1/7. vulvodynia and vulvar vestibulitis: challenges in diagnosis and management.vulvodynia is a problem most family physicians can expect to encounter. It is a syndrome of unexplained vulvar pain, frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. The patient's vulvar pain usually has an acute onset and, in most cases, becomes a chronic problem lasting months to years. The pain is often described as burning or stinging, or a feeling of rawness or irritation. vulvodynia may have multiple causes, with several subsets, including cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential (dysesthetic) vulvodynia and vulvar dermatoses. Evaluation should include a thorough history and physical examination as well as cultures for bacteria and fungus, KOH microscopic examination and biopsy of any suspicious areas. Proper treatment mandates that the correct type of vulvodynia be identified. Depending on the specific diagnosis, treatment may include fluconazole, calcium citrate, tricyclic antidepressants, topical corticosteroids, physical therapy with biofeedback, surgery or laser therapy. Since vulvodynia is often a chronic condition, regular medical follow-up and referral to a support group are helpful for most patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Multiple, genital lobular capillary haemangioma (pyogenic granuloma) in a young woman: a diagnostic puzzle.A 21 year old woman presented with multiple lobulated lesions on the labia majora. The surface of most of the lesions was ulcerated revealing a glistening surface. All lesions were excised. The histopathology revealed features suggestive of lobular capillary haemangioma (pyogenic granuloma). Pyogenic granuloma is considered as a reactive hyperproliferative vascular response to trauma or other stimuli. A literature search revealed reports of a few cases of lobular capillary haemangioma of the glans penis but not on the female genitalia. This case is presented to help physicians become aware that lobular capillary haemangiomas (pyogenic granuloma) may occur at this site.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Reiter's syndrome of the vulva. The psoriasis spectrum.BACKGROUND--Reiter's syndrome is a disease characterized by crusted, scaling, acral and genital plaques; urethritis or cervicitis; and arthritis, which occur in genetically susceptible patients in response to any of many infections. This disease rarely occurs in women, and specific characterizations of vulvar and cervical lesions are rare. OBSERVATIONS--We describe a 39-year-old woman with a history of mucocutaneous candidiasis that was refractory to oral ketoconazole therapy. She presented with well-demarcated, erythematous, crusted plaques over the vulva, hands, and feet, as well as with cervical lesions and a history of conjunctivitis and iritis. Following the biopsy of characteristic skin lesions, recognition of systemic signs, and cultures that were negative for yeast, her condition was diagnosed as Reiter's syndrome. CONCLUSIONS--Reiter's syndrome of the vulva, vagina, and cervix may not be recognized because of its uncommon occurrence in women and the physician's consequent unfamiliarity with its clinical appearance in the genital area. This disease and pustular psoriasis share many common features and exist on a spectrum. A high index of suspicion and correlation of the many facets of the disease will better enable the clinician to make this diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Perianal and vulvar Crohn's disease presenting as suspected abuse.Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Case study: abscess of the labia.A 68 year old female with no history of perianal abscess was examined in the Emergency Department of the hospital verbalizing complaints of swelling and tenderness in the left inguinal area. physical examination revealed redness and swelling of the left labial area. The patient was admitted to the hospital and, following surgical incision and drainage by the physician, wound exploration revealed tunneling extending into the perirectal and vaginal areas. ET Nurse consultation was requested to establish a wound treatment regimen. The system of dressing used were a sterile, rayon/polyester dressing impregnated with 15 percent crystalline sodium chloride to cleanse the wound of slough and debris, in a ribbon form to facilitate packing of tunneling; a sterile 0.9 percent sodium chloride solution in gel form to protect the wound bed and keep it moist during granulation and reepithelialization; and an absorbent pad to collect drainage. This system of dressings addressed the patient's specific needs, was easy to use and proved easy to teach to a family member managing the patient's wound care at home. During the 10 1/2 weeks of treatment, wound healing progressed steadily, odor diminished rapidly and granulation of the wound bed progressed to healing with no maceration of the surrounding skin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. STD interactive case challenge--diagnosing and treating chronic vulvar pain and erythema.A 36-year-old Caucasian woman arrives in your office, her chief complaint being vulvar pain and discomfort of 2 years' duration. She says that the onset of vulvar erythema and pain was gradual, beginning with mild tingling discomfort and eventually developing into dyspareunia and pain whenever she attempted to insert tampons, wore tight-fitting pants, or went horseback riding. The patient denies having vaginal discharge, change in menstrual pattern, or dysuria. She says she complained of the problem to several previous clinicians, who recommended anti-infective treatment for candidal vulvovaginitis, bacterial vaginosis, and recurrent cystitis, yet the symptoms persisted. One physician suggested a psychiatric evaluation, but the patient refused. She switched soap, shampoo, and even underwear fabric in an unsuccessful effort to ameliorate the symptoms. Over the past 6 months she has become increasingly frustrated with this problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Genital ulcers associated with acute Epstein-Barr virus infection.To date there have been only five reported cases of females with genital ulceration associated with primary Epstein-Barr virus infection. We describe two further patients and review the clinical features of all seven cases, noting the typical features, particularly purple ulcer margins and systemic symptoms, which should alert the physician to consider this diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |