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Vulva und vestibulum

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See related patient information handout on vulvodyniawritten by the author Vulva und vestibulum Elizabeth S. 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.

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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, Vulva und vestibulum cyclic vulvovaginitis, vulvar vestibulitis syndrome, essential dysesthetic vulvodynia and vulvar dermatoses.

Evaluation should include a thorough history Vulva und vestibulum 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. Vulva und vestibulum

Diagnostic and Management Challenges

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. Vulvodynia is frequently misdiagnosed. In a general Vulva und vestibulum practice population, the prevalence of this condition may be as high as 15 percent.

In the s, renewed interest was generated with the publication Vulva und vestibulum articles by Friedrich, Lynch and McKay. Vulvodynia is a syndrome of unexplained vulvar pain that is frequently accompanied by physical disabilities, limitation of daily activities such as sitting and walkingsexual dysfunction and psychologic disability.

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The incidence and prevalence of vulvodynia have not been well studied. Risk-taking sexual behavior is rare, and few Vulva und vestibulum have a history of sexually transmitted diseases. In most cases, vulvodynia becomes a chronic problem lasting months to years. Vulvar pain is frequently described as burning or stinging, or a feeling of rawness or irritation.

Most patients consult several physicians before Vulva und vestibulum diagnosed. Many are treated with multiple topical or systemic medications, with minimal relief. In some cases, inappropriate therapy may even make the symptoms worse.

A year-old woman was treated twice for a suspected urinary tract infection while traveling in Europe. The patient did not know what antiobiotic she had taken. On returning to the United States, she continued to experience dysuria and urgency with vaginal soreness, slight itching and dyspareunia. Urinalyses, urine Vulva und vestibulum and vaginal and cervical cultures were negative. Over the course of two months, the Vulva und vestibulum went to emergency departments twice and visited four different family physicians.

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She was treated with numerous antibiotics, including trimethoprimsul-famethoxazole, cephalexin and ciprofloxacin, for presumed cystitis. She also was treated with oral fluconazole and over-the-counter topical anticandidal preparations for presumed candidal infection, with only temporary relief. During the following two months, the patient experienced dyspareunia with intermittent vulvar pain and irritation. She Vulva und vestibulum saw four gynecologists, a urologist and two primary care physicians.

Pelvic examination revealed erythema of the posterior fourchette and a reaction of mild tenderness on swab test. A biopsy of this area was normal. The patient Vulva und vestibulum treated with Vulva und vestibulum for possible cervicitis; the symptoms were not relieved. She was then given a diagnosis of vulvodynia and was prescribed gradually increasing dosages of amitriptyline, along with oral calcium gluconate three times daily and a low-oxalate diet. She was referred to a support group for persons with vulvodynia and to a physical therapist specializing in women's health problems for pelvic strengthening, relaxation training and biofeedback training.

Over the Vulva und vestibulum three months, the patient reported a 70 to 90 percent improvement in her symptoms, with occasional mild exacerbations. A year-old woman with a history of one term pregnancy developed urgency, erythema in the vulvar area and irritation at the base of the clitoris that began suddenly after intercourse Vulva und vestibulum evening. Subsequent symptoms included burning, rawness and dyspareunia, which increased with walking, sitting and intercourse, and also increased one week before menses.

The use of terconazole cream caused further burning and irritation. Over the next five Vulva und vestibulum the patient saw a nurse practitioner and two family physicians. She received treatment numerous times for yeast vaginitis and bacterial vaginosis with topical antifungal medications, fluconazole and metronidazole gel.

Any improvement was temporary, and the symptoms invariably returned. Vaginal cultures grew various enteric organisms, and no yeasts were detected on KOH examination. Conjugated estrogen vaginal cream gave no significant relief. Over the following two months the patient saw two gynecologists and was diagnosed with vestibulitis. She was treated with triamcinolone-nystatin cream for two months and felt improvement in the first week but later developed further irritation of the vulvar and clitoral area.

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No biopsies were performed. She was referred to a third gynecologist, who instructed Vulva und vestibulum to stop all topical medications. She began taking calcium citrate three times daily, started Vulva und vestibulum low-oxalate diet and was referred to a vulvar pain support group. Over the next year, she was treated with fluconazole, mg once weekly for two months, and then once every other week for two months.

She also began biofeedback training and physical therapy for pelvic muscle relaxation and strengthening. The patient underwent a total of two and one half years of treatment. During her last year of treatment, she experienced a 90 Vulva und vestibulum improvement in symptoms. Several subsets of vulvodynia have been identified.