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Cyclic Vulvovaginitis
Aka: Cyclic Vulvovaginitis
- See also
- Vulvitis
- Vulvodynia
- Epidemiology
- Most common cause of Vulvodynia
- Causes
- Eczematous Candidiasis
- Candida Hypersensitivity
- Symptoms
- Cyclic flares with symptom free intervals
- Pain worse just before or during Menses
- Pain exacerbated after intercourse (day after)
- History of frequent antibiotics
- Minimal Vaginal Discharge
- Labs
- Saline Preparation and KOH Preparation (See Vaginitis)
- Candida culture and speciation
- Consider biopsy after Eliminating Candida
- Management
- Clotrimazole or Terconazole Cream
- Acute
- Apply qhs for 10 days then
- Apply 1/2 applicator Mon-Wed-Fri for 2-4 months
- Maintenance
- Apply qhs for 5 days before Menses each Month
- Fluconazole 150 mg
- Weekly for 2 months then
- Bi-Monthly for 2-4 months then
- Monthly prior to Symptom flare
- Physical Therapy with biofeedback
- Low-Oxalate Diet
- Oral Calcium Citrate (Citracal) 200 mg bid
- References
- Black (1995) OBGyn Dermatology, Mosby-Wolfe
- Apgar (1996) Am Fam Physician 53(4):1171-80 [PubMed]
- Barhan (1997) Postgrad Med 102(3):121-32 [PubMed]
- Metts (1999) Am Fam Physician 59(6):1547-56 [PubMed]