Vulvar Problems in Elderly Women: Don\u27t Assume That Menopause Is the Culprit

Like many other parts of the body, the vulva is affected by cessation of estrogen after menopause. Vulvar pruritus and irritation are common findings with normal aging, but they may also be signs of infection, inflammation, or other skin conditions. Misdiagnosis results in incorrect treatment, a dissatisfied patient and, often, referral to a gynecology clinic. In this article, two instructors in the field describe acute and chronic vulvar disorders and summarize how to identify and treat them

Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial disease with a high prevalence. This condition affects Caucasians, African Americans, Africans and Hispanic women, particularly those sexually active at child-bearing age. The etiology of this condition is complex and remains elusive. An accurate diagnosis requires a comprehensive history, physical examination and targeted diagnostic tests. Although many treatment options have been utilized, a rational therapeutic strategy is still under research. Psychological counseling and group support should be considered in all cases

Vulvodynia, A Step-wise Therapeutic Prospective Cohort Study

Vulvodynia is characterised by the presence of vulval allodynia (pain evoked by non-painful stimuli) and vulval dysaesthesias (burning, soreness, rawness, stinging and irritation). We assessed a protocol for the evaluation and management of vulvodynia. The protocol was based on the most recent evidence available. We began a simple evaluation and proceeded to an aggressive one. From the cohort of 74 patients, 69 patients (93.2%) were adherent to the protocol. A total of 25 patients (36.3%) improved after antibiotic therapy: 14 patients (20.4%) had a positive fungal culture and 11 patients (15.9%) had a positive bacterial culture; none with a positive viral culture. Eight patients (11.6%) improved with dietary modification. Ten patients (14.5%) benefitted from tricyclic medications; 13 patients (18.8%) improved after gabapentin therapy; 13 patients (18.8%) did not show improvement of their condition. Some 56 patients (81.2%) manifested an improvement of their symptoms, which allowed them to achieve painless sexual intercourse

Vulvar Problems in Elderly Women: Don\u27t Assume That Menopause Is the Culprit

Like many other parts of the body, the vulva is affected by cessation of estrogen after menopause. Vulvar pruritus and irritation are common findings with normal aging, but they may also be signs of infection, inflammation, or other skin conditions. Misdiagnosis results in incorrect treatment, a dissatisfied patient and, often, referral to a gynecology clinic. In this article, two instructors in the field describe acute and chronic vulvar disorders and summarize how to identify and treat them

Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial disease with a high prevalence. This condition affects Caucasians, African Americans, Africans and Hispanic women, particularly those sexually active at child-bearing age. The etiology of this condition is complex and remains elusive. An accurate diagnosis requires a comprehensive history, physical examination and targeted diagnostic tests. Although many treatment options have been utilized, a rational therapeutic strategy is still under research. Psychological counseling and group support should be considered in all cases

Reducing Emergency Births by Modification in Oxytocin Utilization

Background: The purpose of our study was to explore the correlation between the amount of oxytocin use and emergency vacuum, forceps, cesarean births and neonatal intensive care unit (NICU) response to fetal distress. In 2004, we restricted the criteria for oxytocin utilization for labor induction and augmentation. Methods: This retrospective study was carried out at a large private university tertiary care hospital- affiliated, and included data from the years 2005 to 2007. We utilized hospital data from vital statistics, labor and delivery, central pharmacy and NICU. Information obtained included maternal characteristics, annual birth data, indication and numbers of emergency vacuum, forceps and cesarean births, oxytocin utilization, and number of NICU responses to fetal distress. Results: The total number of deliveries during the studied period equaled14,184. The oxytocin utilization showed a reduction from 93.3% to 78.9%. The number of patients who did not receive oxytocin during labor increased from 6.7% to 21.1%. The correlation between the reduction of oxytocin utilization with the reduction of emergency cesarean births (10.9% to 5.07%), vacuum briths (9.1% to 8.5%), and forceps birth (4% to 2.3%) including NICU responses to fetal distress (P = 0.0001) revealed a significant statistical difference. The overall cesarean section rate did not indicate a significant increase 29.4% to 29.8% (P = 0.14) nor did the patient’s characteristics differ. Conclusion: In our population, reducing oxytocin appears to strongly correlate with a reduction in the number of emergency vacuum, forceps, cesarean births and NICU responses to fetal distress

Vulvodynia, A Step-wise Therapeutic Prospective Cohort Study

Vulvodynia is characterised by the presence of vulval allodynia (pain evoked by non-painful stimuli) and vulval dysaesthesias (burning, soreness, rawness, stinging and irritation). We assessed a protocol for the evaluation and management of vulvodynia. The protocol was based on the most recent evidence available. We began a simple evaluation and proceeded to an aggressive one. From the cohort of 74 patients, 69 patients (93.2%) were adherent to the protocol. A total of 25 patients (36.3%) improved after antibiotic therapy: 14 patients (20.4%) had a positive fungal culture and 11 patients (15.9%) had a positive bacterial culture; none with a positive viral culture. Eight patients (11.6%) improved with dietary modification. Ten patients (14.5%) benefitted from tricyclic medications; 13 patients (18.8%) improved after gabapentin therapy; 13 patients (18.8%) did not show improvement of their condition. Some 56 patients (81.2%) manifested an improvement of their symptoms, which allowed them to achieve painless sexual intercourse