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Figure 9-2.1. Vulvar vestibule and pain map. (Reprinted with the permission of The Cleveland Clinic Foundation.)

should be recorded in the medical record for future reference.

Pain along the posterior vestibule and inner aspect of the labia minora is typical. If the painful area is difficult to discern, diluted acetic acid on the swab helps define the area with acetowhite changes, but may be quite uncomfortable for the patient and is rarely necessary.

The urethra and trigone should be palpated transvagi-nally to identify other potential areas of tenderness. Purulent urethral discharge indicates the need for urethral cultures and possibly antibiotic therapy before further work-up. Isolated trigonal sensitivity should be further evaluated with cystourethroscopy to look for evidence of chronic infection. If localized trigonal pain is identified, we will frequently initiate empiric tetracycline therapy for 3 to 4 weeks.

The vaginal speculum examination is then performed, and is important in order to identify inflammatory or infectious vaginitis.Vaginal lichen planus characteristically presents as well-delineated marked mucosal erythema and desquamation with a mucopurulent discharge. Microscopy should be used to rule out bacterial vaginosis or yeast infections.

The vaginal mucosa of a woman with atrophic vaginitis usually will be pale, thin, and have loss of rugations, but milder degrees of atrophy may have a more subtle presentation. A maturation index or pH may be helpful in quantifying the degree of atrophy and therapeutic response.

Upper genital tract pain,elicited on bimanual examination, may be suggestive of pelvic inflammatory disease, endometriosis, or a pelvic mass. A gentle, methodical approach to the vulvovaginal examination in patients with a history suggestive of urogenital sinus pain is imperative.

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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