{"id":164,"date":"2020-08-13T15:54:01","date_gmt":"2020-08-13T15:54:01","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=164"},"modified":"2021-05-09T20:45:16","modified_gmt":"2021-05-09T20:45:16","slug":"35-vulvar-and-vaginal-disease","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/35-vulvar-and-vaginal-disease\/","title":{"rendered":"35. Vulvar and Vaginal Disease"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/3aYm-WNjn1I\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:03<\/p>\n<input type='hidden' bg_collapse_expand='69e9b56bd6fc68039368967' value='69e9b56bd6fc68039368967'><input type='hidden' id='bg-show-more-text-69e9b56bd6fc68039368967' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b56bd6fc68039368967' value='Hide Transcript'><button id='bg-showmore-action-69e9b56bd6fc68039368967' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b56bd6fc68039368967' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic 35 vulvar and<br \/>\n00:03<br \/>\nvaginal disease vulvar and vaginal<br \/>\n00:05<br \/>\nconditions occur frequently and can be<br \/>\n00:07<br \/>\ndistressing with serious consequences<br \/>\n00:09<br \/>\nvaginitis gynecology visits are very<br \/>\n00:11<br \/>\ncommon with over 10 million office<br \/>\n00:13<br \/>\nvisits per year the percent of American<br \/>\n00:16<br \/>\nwomen who reported symptoms in the past<br \/>\n00:17<br \/>\nyear was 8 percent for Caucasian women<br \/>\n00:20<br \/>\nand 18 percent for African American<br \/>\n00:21<br \/>\nwomen the objectives of this video are<br \/>\n00:24<br \/>\nto formulate a differential diagnosis<br \/>\n00:26<br \/>\nfor vulval vaginitis interpret a wet<br \/>\n00:28<br \/>\nmount microscopic examination describes<br \/>\n00:31<br \/>\nthe variety of dermatological disorders<br \/>\n00:33<br \/>\nof the vulva and finally discussed steps<br \/>\n00:35<br \/>\nin the evaluation and management of a<br \/>\n00:37<br \/>\npatient with vulva vaginal symptoms<br \/>\n00:39<br \/>\nlet&#8217;s meet dr. vulva vagina when a<br \/>\n00:42<br \/>\npatient presents with Volvo vaginitis<br \/>\n00:44<br \/>\nsymptoms I am having itching burning<br \/>\n00:46<br \/>\nirritation and discharge what are the<br \/>\n00:50<br \/>\nmost common causes that are at the top<br \/>\n00:51<br \/>\nof the differential diagnosis bacterial<br \/>\n00:53<br \/>\nvaginosis is the cause 20 to 25 percent<br \/>\n00:56<br \/>\nof the time volvo vaginal candidiasis 17<br \/>\n00:59<br \/>\nto 39% and trichomonas 4 to 35 percent<br \/>\n01:03<br \/>\ntaking a careful history will often help<br \/>\n01:05<br \/>\nto narrow the diagnosis a thick white<br \/>\n01:07<br \/>\ndischarge with itching is the classic<br \/>\n01:09<br \/>\npresentation for yeast a thin white<br \/>\n01:11<br \/>\ndischarge with a fishy odor is the<br \/>\n01:13<br \/>\nclassic presentation for bacterial<br \/>\n01:14<br \/>\nvaginosis and a yellow frothy discharge<br \/>\n01:16<br \/>\nwith odor is the classic presentation<br \/>\n01:18<br \/>\nfor trichomonas the cornerstone of<br \/>\n01:20<br \/>\ndiagnosis is the wet mount a dry<br \/>\n01:23<br \/>\nspeculum was placed in the vagina and a<br \/>\n01:24<br \/>\nspecimen of vaginal discharge of swabs<br \/>\n01:26<br \/>\nbe careful not to get cervical mucus<br \/>\n01:28<br \/>\nwhich will alter the ph of the specimen<br \/>\n01:30<br \/>\nthe pH is a very helpful triage point<br \/>\n01:32<br \/>\nnormal pH and a reproductive age woman<br \/>\n01:34<br \/>\nis between three point eight to four<br \/>\n01:36<br \/>\npoint five a pH of less than four point<br \/>\n01:38<br \/>\nfive is usually east<br \/>\n01:40<br \/>\nwhereas pH greater than four point five<br \/>\n01:41<br \/>\nis usually bacterial vaginosis or<br \/>\n01:43<br \/>\ntrichomonas here is a wet mount<br \/>\n01:45<br \/>\nphotograph of a normal vaginal<br \/>\n01:46<br \/>\nepithelial cell with nice smooth borders<br \/>\n01:49<br \/>\nin contrast here is the classic clue<br \/>\n01:52<br \/>\ncell a bacterial vaginosis<br \/>\n01:53<br \/>\nnote the stippled borders of the cell<br \/>\n01:55<br \/>\nadding a few drops of potassium<br \/>\n01:57<br \/>\nhydroxide to the vaginal discharge<br \/>\n01:58<br \/>\nproduces an amine or fishy odor this is<br \/>\n02:02<br \/>\ncommonly referred to as a positive whiff<br \/>\n02:04<br \/>\ntest<br \/>\n02:04<br \/>\nbacterial vaginosis is a polymicrobial<br \/>\n02:07<br \/>\ninfection characterized by a lack of<br \/>\n02:09<br \/>\nbalance in the vagina<br \/>\n02:10<br \/>\nthere is overgrowth of anaerobic or<br \/>\n02:12<br \/>\nand a lack of normal lactobacilli the<br \/>\n02:14<br \/>\ndiagnosis is made clinically when a<br \/>\n02:16<br \/>\npatient has abnormal vaginal discharge<br \/>\n02:17<br \/>\npH greater than four point five positive<br \/>\n02:20<br \/>\nwhiffed tests and our presence or clue<br \/>\n02:22<br \/>\ncells treatment is with oral or topical<br \/>\n02:24<br \/>\nmetronidazole or topical clindamycin<br \/>\n02:26<br \/>\nhere is a wet mount slide showing the<br \/>\n02:28<br \/>\ncharacteristic budding high fee of vulva<br \/>\n02:30<br \/>\nvaginal candidiasis or yeast it is often<br \/>\n02:33<br \/>\nhelpful to add some potassium hydroxide<br \/>\n02:34<br \/>\nto the slide in order to better<br \/>\n02:35<br \/>\nvisualize the yeast candida albicans is<br \/>\n02:38<br \/>\nthe organism of 90% of cases other<br \/>\n02:40<br \/>\norganisms include Canada glabrata and<br \/>\n02:42<br \/>\nCanada tropicalis vulva vaginal<br \/>\n02:45<br \/>\ncandidiasis is more common in women who<br \/>\n02:47<br \/>\nare pregnant diabetic or obese on<br \/>\n02:50<br \/>\nantibiotics corticosteroids or oral<br \/>\n02:53<br \/>\ncontraception other practices that keep<br \/>\n02:55<br \/>\nthe vaginal area warm and moist such as<br \/>\n02:57<br \/>\nwearing tight clothing wet swimsuits or<br \/>\n02:59<br \/>\nhabitual use of panty liners diagnosis<br \/>\n03:02<br \/>\nis by wet mount visualization of blasto<br \/>\n03:04<br \/>\nspores or pseudohyphae<br \/>\n03:05<br \/>\nor a positive yeast culture treatment is<br \/>\n03:07<br \/>\nwith vaginal and medes all such as<br \/>\n03:09<br \/>\nmikanos electra Mosel or taco nozzle or<br \/>\n03:11<br \/>\nsingle dose oral fluconazole lastly<br \/>\n03:14<br \/>\nhere&#8217;s the characteristic wet mount<br \/>\n03:15<br \/>\nfinding of the trichomonas organism with<br \/>\n03:17<br \/>\nhis characteristic flagella the<br \/>\n03:20<br \/>\ntrichomonas organism is transmitted via<br \/>\n03:22<br \/>\nsexual contact but can also survive in<br \/>\n03:23<br \/>\nswimming pools and hot tubs it is<br \/>\n03:26<br \/>\nassociated with PID and dermatitis and<br \/>\n03:28<br \/>\ncould facilitate HIV transmission the<br \/>\n03:31<br \/>\ndiagnosis is by the wet mount and women<br \/>\n03:33<br \/>\ndiagnosed with trichomonas should also<br \/>\n03:34<br \/>\nbe screened for other STDs especially<br \/>\n03:36<br \/>\ngonorrhea and chlamydia treatment is<br \/>\n03:39<br \/>\nwith oral metronidazole or tech notice<br \/>\n03:41<br \/>\nall the partners should be treated as<br \/>\n03:43<br \/>\nwell many patients presenting with<br \/>\n03:45<br \/>\nvaginitis symptoms will also have<br \/>\n03:47<br \/>\nassociated vulvar itching complaints<br \/>\n03:48<br \/>\nthis is a good time to take a quick<br \/>\n03:50<br \/>\nmoment to review anatomy 101 mixing up<br \/>\n03:53<br \/>\nthe distinction between vulva and vagina<br \/>\n03:54<br \/>\nis something that can instantaneously<br \/>\n03:56<br \/>\nmark someone as an amateur in this<br \/>\n03:58<br \/>\nbusiness<br \/>\n03:58<br \/>\ndon&#8217;t forget vulva is the labia majora<br \/>\n04:01<br \/>\nlabia minora vestibule and perineum on<br \/>\n04:03<br \/>\nthe outside vaginas on the inside many<br \/>\n04:06<br \/>\npatients assume that itching equals<br \/>\n04:09<br \/>\nyeast but this is definitely not the<br \/>\n04:10<br \/>\ncase in a report of 200 new patients<br \/>\n04:14<br \/>\npresenting to evolve our specialty<br \/>\n04:16<br \/>\nclinic the etiology for the itchy vulva<br \/>\n04:20<br \/>\nwas contact dermatitis in 20% of the<br \/>\n04:22<br \/>\ncases<br \/>\n04:23<br \/>\nrecurrent yeast 20%<br \/>\n04:25<br \/>\nlike in sclerosis or like in simplex<br \/>\n04:27<br \/>\nchronic is 11 percent bacterial<br \/>\n04:29<br \/>\nvaginosis 7% valve our vestibule itis<br \/>\n04:32<br \/>\n13% and atrophic vaginitis 13 percent<br \/>\n04:35<br \/>\nsince contact dermatitis is such a<br \/>\n04:38<br \/>\ncommon source of all very itchy it&#8217;s<br \/>\n04:40<br \/>\nimportant to realize with the common<br \/>\n04:42<br \/>\nvulvar irritants consist of shampoos and<br \/>\n04:45<br \/>\nbody washes with fragrance creative<br \/>\n04:49<br \/>\nunderwear 100% cotton underwear is the<br \/>\n04:51<br \/>\nbest and don&#8217;t forget to ask about maxi<br \/>\n04:55<br \/>\npads and panty liners it is important to<br \/>\n04:58<br \/>\ndiscuss these vulva comfort care<br \/>\n05:00<br \/>\nmeasures and to offer tips for breaking<br \/>\n05:02<br \/>\nthe itch scratch cycle it&#8217;s important to<br \/>\n05:04<br \/>\nemphasize that if the itching does not<br \/>\n05:06<br \/>\nget better a topical steroids or does<br \/>\n05:08<br \/>\nnot seem to make sense the number apps<br \/>\n05:09<br \/>\nyou should be performed the biopsy will<br \/>\n05:11<br \/>\nevaluate for dysplasia and cancer and<br \/>\n05:13<br \/>\ncan also diagnose benign volver<br \/>\n05:15<br \/>\nconditions we will conclude this video<br \/>\n05:18<br \/>\nby discussing the B&#8217;nai involve our<br \/>\n05:19<br \/>\nconditions of lichens chlorosis like<br \/>\n05:21<br \/>\ncomplainers and lichen simplex chronic<br \/>\n05:23<br \/>\nas&#8217; like in sclerosis is a benign<br \/>\n05:25<br \/>\nchronic dermatological condition<br \/>\n05:27<br \/>\ncharacterized by marked inflammation<br \/>\n05:28<br \/>\nepithelial thinning and distinct dermal<br \/>\n05:30<br \/>\nchanges here is a photograph of lincoln<br \/>\n05:33<br \/>\nsclerosis note the obliteration of the<br \/>\n05:35<br \/>\nlabia minora and the cigarette paper<br \/>\n05:37<br \/>\nquality of the skin patients will often<br \/>\n05:40<br \/>\nexperience vulva itching and burning<br \/>\n05:42<br \/>\ntreatment is with topical<br \/>\n05:44<br \/>\ncorticosteroids it is important to note<br \/>\n05:47<br \/>\nthat women with lichen sclerosis are at<br \/>\n05:48<br \/>\nincreased risk of developing squamous<br \/>\n05:50<br \/>\ncell carcinoma of the vulva lichen<br \/>\n05:52<br \/>\nplanus is a rare inflammatory skin<br \/>\n05:54<br \/>\ncondition that can affect the skin oral<br \/>\n05:56<br \/>\ncavity vulva and vagina women can<br \/>\n05:59<br \/>\nexperience chronic vulva burning and<br \/>\n06:01<br \/>\nitching insertional dyspareunia and<br \/>\n06:03<br \/>\nperfuse vaginal discharge note that<br \/>\n06:06<br \/>\nlichen planus can affect both the vulva<br \/>\n06:08<br \/>\nand the vagina<br \/>\n06:08<br \/>\nwhereas lichen sclerosis only affects<br \/>\n06:10<br \/>\nthe vulva lichens simplex chronic hiss<br \/>\n06:13<br \/>\nis a bit of a mouthful and describes the<br \/>\n06:15<br \/>\nskin changes that occur with the itch<br \/>\n06:16<br \/>\nscratch cycle here is a photograph of<br \/>\n06:19<br \/>\ncontact dermatitis<br \/>\n06:20<br \/>\nnote the erythema of the labia majora<br \/>\n06:22<br \/>\nwith scratching there is mechanical<br \/>\n06:24<br \/>\nirritation which leads to epidermal<br \/>\n06:26<br \/>\nthickening and an inflammatory cell<br \/>\n06:28<br \/>\ninfiltrate which makes the skin itchy<br \/>\n06:29<br \/>\nearth thus the cycle treatment for like<br \/>\n06:32<br \/>\non simplex chronic is is also topical<br \/>\n06:34<br \/>\ncorticosteroids as well as counseling on<br \/>\n06:36<br \/>\nhow to avoid skin irritants and the<br \/>\n06:38<br \/>\nimportance of breaking<br \/>\n06:39<br \/>\nscratch cycle this concludes the video<br \/>\n06:41<br \/>\non Volvo retinitis we reviewed the<br \/>\n06:43<br \/>\ncommon symptoms wet prep findings and<br \/>\n06:45<br \/>\ntreatments for yeast material vaginosis<br \/>\n06:47<br \/>\nand trichomonas and discussed the<br \/>\n06:49<br \/>\ncomplexity of diagnosing and treating<br \/>\n06:51<br \/>\nthe achieve ova<br \/>\n06:53<br \/>\n[Music]<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:03<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":35,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-164","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/164","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=164"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/164\/revisions"}],"predecessor-version":[{"id":2840,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/164\/revisions\/2840"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=164"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}