Contents

Foreword William J. Ledger v

Preface vii

Contributors xv

PART I. ANATOMY AND PHYSIOLOGY

1. Anatomy of the Vulva 1

Aikaterini Deliveliotou and George Creatsas

Introduction 1

Embryology of Vulva 1

Anatomy of the Vulva 2

Conclusion 7

References 7

2. Tissue Structure and Physiology of the Vulva 9

Miranda A. Farage and Howard I. Maibach Introduction 9

Variations in Epithelial Structure . . . . 12

Blood Flow and Innervation 14

Hormonal Responsiveness 16

Immune Cell Populations 16

Tissue Hydration and Barrier Function . . . . 17

Permeability 18

Microbiology 20

3. Changes in the Vulva and Vagina Throughout Life 27

Miranda A. Farage, Howard I. Maibach, Aikaterini Deliveliotou, and

George Creatsas Introduction 27 Infancy and Early Childhood 30 Puberty 32 Reproductive Years 34 Menopause and Older Age 36 Conclusion 39 References 39

4. Microbial Ecology of the Vulva 43

Ronald W. Berg and Catherine C. Davis Introduction . . . . 43

Anatomical Structure of the Vulva . . . . 43

Factors Controlling Microbial Growth and Diversity . . . . 44

Microflora of the Vulva 48

Conclusion 53

References 54

PART II. SYMPTOMS, DISEASES, AND THERAPIES

5. Are Vaginal Symptoms Ever Normal? 57

Matthew Anderson, Alison Karasz, and Sarah Friedland Introduction . . . . 57

Characteristics of Normal Vaginal Discharge . . . . 58 Characteristics of Normal Vaginal Odor . . . . 59 Normalcy of Irritative Symptoms . . . . 60 Conclusion . . . . 60 References 61

6. Common Diseases of the Vulva 63

Diane Elas and Rudolph P. Galask

Diseases that Cause Vulvar Burning . . . . 66

Diseases that Cause Vulvar Itching . . . . 71

Diseases that Cause Vaginal Discharge . . . . 80

7. Idiopathic Vulvodynia 85

Lauren D. Arnold and Gloria A. Bachmann

Introduction 85

Symptoms 87

Etiology 87

Prevalence 88

Demographics 89

Comorbid Conditions 89

Gynecologic History 90

Psychosocial and Sexual Aspects 90

Treatment 94

Conclusion 96

8. Vulvar Vestibulitis Syndrome 101

Miranda A. Farage and Rudolph P. Galask Introduction 101

Definition and Disease Characteristics 101 Prevalence and Patient Demographics 103 Differential Diagnosis 104

Etiology____105

Management 107 Conclusion . . . . 110 References . . . . 111

9. Vulvar Therapies: Evidence Vs. Testimony 115

Natalie Moulton-Levy and Howard I. Maibach Introduction 115 Vulvodynia 115

Eczematous and Papulosquamous Vulvar Dermatoses . . . . 117

Benign Vulvar Nodules or Tumors 123

Infectious Diseases 123

Vulvar Neoplasm 138

Conclusion 142

PART III. MENSES, HYGIENE, AND PRODUCTS

10. The Menstrual Cycle, the Composition of Menses, and the Effect of Menses on the Skin 151

Miranda A. Farage, William H. Hood, and Paula J. Adams Hillard

Introduction 151

The Menstrual Cycle 152

Composition and Properties of Menses 155 Effects of Menses and Venous Blood on the Skin 160 Conclusion 163 References 164

11. The Menstrual Cycle and the Skin 167

Birgit Drexler, Michael Landthaler, and Silvia Hohenleutner

Introduction 167

Hormonal Changes in the Course of the

Menstrual Cycle 167 Influence of the Sex Hormones on the Skin 168 Premenstrual Syndrome 171

Menstrual Cycle and Associated Skin Disorders 172 Conclusion 179 References 179

12. Genital Hygiene: Culture, Practices, and Health Impact 183

Miranda A. Farage and Mario Bramante

Introduction 183

Genital Hygiene of Infants 183

Genital Hygiene Among Premenarchal Girls 184

Genital Hygiene Among Women of

Reproductive Age 188 Genital Hygiene Among Older Women 204 Conclusion 208 References . . . . 208

13. Products for Vulvar Hygiene 217

Miranda A. Farage and Lisa Lennon Introduction . . . . 217

Cleanliness and Odor-Control Products 217 Menstrual Protection Products . . . . 223 Products for Incontinence Control 227 Other Products Used on the Vulva . . . . 228 Medications . . . . 229 Conclusion . . . . 230 References . . . . 230

PART IV. ETHNICITY AND SOCIOLOGY

14. Vulva Ethnic Differences: An Overview

Marina Goldovsky and Howard I. Maibach Introduction 235

Assessments of Variable Characteristics of Ethnically/Racially Different Skin 236 Lipid Content 247 Clinical Observations 249 Conclusion 249 References 252

15. Female Genital Alterations: A Sociological Perspective 255

Samar A. Farage

The Management of Sexuality as a Problem:

Postmasturbation Disease . . . . 259 Types of Female Genital Alterations 263 Procedures of the 19th and 20th Centuries 264 Contemporary Female Genital Alterations in North America 266 Conclusion . . . . 267 References . . . . 267

PART V. INVESTIGATIONAL METHODS

16. Bioengineering Methods for the Vulva 271

Sibylle Schliemann, Britta Opper, and Peter Elsner Introduction 271

Common Bioengineering Techniques 272 Measuring Mechanical Properties 277 Conclusion 277 References . . . . 277

17. Transepidermal Water Loss Dynamics of Human

Vulvar and Thigh Skin 281

Raphael Warren, Michaelle B. Jones, and Peter Elsner Introduction 281

Evaluation of Transepidermal Water Loss 282 Transepidermal Water Loss Findings 283 Conclusion 284 References 285

18. Vulvar Toxicology 287

Christina Y. Wang and Howard I. Maibach Introduction 287 Irritation of the Vulva 288 Bioengineering Methods of Assessment 290

Behind the Knee Test____290

Vulvar Dermatitis 291 Contact Urticaria 294 Conclusion 295 References 295

19. Consumer Research and In-Market Comments 297

Brigitte Nijs Introduction 297

What Do Women Want from a Feminine Hygiene Pad? 297 Consumer Research Process for Feminine

Hygiene Products 298 Quality Assurance for Production of Feminine

Hygiene Products 300 Consumer Comments from Market Use 301 Conclusion 302 Reference 302

Index

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