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.

Obstetrician-gynecologist as primary care provider.

Obstetrics and gynecology is a unique field that combines preventive and primary care with female pelvic surgery and obstetrics. With the evolution of managed care, it has been a challenge to fit this field into the standard primary care paradigm. This article describes a 3-tiered, patient-oriented definition of primary care that encompasses the essential aspects of all primary care specialties, followed by a critical examination of how primary care specialties, including obstetrics and gynecology, fit into this definition. This approach suggests that to better meet the primary care needs of both patients and society, obstetrician-gynecologists must continue to improve their skills in preventive care, diagnosis and treatment of self-limited conditions, and diagnosis of serious nongynecologic conditions.

Instrumental delivery of the fetal head at the time of elective repeat cesarean: a randomized pilot study.

We sought to ascertain whether the routine use of instruments, forceps or vacuum, at the time of elective repeat cesarean delivery, permits a delivery that is as safe for mother and infant and as easy for mother and physician as traditional manual delivery of the fetal head. In this prospective study 44 women undergoing elective repeat cesarean were randomized to deliver by Vacuum (V), Forceps (F), or by Manual (M) means. Groups were compared with regard to demographic variables and maternal and neonatal outcomes. Deliveries were timed from entry into the uterus until full delivery of the infant. Maternal pain scores were assessed using a 10-cm visual analog scale. There were no differences in demographic variables except that the M group had fewer women with up to two cesareans. A large percentage of women in each group were delivered with the randomized instrument. Use of the V did not demonstrate fewer extensions of the uterine incision or lesser amounts of blood loss as measured by serial hemoglobin determinations. There was a trend for the F group to require a longer period of time for delivery (p = 0.061). Women in the V group reported significantly lower pain scores (p = 0.015). There were no serious neonatal injuries. The routine use of instruments at the time of elective repeat cesarean delivery appears safe and effective.

Vulvar problems in elderly women. Don't 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.