Principles of Medical Treatment
Acute and chronic vulvar conditions are noted in women throughout their life span. Several of these conditions, such as vulvar infections and intraepithelial neoplasia, have well-defined clinical pathways of treatment utilizing pharmacologic interventions
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Principles of Medical Treatment Candace S. Brown, Candi C. Bachour, and Gloria A. Bachmann
6.1
Introduction
Vulvar conditions are common in women at every stage of their adult life cycle. However, depending on the age of the woman, there are more common ones seen at different points in the age spectrum. For reproductive-aged women, infections such as vulvar herpes and candida will often be seen. In the menopausal women, the genitourinary syndrome of menopause (formerly referred to as vulvovaginal atrophy) is typically the presenting complaint when there are vulvar complaints. In the postmenopausal age group, vulvar intraepithelial neoplasia increases in prevalence. Vulvodynia, a chronic pain condition, is a vulvar condition that occurs throughout the life cycle of the female. Unfortunately, this pain condition continues to be elusive in regard to both etiology and treatment. Treatment of infection, atrophy, and dysplasia usually follows evidencebased interventions that effectively treat the vulvar condition. On the other hand, clinicians caring for women with vulvodynia have utilized
C. S. Brown (*) · C. C. Bachour University of Tennessee Health Science Center, Memphis, TN, USA e-mail: [email protected]; [email protected] G. A. Bachmann Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA e-mail: [email protected]
several pharmacologic interventions for management with varying degrees of efficacy and safety. This chapter presents an update on the medical treatment of vulvar disease, with an emphasis on the pharmacologic interventions for vulvodynia, since this is the one area that there remain many unanswered questions.
6.2
Vulvar Infections
Candidiasis is the most common vulvovaginal infection, affecting 75% of all women with at least one episode during their lifetimes [1]. It typically presents with patient symptoms of vulvar pruritus, irritation, dysuria, and dyspareunia. Women may also report redness of the vulvar area and a white, curd-like discharge at the introital area. Although candida is the most common agent for vulvar infection, other sexually transmitted diseases that affect the vulva are also seen. The Center for Disease Control (CDC) classification for vulvovaginal infections is shown in Table 6.1 [2].
6.3
Genitourinary Syndrome of Menopause
With the loss of estrogen due to ovarian follicular depletion, a frequent condition in menopausal women that affects the vulva in addition to the vagina and lower genital tract is the genitouri-
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_6
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C. S. Brown et al.
50 Table 6.1 CDC classifications for vulvar and/or vaginal infections A. Sexually transmitted diseases • HIV infection • Diseases characterized by genital, anal, or perianal ulcers – Chancroid, genital HSV infections, granuloma inguinale (donovanosis, lymphogranuloma venereum (LGV) • Syphilis • Chlamydial infections • Gonococcal infections
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