Vulvar Disorders- MAJ Racine

1. Common etiologies of acute vulvar pruritis include(s):

a. candidiasis

b. contact dermatitis

c. lichen sclerosus

d. choices a and b

e. all of the above

a. Candidiasis by itself is a common etiology of vulvar pruritis, but so is contact dermatitis.

b. Contact dermatitis by itself is a common etiology of vulvar pruritis, but so is candidiasis.

c. Lichen sclerosus is a cause of severe itching, but it is not as common as candidiasis or contact dermatitis and should be suspected in cases of chronic vulvar pruritis.

d. In cases of acute vulvar pruritis, common etiologies include both vulvovaginal candidiasis and contact dermatitis (ACOG, 2008).

e. Although both candidiasis and contact dermatitis are common causes of acute vulvar pruritis, LS is not.

2. You see an 89 y/o woman for a follow-up appointment with continued severe vulvar pruritis that wakes her at night; she has been unresponsive to clotrimazole and estrogen. Your PE reveals white plaques with areas of purpura and excoriation. You suspect this is:

a. allergic vulvar dermatitis and refer her to derm for biopsy and patch testing

b. lichen sclerosus and refer her to derm for vulvar biopsy

c. streptococcal vulvovaginitis and prescribe penicillin

d. iron deficiency and prescribe Fe supplementation

a. Allergic dermatitis does not typically present as white plaques with areas of purpura/excoriation- erythema and scaling are usual signs of allergic dermatitis.

b. This is a classic presentation of LS: intense pruritis and white plaques w/areas of purpura and excoriation in the vulva, in a post-menopausal woman (Dalziel, 2010). Also, LS can mimic many other conditions, including vulvar carcinoma (and she is at increased risk for this as she is over the age of 70), so a biopsy is needed to confirm the diagnosis (ACOG, 2008).

c. Streptococcal vulvovaginitis does not present as white plaques with areas of purpura/excoriation- edema and erythema are typical signs. This condition is also seen mostly in prepubertal females.

d. Iron deficiency could be a cause of intractable pruritis, but by itself would not cause the white plaques with areas of purpura and excoriation.

3. Systemic estrogen therapy is the mainstay treatment for vulvar atrophy:

a. True

b. False

a. Systemic estrogen therapy is not the mainstay treatment for vulvar atrophy- a topical estrogen preparation is a more appropriate treatment strategy.

b. Management options for vulvar atrophy include lifestyle modifications, OTC vaginal moisturizers, and topical low-dose estradiol preparations (ACOG, 2008).

4. Educating patients to decrease risk factors for vulvar cancer- such as avoiding smoking and limiting the number of sexual partners- is an integral part of managing vulvar cancers:

a. True

b. False

a. Smoking and HPV are significant risk factors for vulvar cancer and can help prevent the occurrence of vulvar cancers in patients (Wallace & Sanford, 2006).

b. Prevention of vulvar cancers is an important strategy in the fight against this rare gynecological cancer.

5. The treatment plan for generalized vulvodynia includes all of the following, except:

a. psychotherapy

b. topical compounded preparations

c. surgery

d. pelvic floor therapy

a. Psychotherapy is an appropriate adjunct in the care of a woman with any type of vulvodynia.

b. Topical compound preparations are an appropriate management strategy for women with both types of vulvodynia.

c. Surgery is contraindicated in women with generalized vulvodynia; it is a management strategy for women suffering from localized vulvodynia (vestibulodynia) only (NVA, 2010).

d. Pelvic floor therapy is an appropriate adjunct for therapy in women with vulvodynia.