Vaginal lesion: Etiology—A malfitting diaphragm?

Abstract

The case of a 25-year-old Hispanic woman who suffered a vaginal lesion presumably as a result of a too large diaphragm is reported. The womans family and personal history were essentially negative. Speculum examination revealed a superficially ulcerated lesion 2 cm in diameter on the left postero-lateral vaginal wall about as far posterior as the cervix. A small amount of necrotic tissue was found in the center of the lesion. It spotted on contact and was painful to touch with the cotton swab. There was no vaginal discharge; the cervix was clean and closed. The following possible diagnoses were considered: genital herpes syphilis cancer and trauma due to either the diaphragm or some other object. The patient was asked to discontinue use of the diaphragm for 2 weeks and to refrain from sexual intercourse for 1 week. AVC vaginal suppositories were prescribed twice a day for 8 days. At the follow-up examination 2 weeks later there were no further complaints of pain or discomfort. The Pap smear report was negative for cancer and viral inclusion bodies. The VDRL was drawn and was subsequently found to be negative. On examination the vaginal mucosa was found to be completely clean pink and intact and there was no further evidence of any lesion. The patient was refitted with a size 80 diaphragm and has experienced no subsequent problems. It needs to be emphasized to diaphragm users that the correct size diaphragm is also a totally comfortable diaphragm.