Thursday, July 15, 2010
Atrophic Vaginitis
This patient was a 56 year old black female who came in for her annual well woman exam but upon questioning, revealed that she has noticed a vaginal odor for the past few weeks. The patient had a hysterectomy with ovaries left intact. The patient reports no itching or burning sensation along with the odor. On physical exam, no discharge was noted, but the patient's vaginal mucosa was inflamed and erythematous. We performed a wet smear, which was negative for yeast and BV. We diagnosed the patient with atrophic vaginitis and prescribed premarin cream. The interesting thing about this case for me was that my preceptor knew what the diagnosis was before we even did the wet smear. This was interesting because based on the patient's symptoms, I would not have thought of this. But apparently, this is a very common diagnosis in menopausal age patients. The other thing I had to do was educate this patient about the use of local hormones, since she was very concerned about the side effects of systemic hormones that she has heard so much about.
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I also saw a couple of cases of atrophic vaginitis in patients. In one of those cases, a post-menopausal pt also had a caruncle on her urethra. Essentially, her urethra had started to turn itself inside-out. It was a red bulge where her urethra was. My preceptor said that it was a normal finding in post-menopausal women. In this same woman, she was also very thin, predisposing her even more to atrophic vaginitis. We offered premarin cream, but the pt denied. Good to know: when else could you see atrophic vaginitis? breast-feeding women d/t decreased estrogen levels
ReplyDeleteWonder what their sex lives were like? Did anyone ask?
ReplyDeleteMa'am,
ReplyDeleteI am pretty sure it was covered, because at Belvoir each patient has to fill out a cover sheet with multiple questions on it, including whether they are sexually active. If I recall correctly, I believe my patient was not sexually active, but I don't remember if she was divorced or something else was going on. However, this is a very valid point. I don't think we covered it in detail, and maybe she was not sexually active because it was not comfortable. Sometimes we overlook the sexual history, especially in older patients, but it is certainly important!
Speaking honestly and openly for the "over 40+" crowd, I know I have never been asked about my sexual activity/desire for same/sexual issues-concerns at ANY of my well-woman checks, by Providers of either sex!? Had I not been a nurse/provider my self, I would have probably accepted the "it's a part of life/aging and you can do nothing about it" and suffered the negative consequences.
ReplyDeleteAs a Provider I know I can and must ask those sometimes "difficult" questions of all my patients (female AND male). It is too easy to offer treatment option plans so that patients can enjoy all aspects of their QOL to the very end.
And don't trust those pieces of paper all the time, review it with your patients..."Sexual activitiy-yes/no?" is not what it is all about, what is the QOL related to intimacy and sexual activities?