title: Vulvar granuloma fissuratum: a description of fissuring of the posterior fourchette and the repair.
abstract: OBJECTIVE
  To describe the characteristics of women who experience chronic fissuring of the posterior fourchette and the outcome of treatment administered.
  
  
  METHODS
  We conducted a retrospective review of 42 women with granuloma fissuratum presenting for care between January 1, 1995, and December 31, 2003. Women underwent medical management first, and if improvement was minimal, perineoplasty was recommended. Dyspareunia and vulvar symptom scores, including itching, burning, and pain, before and after treatment were compared.
  
  
  RESULTS
  Twenty women were managed nonoperatively, while 22 women underwent perineoplasty. The median age at diagnosis of granuloma fissuratum was 42.5 years (range 26-78). The fissure resolved in 13 of 20 women (65%) who were managed nonoperatively and in 21 of 22 women (95%) who underwent perineoplasty. Of the 11 women sexually active after perineoplasty, all had preoperative dyspareunia; it resolved in 7 (64%) women. Among the 13 women managed nonsurgically who had resolution of the fissure, 7 women were sexually active after treatment and dyspareunia resolved in 2 (29%) women. Other vulvar symptoms, such as burning, itching, pain, and discharge, showed no significant improvement after either surgical or nonsurgical treatment.
  
  
  CONCLUSIONS
  Although fissuring is common with some vulvar dermatoses, such as lichen sclerosus and contact vulvitis, and often resolves with the appropriate medical management, fissuring may also occur as a primary finding and may benefit from perineoplasty.
authors.affiliation: Departments of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA. kennedy@uiowa.edu
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Kennedy
authors.forename: Summer
authors.initials: S
authors.lastname: Dewdney
authors.forename: Rudolph P
authors.initials: RP
authors.lastname: Galask
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D004414:Dyspareunia / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014845:Vulvar Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000700:Analgesics