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Re: clitoritisFrom: DOCMA@aol.comMon Apr 1 20:19:02 1996
As long as there are a few posts on vestibulitis, I have a difficult patient about which someone may have some insight. The patient is a 38yo G2P2 with a generally unremarkable Gyn hx until 1/96, when her husband returned from an absence of several months. Shortly after his return she began to experience moderately severe periclitoral pain, exacerbated by a long daily car commute, with an association of "rubbing" of her underwear. She further reports that trimming her pubic hair in this same time frame led to unbearable pain in this same region, presumably from contact between the tender area and the ends of the remaining hair. She sought attention from an experienced FP. He descibed to me much later that he saw a small "papilloma" on either the clitoris, or possible the clitoral hood. He does not think that it was Herpes. The patient has no hx of STDs and specifically denies Herpes. Over the next 3 months, the patient had persistent pain and irritation in the region and was treated with a variety of topical agents including multiple anti-fungal agents and steriods. In addition, she was treated with Flagyl for presumed bacterial vaginosis, as well as an oral cephalosporin for a UTI during this same period. She has never experienced any relief with any tx. The pain has settled into a much less severe, but aggravating condition which she describes as a "buzzing" of her clitoris. There is no dyspaurenia, but her libido is severely compromised. Her husband had no symptoms. A screen for STDs was negative. The patient was referred to me at this point. A detailed exam of the area in question was performed, including using the colposcope the visualize the clitoris, the clitoral hood, and the junction between the two. Nothing unusual was observed. In particular, no "papilloma" was seen. There is a specific point at the base of the clitoris, unremarkable in appearance, that when touched, reproduces the patient's discomfort. I am considering the diagnosis of Post-Herpetic Pain Syndrome, but I have never seen a case before, and the history is a bit weak. Does anyone have any other ideas? I hate to commit this patient to a 6 week course of Acyclovir based on a hunch. I have heard of using ETOH on areas of chronic pain, but I suspect that the clitoris is not a candidate for that kind of tx. Thanks in advance! William D. McIntosh, MD Clarksville, TN (private practice)
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