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Re: Unresolved cervicitisFrom: Zach Newton (zbnewton@atl.mindspring.com)Mon Jun 30 19:17:28 1997
Susan- Nice presentation of a difficult case. The status quo is unacceptable. The ectropion is marked by intense chronic inflammation with copious mucopurulent discharge, giving rise to a chronic increase in vaginal pH with inhibition of normal flora. The flooding of the vagina with no telling what content of cellular enzymes and mucopolysaccharides plus the proliferation of an abnormal vaginal flora can reasonably be projected as the pathophysiologic mechanism of this horribly florid condition. I would not project certain cure, but I would submit vaginal swabs for fungal and bacterial cultures and perform cryo with a wide exocervical tip, using 3 minute-thaw-3 minute technique. While vulvitis persists and awaiting response of healing, I would urge twice daily thorough vulvar washing with plain, mild soap, followed by hair-dryer use directed at the vulva. I would avoid any medicated or non-medicated application to the vulva or intravaginal theraputics, save condom use. The validation of her trial of misery with the support of determination to achieve resolution is equally important. Continuity of care with an observant and informed provider is critical. An SSRI in combo with telephone reports weekly of progress until response to cryo can be ascertained would be important adjuvants. You know we all want follow-up. If she is agreeable and you have equipment, documentation by serial pictures would be great.
-- Zach Newton Z. B. Newton, III, M.D. Atlanta/Gyn
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