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Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
Vaginal prurities
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Vaginal prurities

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  • 1. Vaginal Itching and Discharge www.freelivedoctor.com
  • 2. Vaginal or Vulvar Itching <ul><li>95% of women with vulvar itching have yeast. </li></ul><ul><li>Giving an anti-fungal agent (Monistat, Lotrimin, etc.) will cure most of this itching. </li></ul><ul><li>Treatment failures need further evaluation. </li></ul>www.freelivedoctor.com
  • 3. Yeast (AKA Monilia, Thrush, Candida) <ul><li>Itching is hallmark symptom </li></ul><ul><li>Red, swollen, tender vulva </li></ul><ul><li>Wet Mount confirms </li></ul>www.freelivedoctor.com
  • 4. Yeast Treatment <ul><li>Topical anti-fungal agents work well </li></ul><ul><li>Monistat </li></ul><ul><li>Gyne Lotrimin </li></ul><ul><li>Mycelex G </li></ul><ul><li>Oral agents also work well </li></ul><ul><li>Diflucan 150 PO once </li></ul>www.freelivedoctor.com
  • 5. Chronic Yeast <ul><li>Predisposing Factors: </li></ul><ul><li>Heat </li></ul><ul><li>Moisture </li></ul><ul><li>Diet </li></ul><ul><li>Diabetes </li></ul><ul><li>Antibiotics </li></ul>Solution: PRN Anti-fungal Agents www.freelivedoctor.com
  • 6. Tinea Cruris (Jock Itch) <ul><li>Raised, reddened intertrigenous lesion </li></ul><ul><li>Dx: visual, but may obtain KOH scrapings </li></ul><ul><li>Rx: (BID x 2-3 weeks) -Monistat -Lotrimin -Diflucan -Nizoral </li></ul>www.freelivedoctor.com
  • 7. Contact Dermatitis <ul><li>Perfumes </li></ul><ul><li>Deodorants </li></ul><ul><li>Toilet Paper </li></ul><ul><li>Soap </li></ul><ul><li>RX: -Stop exposure </li></ul><ul><li>-Burrow's Solution </li></ul><ul><li>-Topical Steroids </li></ul>www.freelivedoctor.com
  • 8. Crabs (Pubic Lice) <ul><li>Transmitted by: </li></ul><ul><li>Sexual contact </li></ul><ul><li>Infected bedding </li></ul><ul><li>Sharing towels </li></ul><ul><li>Close living quarters </li></ul>www.freelivedoctor.com
  • 9. Crabs (Pubic Lice) Treatment <ul><li>Nix cream </li></ul><ul><li>Kwell Shampoo </li></ul>www.freelivedoctor.com
  • 10. HPV (Condyloma) <ul><li>Clinical warts </li></ul><ul><li>Flat warts </li></ul><ul><li>Soak vulva in vinegar, Exam under 7x power, Red-free light filter </li></ul><ul><li>Cryo, TCA, Laser, Cautery, Podo, etc. </li></ul>www.freelivedoctor.com
  • 11. Vulvar Dystrophy - Hypertrophic <ul><li>Skin too thick </li></ul><ul><li>Sx: Itching </li></ul><ul><li>Dx: Biopsy </li></ul><ul><li>Rx: Steroid Cream </li></ul>www.freelivedoctor.com
  • 12. Vulvar Dystrophy - Lichen Sclerosis <ul><li>Skin too thin </li></ul><ul><li>Sx: Itching </li></ul><ul><li>Dx: Biopsy </li></ul><ul><li>Rx: Testosterone Cream or Clobetasol </li></ul>www.freelivedoctor.com
  • 13. VIN (Vulvar Intraepithelial Neoplasia) <ul><li>Itching </li></ul><ul><li>Doesn’t respond to anti-fungal agents </li></ul><ul><li>May have a white skin discoloration </li></ul><ul><li>Need biopsy for diagnosis </li></ul>www.freelivedoctor.com
  • 14. VIN (Vulvar Intraepithelial Neoplasia) www.freelivedoctor.com
  • 15. Paget's Disease <ul><li>Slow-growing malignancy </li></ul><ul><li>Exzematoid lesion -dry, crusty skin -moist, weepy -contact bleeding </li></ul><ul><li>Looks like yeast, but isn’t cured with anti-fungal Rx </li></ul><ul><li>Confirm by Bx, treat with local excision </li></ul>www.freelivedoctor.com
  • 16. Vaginal Discharge <ul><li>Does it Itch? </li></ul><ul><li>Does it smell bad? </li></ul><ul><li>What does it look like? </li></ul><ul><li>Wet mount, cultures </li></ul>www.freelivedoctor.com
  • 17. Bacterial Vaginosis <ul><li>Smells bad </li></ul><ul><li>“ Whiff Test” (KOH) </li></ul><ul><li>AKA Gardnerella, BV, Hemophilus Vag. </li></ul><ul><li>Anaerobic bacteria </li></ul><ul><li>Rx: Flagyl </li></ul><ul><li>Rx: Clindamycin </li></ul><ul><li>Rx: Amox </li></ul>www.freelivedoctor.com
  • 18. Bacterial Vaginosis <ul><li>Rx: Flagyl </li></ul><ul><li>Rx: Clindamycin </li></ul><ul><li>Rx: Amox </li></ul>www.freelivedoctor.com
  • 19. Trichomonas <ul><li>Bubbly, frothy discharge </li></ul><ul><li>Rx: Flagyl </li></ul>250 TID x 7 days 500 BID x 5 days 2 gm PO stat www.freelivedoctor.com
  • 20. Wet Mount www.freelivedoctor.com
  • 21. Cultures <ul><li>If GC, Chlamydia, Strep suspected </li></ul><ul><li>If pelvic pain present </li></ul><ul><li>Treatment failures </li></ul>www.freelivedoctor.com

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