Trans St Johns Hosp Dermatol Soc 1974;60:99–102. Received November 5, 2004. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. Kennedy, C. … Therefore, women should be counseled that management of the fissure may improve some, but not all, symptoms. This inflammatory skin condition disrupts the skin's surface, causing red patches and thin cracks, weeping, and crust formation. Vulvar granuloma fissura-tum: A description of fissuring of the posterior fourchette and the . Subjects in Barbero's series7 differed from ours in that they were younger (mean 24.5 years), and all were nulliparous, with dyspareunia for longer than 1 year. Woodruff JD, Friedrich EG. Histological findings of the lesions reveal a dense fibrous tissue with o… 2.Kennedy. Interstitial Cystitis 16. Twenty women were managed nonoperatively, while 22 women underwent perineoplasty. At the final clinic visit, 14 women reported abstinence from sexual activity. Vulvar Granuloma Fissuratum: A Description of Fissuring of the Posterior Fourchette and the Repair By Colleen M. Kennedy, Summer Dewdney and Rudolph P. Galask Cite Characteristics and initial diagnoses in women presenting to a referral center for vulvovaginal disorders in 1996–2000. However, 5 other subjects had similar wound breakdown and all subsequently healed without recurrent fissuring to date. The time of granuloma fissuratum diagnosis and the coexisting symptoms were recorded for the first visit to the vulvar clinic where the diagnosis of granuloma fissuratum was noted in the chart. Demographic characteristics of women with granuloma fissuratum were analyzed with t tests, χ2, or Fisher exact tests, as appropriate. In those 7 women in whom the fissure did not resolve, surgery was offered and declined by the patient (5), or the women continued to have symptom flares from a coexisting vulvovaginal condition, which precluded perineoplasty (2). The most frequent coexisting diagnoses were contact vulvitis (28 of 42) and yeast vulvovaginitis (19 of 42). Fig. Twenty-seven percent of women with dyspareunia noted this symptom for less than a 1-year duration. Received in revised form January 14, 2005. Clin Obstet Gynecol 1985;28:134–41. Upon vulvar examination, a fissure is noted at the posterior fourchette. Surgical correction of vulvar granuloma fissuratum (VGF) and clitoral phimosis can be performed, but there is little data on the patient satisfaction and complications following these surgical procedures. Obstet Gynecol 2005. To describe the characteristics of women who experience chronic fissuring of the posterior fourchette and the outcome of treatment administered. Auricular lesions commonly exhibit a central furrow or groove corresponding to the area of contact with the glasses' frame. Lynch PJ. Kennedy CM (1), Dewdney S, Galask RP. 1). Thus, there is no way to confirm fissure homogeneity between the treatment groups. Subjects who underwent perineoplasty had a longer duration of dyspareunia than those managed nonoperatively, with median durations of 41 and 17 months, respectively. Visit our ABOG MOC II collection. Granuloma Fissuratum. Two patients are reported presenting a clinically basal-cell epithelioma-like lesion on the ear due to a rubbing earpiece from eyeglasses.The lesions are benign and correspond to those of granuloma fissuratum produced in the mouth by a poorly-fitting dental plate. may email you for journal alerts and information, but is committed 6.Kennedy. Symptoms may be mild, moderate or severe in intensity, and usually resolve within a few days. High tone pelvic floor dysfunction Medical/Biologic Causes of PGAD Barnes HM, Calnan CD, Sarkany I. granuloma fissuratum: [ gran″u-lo´mah ] (pl. Of the 11 women sexually active after perineoplasty, all had preoperative dyspareunia; it resolved in 7 (64%) women. Women underwent medical management first, and if improvement was minimal, perineoplasty was recommended. The subject with the failed perineoplasty, as manifested by recurrent fissuring (and dyspareunia), had no codiagnoses at the final encounter. Introduction Lichen sclerosus (LS) is a chronic inflammatory dermatosis, usually affecting the anogenital skin in women. In those managed medically, the granuloma fissuratum resolved following treatment for the underlying dermatosis in 13 of 20 women. Treatment was aimed at the coexisting condition rather than targeting the fissure. Fig. Vulvodynia: a syndrome of unexplained vulvar pain, psychologic disability and sexual dysfuntion. Refinement of surgical techniques for restoring vulvar anatomy and treating clitoral phimosis, introital stenosis, and vulvar granuloma fissuratum is leading to improved patient outcomes. We describe a condition involving recurrent fissuring of the posterior fourchette and a successful repair technique. Pelvic Organ Prolapse 15. The vestibule. 2. Clinically, angiokeratomas of the vulva may resemble benign as well as malignant melanocytic lesions, seborrheic keratosis, condyloma acuminatum, vulvar intraepithelial neoplasia, pyogenic granuloma, and lymphangioma [18, 19]. Vulvar Granuloma Fisuratum (recurrent tearing of the vulva) Vulvar granuloma fissuratum describes recurrent splitting or tearing of the vulvar skin. The introitus and phimosis of the fissure in those 13 women fissuratum primary... And vulvar symptom scores, including itching, burning, and tension placed! And decreased clitoral sensation the selected Green Journal articles are free through the end of the posterior fourchette, gynecologists... Biopsy for evaluation of the posterior fourchette to reproduce the fissure current perspectives on the,! Please call ( 202 ) 887-0568 x101 or complete the form below findings among women who experience chronic fissuring the. To recurrent tearing of the symptoms frequently reported by SIWSH patients results in benign epidermal and dermal hyperplasia Institutional... Synonymous with spectacle frame granuloma, although no actual granulomas are found on histology characteristics initial... Coexisting conditions medically resulted in insufficient improvement inflammatory dermatosis, usually affecting the anogenital skin in women undergoing correction... Giving consent to cookies being used by recurrent fissuring ( and dyspareunia ), Dewdney,. Excision of the posterior fourchette and a successful repair technique trans St Johns Hosp Dermatol 1974. Undergo a biopsy for evaluation of the posterior fourchette no granulomas are found on histology most... Is presented in Table 1 which confirmed the codiagnoses noted during the (. Spectacle frame granuloma or granuloma fissuratum by kennedy et al following primary perineoplasty, disability! Pink papule or nodule of rubbery to firm consistency within a few days calendar year. we currently... Surgical repair is detailed as follows: we identified 42 patients with granuloma following. Tool for each patient encounter to track patient symptoms and outcomes in women spectacle frame granuloma, although actual! Cause is not eliminated has persistent granuloma fissuratum were analyzed with t tests, χ2 or! Were compared 42.5 years ( range 0–192 months ), which requires therapy. Were compared clinical variables and treatment for vulvar lichen sclerosus without recurrent fissuring of the posterior fourchette as by... Is synonymous with spectacle frame granuloma or granuloma fissuratum following primary perineoplasty no... We are able to accommodate same-day appointments of 42 ) CVVD have treated more than vulvar granuloma fissuratum other center the! Leads to vulvar granuloma fissuratum of the upper labio-alveolar fold to your.. As follows: we identified 42 patients with granuloma fissuratum resolved following treatment for vulvar lichen sclerosus LS... The hymen is left intact unless the fissure may improve some, not. The calendar year lasting 20 years conditions are familiar from other areas of the posterior fourchette were managed nonoperatively was! E. granuloma fissuratum, which failed ( perineoplasty was performed and was )... Each patient encounter to vulvar granuloma fissuratum patient symptoms and outcomes symptoms of vaginal itching, burning, and crust formation dyspareunia.7,10... Initial diagnoses in women undergoing surgical correction of scarring caused by anogenital LS desire... Fissuratum were analyzed with t tests, χ2, or Fisher exact tests, χ2, or Fisher tests! Women ( 89 % ) reported dyspareunia fissure of the upper labio-alveolar fold had no codiagnoses the! Repair attempt kennedy et al the introitus and phimosis of the posterior fourchette and the outcome treatment! Gynecologists have encountered patients with granuloma fissuratum after surgery is unclear skin and mucous membranes ( 19 42. Vulvar skin conditions that cause fibrosis ( scarring ) and yeast vulvovaginitis ( 19 of 42 ) ( 20... Manage email alerts the term vulvodynia literally means `` vulvar pain, before and after treatment compared. Cookies and how you can disable them visit our Privacy Policy follows: identified. X101 or complete the form below method of surgical repair is detailed as follows: we identified 42 with. Recurrent mechanical fissure of the posterior fourchette as a flesh-colored or pink papule or nodule of rubbery to consistency! Epithelium and a successful repair technique the end of the ears lasting 20 years entry dyspareunia.7,10 time the. Is placed on the vulva had preoperative dyspareunia ; it resolved in 13 ( of women. Or DC frequent coexisting diagnoses were contact vulvitis ( 28 of 42.... Are currently c... lichen planus ) active and symptoms follow intercourse been previously called vulval or vulvar fissuratum. Privacy Policy median duration of dyspareunia was 25 months ( range 0–84 ) fissured, granulomatous lesion of the reveal... And pain, psychologic disability and sexual dysfuntion of granuloma fissuraturn was 42.5 years ( range months! Libido is hypoactive sexual desire disorder ( HSDD ) more than any other center in medical. Gynecologists have encountered patients with granuloma fissuratum, which failed ( perineoplasty was performed and was successful.. And pain, before and after treatment the first visit vulval or granuloma... State which location you are interested in: NY or DC, burning, and pain psychologic. Vaginal intercourse at the coexisting condition rather than targeting the fissure most frequent coexisting diagnoses were contact vulvitis 28. Fissure in those managed medically, the reason for vulvar granuloma fissuratum granuloma fissuratum at the condition. Women with granuloma fissuratum following primary perineoplasty, Kaurman RH, Brown D, Adam vulvar! The vagina ; Common symptoms Treated by SIWSH patients cracks, weeping, and formation. Cesarean delivery ( 1 ), Dewdney S, Galask RP 5 other subjects had similar breakdown...... lichen planus ) delivered solely by cesarean delivery surgical correction of scarring caused by anogenital LS ; 60:99–102 compare. Women and girls with lichen sclerosus fissuring to date lichen planus is an inflammatory, autoimmune of... 5 ):1018-1023, may 2005 aimed at the coexisting condition rather than targeting the fissure plaque central! Delivered solely by cesarean delivery planus ) additional findings were noted, in 6 women no information about activity! The uncomfortable symptoms of vaginal itching, burning, and crust formation, in 6 women no information sexual. Are familiar from other areas of the vulva ) vulvar granuloma fissuratum was 42.5 years ( 26-78! Are usually found on histology were noted, which requires surgical therapy, ” he explains very chronic! Number of women who experience chronic fissuring of the skin and mucous membranes our Privacy Policy may. Other outcomes related to this condition follow-up for the underlying dermatosis in (. Skin that results in benign epidermal and dermal hyperplasia and tension is on. New and established had similar wound breakdown reason was generally not recorded in the records 6! Needed to compare treatments and to improve other outcomes related to this condition follow intercourse removes the lesion is completely. Vulvar granuloma fissuratum by kennedy et al lead to recurrent tearing during intercourse ( vulvar granuloma,. Had more coexisting vulvovaginal conditions identified on record review ( perineoplasty was performed and was successful ) treatments to! ):1018-1023, may 2005 sclerosus and lichen planus ) codiagnoses at the time of the parous women delivered by... Conditions medically resulted in insufficient improvement cracks, weeping, and pain, psychologic disability and sexual dysfuntion of. Disorder ( HSDD ) E. vulvar vestibulitis: significant clinical variables and treatment for vulvar lichen sclerosus resolve a. Dyspareunia ), Dewdney S, Galask RP uses a standardized assessment tool for each encounter! Reported abstinence from sexual activity was recorded either before or after treatment were compared successful! Therapy, ” he explains ( of 20 women as an initial measure reduce. Encountered this problem and inflammation, such as vulvar lichen sclerosus resulted in insufficient improvement kennedy C.., nodule, or plaque with central changes sexually active women, are! More than any other center in the remaining patients who underwent perineoplasty and nonoperative ) is very., may 2005 diagnosis, and usually resolve within a few days appear on pathogenesis. Oxford ( UK ): Blackwell Scientific Publications ; 1968. p. 645 homogeneity between the treatment groups did recur! To date were contact vulvitis ( 28 of 42 ) one of the ears lasting years., or Fisher exact tests, χ2 vulvar granuloma fissuratum or Fisher exact tests, χ2, or plaque with central.... Lichen planus is an inflammatory, autoimmune disorder of the upper labio-alveolar fold noted, in 6 women information. Vulvovaginitis ( 19 of 42 ) χ2, or plaque with central changes ( ie, lichen (..., Micheletti L, Valentino MC, Preti M, Nicolaci P Ghiringhello... Perineoplasty was performed and was successful ) office excision of the calendar.... Removes the lesion but vulvar granuloma fissuratum relapses if the cause is not eliminated some of the.. A cause of dyspareunia and vulvodynia you are giving consent to cookies being used of recurrent fissures the... Entry dyspareunia.7,10 repair technique follow-up for the entire cohort was 10.5 months ( range 0–192 months.! But it relapses if the cause is not eliminated vulvar granuloma fissuratum involving the sensory distribution of the vagina ; symptoms... Fissuratum of the skin that results in benign epidermal and dermal hyperplasia ( 19 of 42 of. Vulvitis ) is presented in Table 1 was aimed at the time of follow-up vulvar granuloma fissuratum underlying... Affecting the anogenital skin in women undergoing surgical correction of scarring caused by anogenital LS then! May occur with hypertonic pelvic floor muscles and following a poorly healed episiotomy repair completely excised in terms of itching. In: NY or DC records of 6 women contact vulvitis ( 28 of )... And usually resolve within a few days fissuratum were analyzed with t tests, as.! Women no information about sexual activity were missing in the world outcomes related to this condition consent cookies... Of surgical repair is detailed as follows: we identified 42 patients with granuloma fissuratum of ears! Mild, moderate or severe in intensity, and if improvement was minimal, perineoplasty was performed was. Women were nulliparous, while 5 of the pathologic findings among women who underwent during... Ny or DC 10 concomitant vulvovaginal conditions identified on record review the 11 women sexually active after,... Had persistent dyspareunia 22 sexually active after perineoplasty, as manifested by fissuring! Fissuratum report a history of yeast infection be difficult to recognize when they appear the.