Recognizing and Treating Vulvar Diseases

Many ob/gyns and nurse practitioners see vulvovaginal disease on a day-to-day-basis, but lack the knowledge to accurately diagnose and treat them. At ACOG’s 61st Annual Clinical Meeting, Hope Haefner, MD, Department of Obstetrics and Gynecology at the University of Michigan, and Lynette Margesson, MD, Adjunct Assistant Professor of Obstetrics and Gynecology and Surgery (Dermatology) at the Geisel School of Medicine at Dartmouth, presented tips to help clinicians identify common and rare vulvar diseases.

The session was designed to give attendees and introduction to different variations of vulvovaginal disease, and to hear how an ob/gyn and dermatologist think through and discuss a case in order to determine an approach to therapeutic care.

While vulvovaginal diseases like yeast infections, vulvodynia, lichen sclerosis and contact dermatitis are common, clinicians may be presented with more challenging cases, like Crohn’s disease of the vulva, or overlapping conditions that make diagnosis more difficult.

Studying normal vulvar anatomy in detail is key to recognizing changes or problems, such as shrunken or scarred anatomy, particularly in patients who don’t discuss symptoms.

“Most [heath care professionals] never get instruction in detail on the normal anatomy, and they don’t have any idea even what’s normal,” said Margesson. “So if they see anything that’s itchy, sore, it’s hard for them because they don’t know the basic structures to begin with.”

They recommend taking an elective course in dermatology to help physicians learn to recognize various features of skin changes.

Margesson and Haefner have worked together for more than ten years and emphasize the importance of the gynecologist/dermatologist partnership. They suggest that gynecologists share photographs of tough cases and collaborate on diagnosis and care with a dermatologist who is interested in vulvar disease.

 “And ask for help if you need it,” Haefner added. “If you’re puzzled, perplexed, don’t give up. Find a partner who can help.”

For more information, visit the University of Michigan’s Center for Vulvar Diseases website, or attend an educational meeting through the International Society for the Study of Vulvovaginal Disease (ISSVD) or the American Society for Colposcopy and Cervical Pathology (ASCCP).