Evaluation and management of vulvar disease
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| Format: | Buch |
| Sprache: | English |
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Philadelphia, Pennsylvania
Elsevier
[2017]
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| Schriftenreihe: | Obstetrics and gynecology clinics of North America
volume 44, number 3 (September 2017) |
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| 245 | 1 | 0 | |a Evaluation and management of vulvar disease |c editor Aruna Venkatesan |
| 264 | 1 | |a Philadelphia, Pennsylvania |b Elsevier |c [2017] | |
| 300 | |a xiv Seiten, Seite 321-522 |b Illustrationen | ||
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| 490 | 1 | |a Obstetrics and gynecology clinics of North America |v volume 44, number 3 (September 2017) | |
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| 700 | 1 | |a Venkatesan, Aruna |0 (DE-588)1140953737 |4 edt | |
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Datensatz im Suchindex
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| adam_text | Titel: Evaluation and management of vulvar disease
Autor: Venkatesan, Aruna
Jahr: 2017
Evaluation and Management of Vulvar Disease
Contents
Foreword: Differentiating Between Normal, Benign, and Potentially
Serious Vulvar Conditions
William F. Rayburn
xi
Preface: Evaluation and Management of Vulvar Disease
Aruna Venkatesan
xiii
A General Approach to the Evaluation and the Management of
Vulvar Disorders
321
Gabriela A. Cobos and Miriam Keltz Pomeranz
The evaluation of the vulva should always begin with a detailed clinical his-
tory. The clinician should be very familiar with vulvar anatomy and the
changes it undergoes depending on the patient s age and hormonal sta-
tus. A systematic approach should be developed when examining the
vulva so as to not leave out any parts. Finally, there is a wide array of ancil-
lary tests and diagnostic procedures that can be pursued to arrive at the
correct diagnosis and begin proper management.
High-Yield Vulvar Histopathology for the Clinician 329
Jason C. Reutter
Certain adjustable factors may influence how helpful a pathology report
is to the clinician. Different biopsy techniques may be preferable based
on the type of lesion being biopsied and the background epithelial
surface. Key observations from the history and physical examination,
possibly with a clinical photograph, are helpful to the pathologist.
When reading the pathology report, the clinician should realize the
difficulties arising from definitively classifying some diseases and how
treatment can affect the tissue. Finally, miscommunication with the
pathologist must be avoided by understanding the current nomenclature
of vulvar disease.
Vulvar Neoplasms, Benign and Malignant 339
Jill I. Allbritton
Cutaneous vulvar neoplasms are commonly encountered at gynecology
visits, with 2% of women having a benign vulvar melanocytic nevus and
10% to 12% of nevi being vulvar. High-grade squamous intraepithelial le-
sions (vulvar intraepithelial neoplasia 2 or 3) occur in 5 per 100,000 women,
with an Increasing incidence in the past 30 years. The recognition of these
lesions and differentiation between benign, premalignant, and malignant
stages are crucial for adequate diagnosis, clinical monitoring, and treat-
ment. The presentation, diagnosis, and management of benign and malig-
nant vulvar proliferations are discussed with focus on the practical aspects
of clinical care.
Contents
Red Rashes of the Vulva
Lynne H. Morrison and Catherine M. Leclair
Red patches and plaques of the vulva may be manifestations of neo-
plasms, infections, or inflammatory skin diseases. These diseases can
mimic one another clinically; features that generally allow the diseases
to be identified on most cutaneous surfaces can be altered in the moist,
occluded vulvar environment, making clinical diagnosis difficult. A
detailed history and thorough physical examination can point to the likely
diagnosis, but biopsy and culture may be needed for diagnosis
especially in refractory disease. It is not uncommon for several of these
processes to be present concomitantly or complicating other vulvar
diseases.
Atopic and Contact Dermatitis of the Vulva
Rita Pichardo-Geisinger
Pruritus, or itch, is a common vulvar complaint that is often treated empir-
ically as a yeast infection; however, yeast infections are just one of the
many conditions that can cause vulvar itch. Ignoring other conditions
can prolong pruritus unnecessarily. Atopic dermatitis, irritant contact
dermatitis, and allergic contact dermatitis are extremely common
noninfectious causes of vulvar itch that are often underdiagnosed by
nondermatologists. Identifying these conditions and treating them appro-
priately can significantly improve a patient s quality of life and appropri-
ately decrease health care expenditures by preventing unnecessary
additional referrals or follow-up visits and decreasing pharmaceutical
costs.
Vulvar Pruritus and Lichen Simplex Chronicus
Rebecca Chibnall
Vulvar pruritus and lichen simplex chronicus are common reasons for
presentation to women s health practitioners, including gynecologists
and dermatologists. Both conditions are multifactorial and are often
confounded by other inflammatory, neoplastic, infectious, environmental,
neuropathic, hormonal, and behavioral variables. Careful history taking
and thorough physical examinations, including wet mount and potentially
skin biopsy, are necessary for appropriate diagnosis. Treatment should
focus on decreasing inflammation, reducing irritants, and providing symp-
tomatic relief to achieve remission. Comprehensive treatment covering
environmental, biological, and behavioral therapy can result in long-term
cure for patients with these conditions.
Genital Lichen Sderosus and its Mimics
Anuja Vyas
A variety of disorders may be confused with vulvar or genital lichen scle-
rosus, as they can share several common features. This article dis-
cusses the diagnosis, workup, and management of vulvar lichen
sclerosus, with specific attention on distinguishing it from other derma-
tologie mimics.
Contents vii
Erosive Lichen Planus 407
Melissa Mauskar
Liehen planus is an inflammatory mucocutaneous condition with a myriad
of clinical manifestations. There are 3 forms of lichen planus that affect the
vulva: papulosquamous, hypertrophic, and erosive. Erosive lichen planus
can progress to vulvar scaring, vaginal stenosis, and squamous cell carci-
noma: these long-term sequelae cause sexual distress, depression, and
decreased quality of life for patients. Diagnosis is often delayed because
of patient embarrassment or clinician misdiagnosis. Early recognition
and treatment is essential to decreasing the morbidity of this condition.
Multimodal treatment, along with a multidisciplinary approach, will
improve outcomes and further clinical advances in studying this condition.
Fissures, Herpes Simplex Virus, and Drug Reactions: Important Erosive Vulvar
Disorders 421
Tanja G. Bohl
Vulvar fissures, excoriations, and erosions are common problems resulting
from a variety of causes, many involving other mucosal and cutaneous
sites. The authors present historical and examination features and useful
investigations that can help establish a diagnosis so that definitive therapy
can be instituted. Vulvar involvement also can be part of life-threatening
conditions that require hospital admission and a multidisciplinary
approach for optimal patient care. The clinical morphology of these exam-
ination findings and response to therapy can be modified by various host
factors, particularly immune status, and atypical presentations and re-
sponses to therapy should always prompt patient réévaluation.
A Clinical Approach to Vulvar Ulcers 445
Kristen M.A. Stewart
This article discusses the differential diagnosis of vulvar ulcers and
describes a general clinical approach to this common but nonspecific ex-
amination finding. The differential diagnosis includes sexually and nonsex-
ual^ transmitted infections, dermatitides, trauma, neoplasms, hormonally
induced ulcers, and drug reactions. Patient history and physical examina-
tion provide important clues to the cause of a vulvar ulcer. However, lab-
oratory testing is usually required for accurate diagnosis because the
clinical presentation is often nonspecific and may be atypical due to sec-
ondary conditions.
Challenging Ulcerative Vulvar Conditions: Hidradenitis Suppurativa, Crohn
Disease, and Aphthous Ulcers 453
Kristen M.A. Stewart
This article discusses the clinical evaluation and approach to patients with
3 complex ulcerative vulvar conditions: hidradenitis suppurativa, metasta-
tic Crohn disease of the vulva, and aphthous ulcers. These conditions are
particularly challenging to medical providers because, although each is
known to present with nonspecific examination findings that vary in
morphology, the predominance of the diagnosis is based on clinical exam-
ination and exclusion of a wide variety of other conditions. Care of patients
Contents
with these conditions is further complicated by the lack of therapeutic data
and the significant impact these conditions have on quality of life.
Vulvovaginal Graft-Versus-Host Disease
Rachel I. Komik and Alison S. Rustagi
Vulvovaginal chronic graft-versus-host disease (cGVHD) is an underrecog-
nized complication of stem cell transplantation. Early recognition may
prevent severe sequelae. Genital involvement is associated with oral,
ocular, and skin manifestations. Treatment includes topical immunosup-
pression, dilator use, and adjuvant topical estrogen. Clinical and histologic
features may mimic other inflammatory vulvar conditions. In the right
clinical context, these findings are diagnostic of cGVHD. Female recipients
of allo-hematopoietic stem cell transplantation (HCT) are at higher risk of
condylomas, cervical dysplasia, and neoplasia. The National Institutes of
Health publishes guidelines for the diagnosis, grading, management,
and supportive care for HCT patients by organ system.
Vulvodynia: Diagnosis and Management
Amy L. Stenson
Vulvodynia is a common condition that negatively affects sexual health
and quality of life for many women. A new classification system that di-
vides vulvodynia into subtypes based on pain characteristics has been
adopted. Diagnosis relies on ruling out possible contributing pathologic
conditions. A multidisciplinary approach to treatment is likely to achieve
the best outcome for all types. Medical therapy with systemic neuromodu-
lators is suggested for generalized vulvodynia. For patients with vestibulo-
dynia, topical therapy may be beneficial. Vestibulectomy has a high
success rate and may be a good option if the patient is not responding
to treatment.
Pelvic Floor Physical Therapy for Vulvodynia: A Clinician s Guide
Stephanie A. Prendergast
Vulvar pain affects up to 20% of women at some point in their lives, and
most women with vulvar pain have associated pelvic floor impairments.
Pelvic floor dysfunction is associated with significant functional limitations
in women by causing painful intercourse and urinary, bowel, and sexual
dysfunction. A quick screening of the pelvic floor muscles can be per-
formed in the gynecology office and should be used when patients report
symptoms of pelvic pain. It is now known the vulvar pain syndromes are
heterogeneous in origin; therefore, successful treatment plans are multi-
modal and include physical therapy.
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| series2 | Obstetrics and gynecology clinics of North America Clinics review articles |
| spellingShingle | Evaluation and management of vulvar disease Obstetrics and gynecology clinics of North America |
| title | Evaluation and management of vulvar disease |
| title_auth | Evaluation and management of vulvar disease |
| title_exact_search | Evaluation and management of vulvar disease |
| title_full | Evaluation and management of vulvar disease editor Aruna Venkatesan |
| title_fullStr | Evaluation and management of vulvar disease editor Aruna Venkatesan |
| title_full_unstemmed | Evaluation and management of vulvar disease editor Aruna Venkatesan |
| title_short | Evaluation and management of vulvar disease |
| title_sort | evaluation and management of vulvar disease |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=029942719&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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