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Re: F/U Question to Dr. Montgomery Re: Extreme Vaginal Discomfort - Need as many opinions as possibleFrom: Kelly Shanahan, MD (anonymous@obgyn.net)Thu, 10 Aug 2000 23:25:18 -0500 (CDT)
>>> >>>I have been suffering with severe discomfort in my vaginal area >>>(particularly in the labia minora)for about 4 months. I have been >>>experiencing burning, irritation, and rawness, but no itching or >>>discharge. I am not sexually active and I have not changed soaps or >>>anything like that. >>> >>>I have gone to my GYN several times and he seems to believe it is >>>"vaginitis" and a yeast infection. He has given me many different >>>creams which have provided some relief, but no cure, and today I feel >>>like that area of my body is on fire. He also prescribed a vaginal >>>suppository for the yeast, but it only gave me temporary relief as well. >>> >>>I am so frustrated and miserable. I would really appreciate some help. >>>Thanks. >> >>Lisa, >>I am going to make you an expert in vulvar problems right now. The >>rules to treat vulvar symptoms are very straight forward. At the first >>presentation, you listen to the symptoms and do the standard swab of the >>vaginal/vulvar secretions and place them on a slide to look for the >>common causes of symptoms, such as yeast, gardnerella, trichomonas and >>you treat what you think you might see. The second presentation with >>the same symptoms warrants formal cultures of the vulva/vagina that are >>sent to the lab to see if anything grows that can be treated >>specifically. At the third presentation for the same symptoms, you >>don't have a diagnosis yet because the patient (you in this case)hasn't >>gotten any relief with the things you have tried for infections. To get >>the diagnosis, you now need to do a vulvar biopsy. This is a little >>biopsy that allows the pathologist to tell you exactly what is going on >>in the skin in the area that is causing the symptoms. There are a >>plethora of vulvar problems that require specific treatment and aren't >>infections. The only way to appropriately direct treatment is to get a >>biopsy. That is where you are currently at-you need a biopsy of the >>problem area. Now you are qualified to treat everybodies vulvar >>problems on the Forum... >>Lynn >>-- >>Lynn D. Montgomery, MD >>Director, Maternal-Fetal Medicine >>Rocky Mountain Perinatal Center >>Missoula, Montana >> >Dr. Mongomery: Could you tell me exactly what the biopsy involves? Does >it hurt? If so, how much? Is an effective anesthetic used? How long does >the procedure last? Thanks. A biopsy involves taking a small snip of tissue and sending it to the lab to be examined by a pathologist . First, the skin is cleansd, then an anesthetic (usually a lidocain injection) is given . Then a small circular punch biopsy is done (or the area can be elevated and snipped with a scaple or scissor). It only takes a minute or two, and is done in hte office. Usually, the biopsy site does not need sutures, but a chemical substance or a small peice of gelfoam is applied to stop any bleeding
-- M. Kelly Shanahan, MD, FACOG South Lake Tahoe, CA
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