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Re: Lichen Planus and urinary incontinenceFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Wed Oct 24 13:20:03 2007
At Wed, 24 Oct 2007, Allan wrote: > >I am treating this 82 yo otherwise very healthy woman for Lichen Planus. >Her labial agglutination was so severe that her urethra was hidden >behind a flap of tissue created by her labia minora fusing in the mid >line. I could not even pass one finger through the small opening that >was left the first time I saw. I took down the labial adhesions to >expose her urethral meatus. Her vaginal epithelium was bright red. >Cervix not present because she had a hysterectomy at age 50. I have >been giving her Vagifem in the vagina and Clobetasol on the labia. She >has made significant improvement. She is not complaining of anything >now except for her vagina appearing bright red. Besides for the >atrophic vaginal epithelieum, I see no lesions. > >Here is the problem - she has mixed urinary incontinence and does not >want to do anything about it. I am afraid she may not be getting the >maximum benefit of the Clobetasol (I have given her cream and ointment) >because of the constant wetness at the introitus. I am thinking about >telling her that it is going to be as good as it can get. She is >asymptomatic now, so I think systemic therapy would be unnecessary. Any >suggestons? > >-- >Allan
I think you are doing the best you can, very frustrating problem. I
have taken down complete vaginal/Vulvar fusion on more than one
occassion only to have it reccur with 6-12 months because patients don't
bother with pressure dilation and estrogen cream. The only thing I may
add is to do a biopsy of any area's that don't just look atrophic, VIN
and VAIN are very difficult to diagnose IMHO.
>Southeasten PA
--
Take care, John
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