Gynecology

Question 1

What is the treatment for lichen sclerosis

Answer 1

The mainstay treatment is super-high-potency topical corticosteroids, such as clobetasol propionate 0.05%.

Question 2

Features of lichen scelrosis

Answer 2

Classic anatomic features of lichen sclerosus are hypopigmented vulvar skin with ivory/white patches or plaques. The wrinkling of the labial skin can give a parchment-paper appearance.

Question 3

When should you stop topical CS before biopsy of lichen sclerosis

Answer 3

Lichen sclerosus is associated with a 2%–5% risk of transformation to squamous cell carcinoma of the vulva. Because topical corticosteroids can affect histologic findings, they should be discontinued THREE WEEKS before biopsy.

Question 4

How is chronic pelvic pain diagnosed?

Answer 4

Chronic pelvic pain syndrome is a clinical diagnosis based on history of chronic pelvic pain and symptoms associated with voiding in the absence of inflammatory processes in the urinary tract in men (increases with age). Urinary tract cancer and recurrent infection—including tuberculosis—must be excluded. There is no specific test for this syndrome; rather, sources of infection or inflammation are excluded.

Question 5

Treatment for chronic pelvic pain

Answer 5

Administration of α-blockers for 3–6 months had a beneficial effect in most published trials, although differences in study design and outcome measures limit the strength of the evidence (SOE=B). NSAIDs are sometimes added to the α-blocker. Physical therapy is sometimes a helpful nonpharmacologic adjuvant