Vulva History and Physical

History and physical

There are special considerations when dealing with vulvar patients.

1. Let your patients tell you their stories. Vulvar patients take time. Remember that it takes a lot of courage for women to come forth and complain about problems in their private areas. 2. Be non-judgmental, supportive and listen

Symptom Tips: 1. Re-evaluate. Do not guess. 2. Do not make telephone diagnoses. It is impossible to guess over the telephone what kind of problem a patient may have.

History - These patients are often anxious. The area is fraught with misconception and taboo. The longer the problem exists the more upsetting it is. It is not uncommon to have fears of cancers or infection (especially sexually transmitted diseases) or loss of fertility or loss of sexual function.

Historical: General medical: social and family, sexual, menstrual, previous treatment, gynecological & Obstetric, response to treatment. All medications, prescribed and over-the-counter, including supplements and homeopathic therapy.

Symptom Characteristics. For each symptom note the following: Episodic nature, factors that help or worsen, time of the day, month. Degree of incapacity. Association with menstrual periods.

Physical Examination Tips: Be sure to have adequate magnification and lighting. Examine all surfaces of the external genitalia. If indicated, speculum examination looking right into the vagina may be necessary. Erythema of the vulva is normal in 52% of premenopausal and 36% of postmenopausal women. Examine the rest of the skin, especially the mouth because the mucous membranes of the mouth and the vulva are similar. Multifactorial processes are common. One may see a yeast infection associated with squamous cell carcinoma.