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• W2611293017 abstract "Dear editor, it is well known that genital discomfort in women (discharge, pruritus, dyspareunia, malodor) is a common problem and are the main reason for visiting a primary gynecologic clinic [ [1] Kent H.L. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991; 165: 1168-1176 Abstract Full Text PDF PubMed Scopus (234) Google Scholar ]. Unfortunately, symptoms are nonspecific and are caused by various etiologies [ 2 Anderson M.R. Klink K. Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004; 291: 1368-1379 Crossref PubMed Scopus (265) Google Scholar , 3 Vulva Dermatoses. A review and Update. Simonetta C, Burns EK, Guo MA. Mo Med 2015;112 July–August (4);301–7 [Review]. Google Scholar ]. Proper diagnosis is based on a thorough genital examination, sampling vaginal pH and performing a wet-mount (microscopy of vaginal discharge) [ [4] Mandell Mandell: Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. churchil Livingston, 2015 Google Scholar ]. Occasionally there is need to send a culture, perform molecular biology tests or obtain a biopsy [ [4] Mandell Mandell: Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. churchil Livingston, 2015 Google Scholar ]. Women with genital discomfort seek help from various clinical specialties including gynecology, dermatology, infectious-diseases, primary physicians, physiotherapy and sexology. Yet these sub-specialties consider a differential-diagnosis oriented to their field of training [ 3 Vulva Dermatoses. A review and Update. Simonetta C, Burns EK, Guo MA. Mo Med 2015;112 July–August (4);301–7 [Review]. Google Scholar , 4 Mandell Mandell: Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. churchil Livingston, 2015 Google Scholar , 5 Eckert L.O. Clinical practice. Acute vulvovaginitis. N Engl J Med. 2006; 355: 1244-1252 Crossref PubMed Scopus (97) Google Scholar ]. In our letter, we report all diagnoses that were made for women with genital discomfort in a vulvo-vaginal clinic during one year. As the title states “yeast, trichomonas and bacterial vaginosis were only the tip of the iceberg”, accounting for only 19% of diagnosis. We included all primary visits of women who were evaluated during 2014, in a university affiliated VVc for genital discomfort (pruritus, discharge, dyspareunia and malodor). All patients were seen by a board-certified OB&GYN who completed two years of clinical training in vulvo-vaginal diseases. Data was recorded from free text computerized files. Socio-demographic characteristics, medical history, duration of symptoms and their characteristic along with clinical diagnosis and response to treatment were documented. All together there were 297 primary visits. Mean age was 37 years (SD ± 15), most women were Caucasians and 172 (58%) were married. Duration of symptoms ≥ 12 months was present in approximately one third of patients. Women were diagnosed with 36 different conditions (Fig. 1). Vulvodynia (22%) was the most prevalent followed by candidiasis (15%), contact dermatitis (11%), atrophic vaginitis (9%) and lichen sclerosus (6%). Most conditions diagnosed 28/36 (77%) were less than 3% prevalent. Noteworthy, one of five women were diagnosed with two different entities. Of the 119 women who attended a follow-up visit, clinical confirmation of diagnosis was documented in 93 (78%) and a second condition was added to the primary diagnosis in 15 (13%) i.e. initial diagnosis was confirmed in 108 women (91%). Although the report is based on a retrospective study, and thus prone for selection and recall bias, by including all women visiting the clinic minimizes these biases. It is known that referral clinics are prone to selection-bias given that the medical cases referred are potentially more complex. Yet, consultations in real time to physicians in primary clinics, managing women with genital discomfort, enables to determine that our findings are applicable also to primary clinics." @default.
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• W2611293017 date "2017-07-01" @default.
• W2611293017 modified "2023-10-16" @default.
• W2611293017 title "Genital discomfort: yeast , trichomonas and bacterial vaginosis are only the tip of the iceberg" @default.
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• W2611293017 doi "https://doi.org/10.1016/j.ejogrb.2017.04.049" @default.
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