If It Ain't Broke Don't Fix It: Evidence Behind New LS Treatments

Dr. Selk interviews Dr. Andrew Goldstein, an obstetrician and gynecologist and the director of the Center for Vulvovaginal Disorders in New York City and Washington DC, about his new randomized control trial studying laser therapy in lichen sclerosus (LS). Topics covered include reasons behind conducting the trial, methodology of the study, results of the study, how to counsel patients about laser for LS, previous research and other evidence on laser for LS, importance of unbiased study design, differences based on type of laser used, and the ethics of counselling patients about treatment.

In this week's episode Dr. Selk interviews Dr. Claire Danby, who is an obstetrician gynecologist at Maine Medical Center with a dedicated vulvovaginal clinic and a clinical assistant professor at Tufts University. Today they discuss desquamative inflammatory vaginitis (DIV). Topics covered include the definition of DIV, presentation, diagnostic criteria, etiology, demographics, prevalence, a systematic approach to diagnosis, treatment, treatment changes based on menopausal status, other conditions that get confused with DIV, and cure rate of DIV.

Dr. Selk interviews Dr. Martha Goetsch who is a long-term researcher and clinician specializing in vulvar conditions at the Oregan Health and Sciences Unit. In this week's episode they discuss some of her recent research on estrogen in vulvar pain. Topics covered include the background and reasons for exploring this area, theories behind the cause of vulvar pain, methods studied to reduce vulvar pain, and results after implementing these methods in post-menopausal women. They also discuss estrogen regimens in post-menopausal patients, differentiating between atrophy/dryness and pain, systemic absorption of topical estrogens, how long to treat with estrogen post-menopause, reassuring patients about estrogen use, the utility and importance of using lidocaine in these patients and what concentration of lidocaine to use.

This week Dr. Selk interviews Dr. Jacob Bornstein in his second episode with "The Vulva Diaries"! Dr. Bornstein is a professor of Obstetrics and Gynecology in Israel, past president of the ISSVD and chair of the terminology committee, with extensive publications in vulvar disease. In this episode they discuss the terminology of vulvodynia. Topics covered include history behind the terminology of vulvodynia, potential etiologies of vulvodynia, the process behind updating terminology, key elements that factor into determining the terminology of vulvodynia, importance of ascertaining the main associated cause of a patient's vulvodynia, evidence behind treatments for vulvodynia, and the story of the emergence of vulvodynia into the research spotlight.

This week is part 2 of our two episode series on steroid therapy with Dr. Gayle Fischer. Dr. Fischer is a professor of Dermatology at the University of Sydney in Australia, and has written books and has many years of research experience in the area of vulvar dermatology and lichen sclerosus (LS). In this episode, Dr. Selk and Dr. Fischer discuss steroid therapy in pregnancy, whether prescribed steroid strength depends on a patient's age, how often to follow-up with patients, natural remedies and how to advise patients about this, how to optimize steroid treatment, whether steroids can ever be stopped, and whether steroid treatment can prevent complications of LS.

Dr. Selk interviews Dr. Gayle Fischer in part 1 of our 2 episode series on steroid therapy. Dr. Fischer is a professor of Dermatology at the University of Sydney in Australia, and has written books and has many years of research experience in the area of vulvar dermatology and lichen sclerosus (LS). Topics covered include the importance of using long-term steroids in certain vulvar conditions, how to respond to patient fears about steroids, studies assessing side effects of steroid use in these conditions, matching the strength of the steroid to the severity of disease, providing instructions to patients, importance of raising awareness about vulvar diseases, long-term steroid use in pediatric vulvar disease, and psychosocial implications of pediatric LS.

In today's episode Dr. Selk interviews Dr. Jacob Bornstein, a professor of Obstetrics and Gynecology in Israel, past president of the ISSVD and chair of the terminology committee, with extensive publications in vulvar disease. Today we are covering vestibulectomies -- what a vestibulectomy is, the history behind it's development, indications, it's success rate in treating vulvodynia, and at what point to offer vestibulectomy. Other topics discussed include complications associated with vestibulectomy and the rate at which they occur, answers to questions commonly asked by patients (what will it look like? and will it prevent vaginal delivery?), how long to follow patients post-operatively, which patient populations are less likely to be cured, extensive versus minimal surgical techniques, and post-operative recovery.

Dr. Selk interviews Dr. Gayle Fischer, a dermatologist at the University of Sydney in Australia and an expert in lichen sclerosus (LS), about new LS treatments. Topics covered include steroid treatment and why patients seek different treatments, new ancillary treatments and evidence behind them, patient counselling tips, post-procedural steroid use, dangers of calcineurin inhibitors in LS, and benefits of topical steroid treatment.

In another episode with Dr. Melissa Mauskar, a dermatologist from UT Southwestern Medical Center in Dallas, Texas, her and Dr. Selk discuss pigmented vulvar lesions. Topics covered include types of vulvar pigmented lesions, mimickers of pigmented lesions, when to biopsy, vulvar melanoma, specific ways to biopsy melanomas, post-inflammatory hyperpigmentation, treatments, and symptoms associated with pigmented lesions.

In this week’s episode Dr. Selk chats again with Dr. Jennifer Bradford, a gynecologist in Sydney, Australia with a tertiary care practice in vulvovaginal disease and co-author of “The Vulva” handbook. In this second episode covering lichen sclerosus and lichen planus with Dr. Bradford, they discuss how pregnancy can affect these conditions. Topics discussed include how lichen sclerosus (LS) and lichen planus (LP) symptoms change over the course of pregnancy and post-partum, LS and LP treatments during pregnancy, vaginal delivery with LS or LP, managing post-partum LS flares, topical steroid safety in pregnancy (and tips on how to counsel patients about this), elective C-sections, potential effect of breastfeeding on post-partum flares, and tips for motivating patients to improve treatment compliance post-partum.