed gonads showed no or very sparse spermatogenesis. The chromosomal sex was determined by karyotyping to be a normal male 38XY. Based on these findings, the diagnosis of male pseudohermaphroditism was made. The aetiology of the condition in this cat was not determined.

Animals↗
PubMed1979

Masculinisation of the external genitalia in ewes with clover disease.

Prolonged exposure of ewes to oestrogenic pasture resulted in partial fusion of the labia of the vulva and hypertrophy of the clitoris. Partial fusion of the labia was also seen in ewes which had grazed oestrogenic pastures on normal commercial properties, and was related to the amount of histological change in the cervix. This lesion may be useful as a screening test for previous exposure to oestrogenic pasture.

Animals↗
PubMed2006

Recurrent inhibition of the bladder C fibre reflex in the cat and its response to naloxone.

Recurrent inhibition of the bladder C fibre reflex was studied in adult female cats anaesthetized with alpha-chloralose. Test reflexes were evoked by electrical stimulation of bladder Adelta and C afferents in the right pelvic nerve and were recorded from the proximal end of a small ipsilateral pelvic nerve branch, transected close to the bladder. Such test reflexes were consistently depressed by repetitive electrical stimulation of the contralateral bladder pelvic nerve (20 Hz, 20 s) at intensities sufficient to recruit axons of bladder preganglionic neurones. The inhibition could be evoked after transection of the left dorsal roots S1-S4 and the sympathetic supply to the bladder but was abolished by transection of the pelvic nerve central to the site of stimulation. Hence, it most likely involved central recurrent collaterals of antidromically activated bladder preganglionic neurones. The reflex suppression was quite considerable - maximal C fibre reflexes were reduced to a group mean of 25% (+/- 9% confidence interval) of their control size. The effect had a slow onset, requiring a few seconds of conditioning stimulation to be revealed, and was very long lasting (minutes). Naloxone (0.01-0.5 mg kg(-1) i.v.) abolished the recurrent inhibition of both the C fibre and Adelta bladder reflexes, while inhibition from afferents in the dorsal clitoris nerve remained unchanged. It is concluded that the segmental bladder C fibre reflex and the spino-ponto-spinal Adelta micturition reflex are both targets of recurrent inhibition from bladder parasympathetic preganglionic neurones and that the effect involves an enkephalinergic mechanism.

Animals↗