A 41-year-old premenopausal white woman presented to her gynecologist with intense vulvar pruritus for a 6-month duration, with a recent increase in severity (FIGURE 1).
The MonaLisa Touch Laser is a fractional CO2 laser technology which stimulates the growth of new, healthy vaginal and vulvar epithelium and collagen production.
According to the company, Osphena is the only US FDA-approved oral pill for the treatment of moderate to severe dyspareunia (painful sex), a symptom of vulvar and vaginal atrophy (VVA), due to menopause.
The device is a 20-mm diameter plastic vaginal probe with gold metallic transversal rings as electrodes, inserted 20 mm, with 30 minutes of electrical stimulation increased slowly until sensation "reached a level described as the maximum tolerable without experiencing pain." Vulvar pain was assessed on a 10-cm visual analog scale and dyspareunia on the Marinoff dyspareunia scale.
We report two cases of the unusual presentation of squamous cell cancer of the cervix that developed vulvar and umbilical metastasis in the 5th month of primary treatment.