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Re: Perineal scarringFrom: Atkinson, Samuel M, Jr (ATKINSONS@ecu.edu)Wed Aug 27 15:16:15 2008
Are you sure that she does not need a simple perineal release? Many of these elderly, non estrogenized women have a perineal bridge after an overly enthusiastic repair. Just because two fingers fit in does not mean it is open enough. Try spreading the fingers and see the perineum whiten more, and get uncomfortable. They also tear occasionally with IC. A simple vertical incision of the perineum and transverse closure with some fine interrupted sutures will do the job. I do most of these in office under local. Most recently it was a patient in her 70's. She had been widowed for several years, had a posterior repair and then met a younger "gentleman". Her local gynecologist just raved at how beautiful the repair was. As she was prominent socially, she did not feel free to elaborate to him and thus came to me, and especially wanted the office procedure so no one, including her children, would know. sAm -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Tuesday, August 26, 2008 6:16 PM To: Multiple recipients of list OB-GYN-L Subject: Gyn: Perineal scarring 51 YO menopausal 5005 who is S/P LAVH years ago, and subsequently had pelvic reconstruction surgery with an academically based urogyn a few years ago for a rectocele and lax perineum (no grafts). I did her LAVH and haven't seen her since referral to the urogyn. She has seen another gyn who diagnosed lichen sclerosus without a biopsy (per the patient) and clobetasol was "too strong" and didn't help. She has perineal discomfort and no sex drive, and is not on HRT. On exam, her perineum is whitened and scarred looking, like from surgery, and is not reminiscent of LSA. The labia and clitoris are normal. Her vagina is well estrogenized, the introitus admits two fingers comfortably, and the length and depth are well preserved. The biopsy shows "Benign epithelial hyperplasia with overlying keratosis." My instinct is to use medium potency steroids regularly, and address sex drive, also. Any thoughts are welcome, and what dose/schedule of steroid would you use? Garry
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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