OB-GYN-L Messages for November, 2008: Re: Is this vulvodynia?

Vulvodynia won't have ulcers. I'd biopsy them. Only way to know for certain esp. if the STD w/u was negative.

= **************************************************************************** Charlie Chambers

"Almost anything you do will seem insignificant but it is very important that you do it....You must be the change you wish to see in the world" -- Mahatma Ghandi. = *******************************************************************************

> 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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Vulvodynia won't have ulcers. I'd biopsy them. Only way to know for certain esp. if the STD w/u was negative.

****************************************************************************

Charlie Chambers

Hood River, OR

cchamber@alumni.rice.edu

"Almost anything you do will seem insignificant but it is very important

that you do it....You must be the change you wish to see in the world"

-- Mahatma Ghandi.

*******************************************************************************

On Nov 28, 2008, = at 2:26 PM, Marilyn Ringstaff wrote:

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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