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Re: Gyn: Perineal scarring From: Henry Gregor (henrygregor@yahoo.com) Wed Aug 27 10:24:15 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "FRI: Natural Selection" Previous message: Dr Eberhard Lisse: "Re: MS Outlook question" In reply to: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" Next in thread: Ronald Ainsworth: "Re: Gyn: Perineal scarring" Reply: Ronald Ainsworth: "Re: Gyn: Perineal scarring" Reply: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" 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 Next message: art fougner, md: "FRI: Natural Selection" Previous message: Dr Eberhard Lisse: "Re: MS Outlook question" In reply to: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" Next in thread: Ronald Ainsworth: "Re: Gyn: Perineal scarring" Reply: Ronald Ainsworth: "Re: Gyn: Perineal scarring" Reply: Joanne Bulley, MD: "Re: Gyn: Perineal scarring"

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