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Is this vulvodynia?From: Marilyn Ringstaff (marilyn.ringstaff@OBGYN.net)Fri Nov 28 15:24:39 2008
I have a patient who has had dyspareunia (at introitus) & constant irritation–symptoms for > a year, initially had erythema at 5 & 7 o'clock, now has very shallow ulcerative lesions ~ 2-3 mm-present for a couple of mos. Monogomous/male partner with no symptoms, herpes culture of lesions negative, no STD history, labs including Herpes Select are negative, culture of the lesions pending. Urine culture is negative. Wet Mount (-) except for small amt yeast and treated now twice w/o relief of symptoms. She tried Nuvaring and s/s got worse, now using only condoms for contraception- & tried diff kinds/non-latex, etc. We've gone all through the vulvodynia 'self-help' checklist from the NVA (http://www.nva.org/new_patient_guide/index.html) without any changes. >From what I've read of vulvodynia, erythema can be present, but lesions aren't typical, I colpo'd the area and there are no acetowhite areas- so didn't biopsy/didn't want to make symptoms worse. Would you biopsy? Would yeast cultures be helpful? Other thoughts? Thanks, Marilyn
-- Marilyn Ringstaff, CNM, JD Rome, Georgia
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