Education of the patient and general vulvar care

Education of the patient

Many women will have suffered for a long time before coming to you. They may have seen a number of other clinicians. Obtaining previous records is especially helpful if cultures, biopsies, and other tests have been done. Message to women: “We need your records.”

It is better for the patient to describe her symptoms or signs rather than the diagnoses she has previously been given. Start with a clean slate in taking the history. Remember that parts of the history that one might think inconsequential, may actually be related to cause. Message to women: “We need your symptoms and concerns; we need a lot of background information.”

Vulvovaginal disorders may take time to sort out. When multiple conditions are occurring at the same time, treatment is directed to each of the conditions, each of which may take its own time to improve. Message to women: “We need you to know that this process may take time.”

Treatments may be undertaken more slowly, sequentially, so that it is clear which effect is related to which treatment. Message to women: “We need you to know that we sometimes treat slowly in order to understand which treatment is working.”

Sometimes the treatments themselves can cause secondary problems. For instance, yeast may occur with the use of both topical estrogens and steroid ointments, as well as with antibiotics. Medications may cause side effects. Be prepared to inform the patient of potential side effects or drug-to-drug interactions and what can be done about them. Message to women: “Sometimes the cure can cause other issues. We will try to minimize that. Some drugs that are safe do cause side effects; many of these can be managed. Some drugs that are otherwise safe may have drug-to-drug interactions that we need to be aware of.”

Treatments need explicit directions, in writing, along with adequate understanding on the part of the woman of exactly when she needs to take or apply medications, then where, how, and how much. Message to women: “Following directions on the treatment is very important. Please make sure you understand where and how to apply ointment. Keep a calendar in your bathroom!”

Pain may take longer to resolve than the condition itself. Post-herpetic neuralgia is an example of this, but neuropathic pain associated with inflammation of the skin or with pelvic floor factors, may need secondary assessment and treatment. Message to women: “If pain lingers even after a condition is resolved, we will deal with that as its own problem.”

Patients, themselves, play a big part in their own recovery. It is essential that they become “their own detectives,” paying close attention to triggers for their conditions. Often, simple lifestyle changes can make a big difference. Message to women: “Your participation is very important. It’s not all about medication. Sometimes the smallest lifestyle changes can really help. With chronic conditions, it is easy to “live with” discomfort. Try to continue to be aware of triggers for your condition and what you can do to minimize them.”

Many women are very discouraged and their lives are affected on many planes. They feel very alone. False optimism is never fair, but encouragement and acceptance and a willingness to “go the extra mile” for them is needed. Message to women: “You are not the first person I have seen with this. Many women suffer from your condition, but no one knows because no one talks about it. Because I have seen this before, I know some things we can do to help. Do you have someone else you can talk to, as well, to cope with this problem?”