Vulvar Disorders Research Articles

Gynecologic disorders in the geriatric patient.

The woman past 65 years of age is as much in need of periodic gynecologic examinations and the ancillary tests used to diagnose early genital cancer as her premenopausal counterpart. Many gynecologic ills peculiar to the geriatric patient result from the tissue shrinkage that follows menopausal loss of estrogen secretion. Some of the resulting distress can be relieved by local estrogen or androgen therapy. A number of minor vulvar and vaginal disorders may appear with advancing age, often causing the patient discomfort and worry until she is reassured that they are benign. The incidence of some genital neoplasms declines after menopause, but several others--notably vulvar, vaginal, and endometrial carcinoma--actually increase in incidence as patients become older. Geriatric gynecology is not a separate discipline, but older women with genital disorders are a special group of people. Many are very old; some are sick. They are easily worried and frightened. They need not only awareness of their problems but also kindness, tact, gentleness, and thoughtfulness, all of which should be natural attributes of a physician.

An appraisal of routine direct immunofluorescence in vulvar disorders

Sixty-four biopsies were obtained from patients with a variety of vulvar disorders for direct immunofluorescence study. Twelve of 24 vulvar biopsies from patients with lichen sclerosus demonstrated deposition of fibrin in the upper dermis, while 7 vulvar biopsies showed fibrin deposition at the dermal-epidermal junction. Blood vessel immunofluorescence was observed in several patients but was not a disease-specific finding. Patients with pemphigus and pemphigoid yielded characteristic reactions and served as positive controls. Direct immunofluorescence may be of value in assessing patients with vulvar disorders, and in particular lichen sclerosus.