June 15, 2016
Part I: Vulvar Diseases
8:30 – 10:00
Chair: Jacob Bornstein
The approach to vulvar disease, which has been changed lately, has led to the introduction of the new terminologies for vulvar conditions. In particular, Vulvodynia is now considered to have a variety of causes rather than an idiopathic pain. The new concept will be presented and discussed in the session.
A recent controversy regarding the relative significance of the sub types of Vulvar Squamous Intraepithelial Lesions (VSILs), rose as a result of the introduction of the Lower Anogenital Squamous Terminology (LAST) in 2012. This terminology of HPV lesions ignored one important subtype of intraepithelial lesions – the Differentiated Vulvar Intraepithelial Neoplasia (DVIN), and on the other hand, reintroduced the Low Grade Squamous Intraepithelial Lesion (LG-SIL), which is regarded by the ISSVD as only an HPV effect or Condyloma, without a malignant potential. These controversies have been resolved in the new ISSVD terminology of VSIL. It will also be presented and discussed.
Prevention of VLSIL by the HPV vaccine, its clinical presentation, as well as of micro-invasive and invasive Vulvar cancer and the controversy of vaccinating the patient who has already been exposed to HPV will also be presented to complete the scope.
- The new ISSVD and consensus terminologies of Vulvar Squamous Intraepithelial Lesions (VSIL) and Vulvodynia
- Jacob Bornstein (Israel)
- Prevention of VSIL by the Nonavalent HPV Vaccine
- Elmar Joura (Austria)
- Should we administer the HPV vaccine in patients with HPV?
- Marc Steben (Canada)
- Multicentric lower genital tract SIL
- Eduardo Schejter (Israel)
- Treatment of VLSIL and Early Invasive Vulvar Cancer
- Michel Roy (Canada)
- Mario Preti (Milan, Italy) – Vulvar cancer – diagnosis and modern treatment
- Mario Preti (Italy)
Part II: Vulvar Pain Syndrome (Vulvodynia)
10:30 - 12 :15
Chair: Gilbert Donders
Vulvar pain syndrome, or vulvodynia, is a complex pain syndrome characterized by altered pain transmission. Vulvodynia is a chronic health problem, and has a major impact on the quality of life of increasing number of women. It is a hidden problem, and we have only seen the tip of the iceberg. Neuropathic vulvodynia, also known as generalized vulvodynia, pudendal neuralgia, or dysesthetic vulvodynia, is relatively easy to manage with tricyclic antidepressants or gabapentinoids. Vulvar vestibulitis, also known as vestibulodynia, is more difficult to manage. Emerging data of the pathogenesis suggests that vestibulitis is an autoreactive condition characterized by specific lymphoid tissue inflammation which leads to epithelial nerve fiber proliferation. Pain genetics also contributes to the allodynia characteristic to vestibulitis. Polymorphisms associated with vestibulodynia have been described in specific genes. In differential diagnosis, rule-out diagnoses include specific infections, other specific inflammatory disorders such as dermatoses, or rare neurologic conditions. Individualised multidisciplinary management is often a major challenge to health care professionals. Multiple conservative therapeutic approaches have been used with variable success. However, pragmatic algorithms developed have proven useful in clinical practice. Surgery by posterior vestibulectomy is strikingly effective in refractory cases of vestibulodynia.
- Etiopathogenesis: Inflammatory aspects - Päivi Tommola (Finland):
- Etiopathogenesis: Genetic aspects - Nina Bohm-Starke (Sweden)
- Conservative management - Gilbert Donders (Belgium):