| 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. ( info) |
2/54. Severe vulval apocrine acne successfully treated with prednisolone and isotretinoin. Apocrine acne, otherwise known as hidradenitis suppurativa, is a chronic inflammatory scarring disease affecting the apocrine gland-bearing skin. We present a case of a 34-year-old woman with severe vulval apocrine acne who was successfully treated initially with prednisolone and then maintained on long-term isotretinoin. This case indicates that long-term treatment with isotretinoin may be more successful than the usual 4-6 months treatment regime. ( info) |
| PURPOSE: To report two cases of cicatrizing conjunctivitis associated with paraneoplastic lichen planus. methods: case reports. RESULTS: Two patients were examined because of redness and discomfort in both eyes. A 63-year-old woman with follicular, small-cleaved cell lymphoma had cicatrizing conjunctivitis, stomatitis, vulvitis, and skin lesions. A 25-year-old man with malignant thymoma had cicatrizing conjunctivitis, erosive stomatitis, and penile papules. Histopathologic studies of conjunctiva and skin biopsy specimens in the first patient and labial biopsy specimens in the second revealed lichen planus. CONCLUSION: Paraneoplastic lichen planus is a possible cause of cicatrizing conjunctivitis associated with inflammatory skin and mucous membrane disease. ( info) |
| BACKGROUND: Recent reports have argued for a revision of the criteria used for the establishment of a diagnosis of vulvar vestibulitis syndrome (VVS). On theoretical grounds it might be hypothesized that women with VVS also suffer from vaginismus. CASE: A young woman presented with a history, symptoms and objective findings typical of vaginismus, yet she suffered from continuous, burning pain and itching in the vestibule. Earlier in the course of the problem she had received a diagnosis VVS. The patient was treated with behavioral therapy developed for vaginismus. Notations made during the course of therapy supported the assumption that the pain and itching were conditioned responses to penetration in the same way that a vaginal muscular reflex is. CONCLUSION: Differential diagnostic difficulties exist in the field of VVS and vaginismus. Psychophysiologic theories are needed as the basis for research to clarify the connections between different diagnostic entities associated with coital burning pain and itching in the vestibule. ( info) |
5/54. vulvitis circumscripta plasmacellularis mimicking child abuse. vulvitis circumscripta plasmacellularis (VCP) is a rare, benign vulvar disorder that is typically described in adult women. Our case occurred in an 8-year-old girl. The primary diagnostic concern was sexual abuse. VCP may also mimic lichen sclerosus, extramammary Paget's disease, pemphigus vulgaris, fixed drug eruption, squamous cell carcinoma, candidiasis, allergic contact dermatitis, and herpes simplex infection. Evaluation should include a biopsy because the histopathologic features of VCP are distinctive. ( info) |
6/54. Ulcus vulvae acutum. An acute vulvar ulcer was diagnosed based on a case history of a 17-year-old girl with genital ulcers. No relevant causative factors could be established. The gangrenous form of the disease, cutaneous anergy, and the cultured anaerobic pathogens suggested the possibility of an infectious pathogenesis. ( info) |
7/54. vulvitis attributed to hypersensitivity to estrogen. A report of 11 cases. BACKGROUND: vulvitis that is refractory to all treatment remains a therapeutic challenge. hypersensitivity to progesterone and estrogen has been recognized as a rare cause of premenstrual dermatoses. Such hypersensitivity seemed to be the cause of vulvitis in the patients described below. CASES: Nine women had treatment-resistant cyclic vulvitis and two patients had vulvitis develop after commencing hormone replacement therapy (HRT). These patients demonstrated delayed-type hypersensitivity responses by intradermal testing to endogenous estrogens, with two of the patients also reacting to intradermal testing with progesterone. A group of 19 healthy control subjects with no history of vulvar symptoms did not react to any test substance. Ten subjects with other vulvar dermatoses also did not react to any test substance. Of the nine patients with cyclic vulvitis, one recovered at menopause, and three responded to therapy aimed at lowering endogenous estrogen levels. One was able to control symptoms with a potent topical corticosteroid, and four elected not to be treated. Both patients with HRT-related vulvitis recovered when HRT was ceased. CONCLUSION: hypersensitivity to estrogen appears to be implicated in chronic, cyclic vulvitis and vulvitis related to HRT in these patients. This is the first report of vulvitis due to estrogen hypersensitivity. The problem may not be rare and should be considered in patients with unexplained cyclic vulvitis unresponsive to standard therapy or in those developing noncandidal vulvitis on HRT. Specific therapy aimed at suppressing or antagonizing estrogen may be required in these patients. ( info) |
8/54. Interstitial cystitis coexisting with vulvar vestibulitis in a 4-year-old girl. Interstitial cystitis (IC) is a disorder that is difficult to diagnose and is thought to be uncommon in children. We report the first case of IC coexisting with vulvar vestibulitis in a 4-year-old girl. She presented with urinary symptoms and pelvic and vulvar pain. Cystoscopic and histological investigation confirmed interstitial cystitis and vulvar vestibulitis. Gynecologists are often called upon to deal with symptoms referable to the genital tract. It is important to always include interstitial cystitis in the differential diagnosis of urinary symptoms associated with pelvic pain. ( info) |
9/54. Web-enabled Glazer surface electromyographic protocol for the remote, real-time assessment and rehabilitation of pelvic floor dysfunction in vulvar vestibulitis syndrome. A case report. BACKGROUND: The browser-based software for the Glazer pelvic floor muscle surface electromyography (sEMG) protocol can be used for remote, real-time assessment and treatment over the internet. CASE: The initial application of this system is reported for a patient meeting clinical diagnostic criteria for vulvar vestibulitis syndrome. The patient underwent pelvic floor muscle sEMG evaluation in the washington, D.C., office of the second author, remotely controlled by the first author from his office in new york city. Pelvic muscle sEMG findings were consistent with previous reports on vestibulitis patients, and rehabilitative exercises were prescribed. Follow-up evaluations and home training normalized the sEMG and resulted in elimination of pain. CONCLUSION: Remote, real-time pelvic floor muscle sEMG in the diagnosis and treatment of vulvar vestibulitis is a novel application of telemedicine with demonstrated efficacy, permitting this technology to be available to all practitioners. ( info) |
10/54. Ulcerative vulvitis in atypical Reiter's syndrome. We report a case of atypical Reiter's syndrome occurring in a female patient who had severe, ulcerative vulvar disease develop in association with conjunctivitis, low back pain, stomatitis, and psoriasiform skin lesions. Vulvar lesions have rarely been described in Reiter's syndrome and are not well characterized. ( info) |