October 8, 2017
Part I: Vulvar Diseases
13:45 – 15:15
Chair: Jacob Bornstein
What is new with vulvar disease? A lot. This year this popular course will focus on the recent developments in the field:
- The new paradigm of vulvar pain and vulvodynia and the new ISSVD terminology including Differentiated Vulvar Intraepithelial Neoplasia (DVIN), as well as Low and high Grade Squamous Intraepithelial Lesion.
- High resolution anoscopy (HRA) has emerged as an essential examination in many pa-tients. It will be introduced and explained.
- Finally, the next generation treatment approach of Vulvar Squamous Intraepithelial Le-sions, by immunotherapy, will be presented. This is a non-invasive management that may replace a mutilating excision of the lesions.
13:45 – 14:15
What is new with the Vulvar terminology? - Professor Jacob Bornstein, Israel
14:15 – 15:00
How to perform high resolution anoscopy (HRA) – Professor Joel Palefsky, USA
15:00 – 15:15
A new era of DNA Immunotherapy for Vulvar HSIL –Dr. Prakash Bhuyan, USA
Part II: Vulvar Pain Syndrome (Vulvodynia)
15:45 - 17:30
Chair: Jorma Paavonen, Co-chair: Gilbert Donders
Vulvar pain syndrome, or vulvodynia, is a chronic health problem affecting the quality of life of many women, and a challenge to health care professionals. Although increasingly recognized, 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 or localized provoked vulvodynia (LPV), is more common and 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. In differential diagnostics, specific infections, other specific inflammatory disorders such as dermatoses, or rare neurologic conditions should be considered. Individualised multidisciplinary management is often necessary. Multiple conservative therapeutic approaches have been used with variable or poor success. However, a pragmatic management algorithm have proven useful in clinical practice. Surgery by posterior vestibulectomy is strikingly effective in refractory cases of LPV.
- Vulvodynia: definition and classification (10 min)
Päivi Tommola, MD, Department of Obstetrics and Gynecology, University Hospital, Helsinki, Finland
- Vulvar pain syndrome: Topographical classification of introital dyapareunia (15 min)
Gilbert Donders, MD, University of Antwerp, Belgium
- Localised provoked vulvodynia: pathogenesis and pain mechanisms
(15 min) Päivi Tommola, MD, Department of Obstetrics and Gynecology, University Hospital, Helsinki, Finland
- Conservative management (15 min)
Christina Damsted Petersen, MD, Clinic for Gynecology and Sexual Health, Copenhagen, Denmark
- Surgical management by vestibulectomy (15 min)
Jorma Paavonen, MD, Department of Obstetrics and Gynecology, University Hospital, Helsinki, Finland
- Discussion (10 min).