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Re: Gyn: Perineal scarring From: Joanne Bulley, MD (islesannie@gmail.com) Thu Aug 28 17:28:34 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Raymond Stephen: "Re: serious scientific controversial issue in basic Gynecology" Previous message: kamala nag: "Re: serious scientific controversial issue in basic Gynecology" In reply to: Henry Gregor: "Re: Gyn: Perineal scarring" Next in thread: Henry Gregor: "Re: Gyn: Perineal scarring" Reply: Henry Gregor: "Re: Gyn: Perineal scarring" Dr. Lynette Margesson and Dr. Hope Haefner told me so. Lynne is a dermatologist who has a specialty in the vulva - writes text books - lectures - and has a very active practice here in NH. We got REALLY lucky when she moved here from Toronto. Hope was a med student under me when I was a chief in Ann Arbor at St Joe's. She is now head of the Vulvar division at U of Mich - and head of the vulvar disease society (I think). At any rate - they are my friends as well as the experts in teh field. They told me to use the ointment - but also - because the creams and lotions have more parabens and alcohols that can feel really bad to the vulva that is already giving pain - and they can contribute to further irritation. I don't think it is a second eyar med student question. As to your comment about not going into derm ... when my daughter was 7 years old .... and she had a friend whose dad was a very good local dermatologist ... my daughter said to me, "Mom, you should have been a Dermatologist like Claire's Daddy - and you'd be home a lot more." So I said, "I did my dermatology rotation and looked at a lot fo skin and pictures and just couldn't figure it out." Her response, "Mommy, you had to study harder." She is now in her second year of law school - need I say more? Joanne At Wed, 27 Aug 2008, Henry Gregor wrote: > >Joaane, > >Help me here with year two med school basic question...why the ointment and not the cream? (It was foreordained I couldn't go into dermatology..never could keep the differences among ointments, creams and lotions and rationeales for uses straight in my mind, hehe.) >Hank > >--- On Tue, 8/26/08, Joanne Bulley, MD <islesannie@gmail.com> wrote: > >From: Joanne Bulley, MD <islesannie@gmail.com> >Subject: Re: Gyn: Perineal scarring >To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> >Date: Tuesday, August 26, 2008, 8:51 PM > >If she says the clobetasol didn't work - she was probably given a cream >or lotion - must use OINTMENT - 0.05% > >If I were 100% convinced it was surgical scarring I would use estrace >cream BID (even if the rest of the area looks well estrogenized. > >But see how the histology compares to L Margesson's info on that >powerpoint link I sent. > >By the way - I don't know about others but for local estrogen cream I do >only use Estrace: I want 17 Beta E2 -- not equine estrogens or >estropipate. I would rather give the cells the identical molecule that >the ovarian granulosa cells made / make. > >Joanne >(just my bias and $0.02!) > >At Tue, 26 Aug 2008, Garry E. Siegel, M.D. wrote: >> >>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 >> >-- >Joanne Bulley, MD >solo gyn >Keene, NH > -- Joanne Bulley, MD solo gyn Keene, NH Next message: Raymond Stephen: "Re: serious scientific controversial issue in basic Gynecology" Previous message: kamala nag: "Re: serious scientific controversial issue in basic Gynecology" In reply to: Henry Gregor: "Re: Gyn: Perineal scarring" Next in thread: Henry Gregor: "Re: Gyn: Perineal scarring" Reply: Henry Gregor: "Re: Gyn: Perineal scarring"

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