A careful evaluation is necessary to design an effective treatment regimen. We obtain a thorough history, including previous treatments and any contributing psychological factors, including sexual abuse, when timing is appropriate. A broad differential should be used to rule out other vulvar or vaginal conditions such as candidal vagini-tis,lichen planus, or a chronic abscess of Bartholin's glands. Any potential allergens or irritants should be identified. Particular attention should be given to patterns of exacerbation of vestibulitis symptoms in conjunction with ingestion of foods with high oxalate concentrations. For example, we have found a strong relationship between consumption of various types of berries and worsening symptoms.

When vestibulitis is suspected, a detailed vulvar and vaginal examination must be performed. Any cutaneous or mucosal abnormalities as well as atrophic changes in the vaginal mucosa should be noted. The vestibule must be inspected for erythema and other signs of chronic inflammation. Pain mapping with a cotton-tipped swab should be done, before any vaginal instrumentation, to delineate the area of sensitivity (Figure 9-2.1). This

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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