ABSTRACT Acute vulvar ulcer (Lipschütz’s ulcer) is a rare lesion with local hyperimmunoreactivity triggered by infection, which is characterized by acute, painful, and necrotic ulcerations. This condition is usually found in non-sexually active adolescents, and it resolves spontaneously. We report a case of a 35-year-old woman who was diagnosed with COVID-19 who did not have severe symptoms, but had high levels of D-dimer for 9 days. The COVID-19 diagnosis was followed by the appearance of an acute, necrotic, extremely painful vulvar ulcer, although symptoms caused by COVID-19 had improved. We emphasize the importance of the differential diagnosis to exclude diseases such as Behçet’s syndrome, Sexually Transmitted Infections, as well as the presence of viruses that generally trigger Lipschütz’s ulcer, such as Epstein-Barr virus and cytomegalovirus. No treatment is usually necessary, however, in the present report due to the pain experienced by the patient, we successfully used oral prednisone.

«Vulvovaginitis» are one of the main reasons that lead women to visit their gynecologist. Most physicians in this area tend to base their diagnostic evaluation on the signs, symptoms and physical examination of the patient, overlooking the microscopic evaluation of the vaginal discharge. This practice leads to a high percentage of underdiagnosed «vulvovaginitis». Cytolytic vaginosis is one of these rarely diagnosed pathologies, due to the fact that it mimics vulvovaginal candidiasis

Overview and Aims: The concept of "genitourinary syndrome of menopause" (GUSM), created in 2013, is widely used, despite the lack of studies and validation. This survey intended to evaluate the knowledge, agreement and concerns of Portuguese gynaecologists about it. Study design, population and methods: An online survey was sent to Portuguese gynaecologists (all the members of the Portuguese Society of Gynaecology, personal contacts and specific groups in social networks). Results: Out of 118 completed surveys, 66.1% belonged to specialists and 43.9% to residents. It was reported by 83.9% that they were acquainted with the GUSM, without differences between specialists and residents (85.0% vs. 83.3%, p=1.000). Most (66.7%) use "vaginal atrophy" or "atrophic vaginitis" in their daily practice; GUSM is used by 6.1% and 27.3% use both denominations. Considering "0" to be total disagreement and "10" total agreement, the justifications for the creation of this syndrome were rated as follows: "vaginitis implies infection or inflammation, which is not always the case" 8.1±2.57; "urinary signs and symptoms tend to be overlooked" 6.4±2.96; "atrophy has a negative connotation" 4.7±3.46 and "vagina is not generally a well-accepted term by women and the media" 3.4±3.41. It was considered by 37.9% that it may lead to sub-diagnosis/no diagnosis of sexual dysfunction; of vulvar pathology by 32.6% and of urinary tract pathology by 23.7%. Globally, 77.8% agree with the concept of GUSM, without differences between specialists and residents (80.0% vs. 73.5%, p=0.459); 75.4% consider that they will use it in the future (residents 57.9% vs. specialists 83.3%, p=0.053). Conclusion: Most Portuguese gynaecologists are aware of the concept of GUSM, and intend to use it the future, despite not fully agreeing with the assumptions that led to its creation.

Desquamative inflammatory vaginitis (DIV) is a well characterized clinical syndrome of unknown aetiology and pathogenesis. It presents as a diffuse exudative vaginitis, with pain, profuse purulent discharge and epithelial cells exfoliation. Diagnosis is often difficult, since it shares several characteristics with other vulvovaginal inflammatory disorders. Wet mount plays a key role, presenting a marked increase in leukocytes and parabasal cells; pH is elevated (>4.5). The exclusion of other causes of purulent vaginitis is mandatory for the diagnosis. Although the treatment can be a challenge, often requiring maintenance since relapse is common, good results are described with topical clindamycin and corticosteroids.

The classification of vulvodynia has been recently revised. This article highlights the main changes that were introduced: for the first time, a minimum duration of symptoms (3 months) was included in the definition; women with other vulvar conditions (e.g. lichen sclerosus) are no longer excluded from a possible diagnosis of vulvodynia; a list of possible associated factors was added to the document; new discriminators were included (onset and temporal pattern) and the term "non-provoked vulvodynia" was replaced by "spontaneous vulvodynia".

Aesthetic vulvar and vaginal surgery have been increasing in the last few years. The same procedure can be found under several designations, as well as different designations might refer to the same procedure. Despite the increasing number of patients seeking these procedures, there is a lack of scientific basis for the performance of most of it, as well as of good follow-up studies in terms of complications. It is important to distinguish cases of plastic surgery needed for the treatment of vulvar lesions or correction of symptomatic hypertrophic labia minora, pelvic organs prolapse or urinary incontinence from pure aesthetic surgery, just to pursue a sometimes unrealistic model of perfection. Despite the easiness of performance of most of these procedures, the chance of complications must always be kept in mind. A psychological evaluation of the women candidate to genital aesthetic surgery should be considered in most cases.