Re: Perineal scarring
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Thu Aug 28 20:20:58 2008
I don't think that's what she needs but it is intriguing at best. I'll
likely reassess.
Thanks,
Garry
At Wed, 27 Aug 2008, Atkinson, Samuel M, Jr wrote:
>
>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
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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